Health Insurance Industry Issues and Legislation

PWC projects that deferred care leading to worsening conditions requiring more expensive treatments, continuing COVID-related healthcare issue costs, increasing mental health needs, poor pandemic era health behaviors, and new high-priced specialty drugs will drive healthcare spending spiraling upward in the 3rd and 4th quarters of 2021 and well into 2022. Recouping provider costs for COVID-related protective equipment and supplies, adding interoperability, and enhancing cybersecurity will all push provider prices higher. All this makes the implementation of an aggressive, integrated healthcare cost-containment strategy more important than ever for self and fully insured entities alike.

H.H.C. Group's Health Plan GPS (HPGPS) is a user-friendly mobile app and website for member engagement and communications, two keys to the ongoing success of any Reference-Based Pricing (RBP) plan. We give you the tools to engage with members and reduce both plan and member healthcare costs. Contact us to learn more.

Changing from a network-based plan to one which pays providers based on some multiple of what Medicare pays can save a self-insured group a lot of money, but those savings can come at a price. That price is the potential for providers to bill patients for the difference between what the group pays and the billed amount. Setting the multiple at a rate that reduces the group's healthcare spend enough while minimizing provider balance billing is key. So too, it is having people on staff or having a company that can assist patients they get balance billed.