April 2018 Volume 20 Issue 4
Providing Current Information on

Health Insurance Industry Issues and Legislation

Best-Performing Companies Spending Far Less for Employee Healthcare
Research indicates that best performing companies are spending $2,251 less per
employee per year than the national average ($12,201) and $3,583 less than highcost
companies. Best-performers are those who are effectively managing their cost
trends and administrative efficiency. They are employing multifaceted strategies
and embracing innovation to keep their healthcare related spend in check.
The HealthCare Tapeworm
Prices and value for traditional fully-funded health plans are going in opposite
directions. Prices keep rising while value seems to be going in the other direction. In
2016, healthcare spending per person in the U.S. rose 4.6% while reported utilization
was flat or even declined. Increasing provider charges, higher pharmacy prices and
even the Affordable Care Act are all driving premium costs higher. To break the cycle,
more and more payors are turning to self-funding or are considering self-funding their
healthcare insurance plans and many are turning to Reference Based Pricing to reign in
their healthcare spend.
Reference-Based Pricing (RBP) - Bending the Cost Curve
Smart payors who have had enough of ever increasing premiums are starting to
self-insure. Many are implementing or considering implementing RBP to reign
in their healthcare insurance spend. HHC Group helps payors, their brokers and
TPAs determine if RBP is right for them. We then assist each payor in building and
implementing a customized Plan that best fits their individual needs and situation.
Rigged System Blocking Use of Lower-Cost Drugs
A "rigged payment scheme" involving drug pharmaceutical companies, insurers
and drug plans is blocking access to lower-cost versions of the most costly drugs
in the U.S. according to the head of the Food and Drug Administration. FDA
Commissioner Scott Gottlich singled out the large pharmacy benefit managers'
contracting practices are blocking cheaper versions of expensive biotechnology
drugs. Rebates and discounts he says are not the answer.
Three Star Preferred Provider Program Additions
Icon Anesthesia Services of New England
Middletown, MA 01949

Deng Family Medical Center
Midwest City, OK 73130

Dr. Charles Tillman, M.D.
Mexico, MO 65263

Infectious Disease Consultants
Columbus, OH 43205

Dr. Cary Frix, M.D.
Henderson, TN 38340

Akron, OH 44304

Mary F. Holley, M.D.
Guntersville, AL 35976

Surgicenter of Racine LTD
Racine, WI 53406