June 2016 Volume 18 Issue 6
Providing Current Information on

Health Insurance Industry Issues and Legislation

Medicare Based Pricing - A Money Saving Option
Educating consultants about the value of self-funding and of Medicare-Based
Pricing (MBP) is particularly important during renewal season. In an interview with
InsuranceNewsNet, Bruce Roffé, president and CEO of H.H.C. Group, laid out the
basics and benefits of self-funding and MBP. He provided insight into why MBP
makes sense both for employers and their consultants.
Provider-Sponsored Health Plans – The Wave of the Future?
The number of provider-sponsored health plans more than doubled in 2015 versus
the prior year, increasing from 107 to 270. Additionally, a just released PwC report
estimates that half of health systems are considering applying or will be applying
for insurance licensure in 2016. The report outlines what providers need to consider
before launching a plan. As Dennis Laraway, executive vice president and CFO of
Houston-based Memorial Hermann Health System told PwC, "This is not for the faint
of heart."
Price Transparency Tools Alone Don't Get the Job Done
This is the key finding of a new Journal of the American Medical Association
(JAMA) study designed to determine if such tools, which include provider price
information, reduce healthcare spending. The study found that low utilization is the
most common challenge reported by the insurers which offer these tools. The study
provides suggestions for increasing utilization of the tools to turn them into savings
Cost of Healthcare Tops $25K for a Family of Four
Total healthcare expenditures in 2015/2016 for a family of four covered by an
employer sponsored PPO plan are $25,826. While lower than in previous years,
the rate of increase is almost 2.5 times the rate of increase in the inflation
rate. Employees continue to bear an increasing percentage of the burden and
spending for specialty prescription medicines is skyrocketing, according to the
2016 Milliman Medical Index. In addition to the cost data, Milliman offers ideas
for slowing rate of healthcare spending inflation.
Three Star Preferred Provider Program Additions
Advanced Monitoring Services, Inc.
Springdale, AR 72762

Anesthesia Associates of Central Kansas
Salina, KS 67402

Anesthesia Services of Mid Missouri
Columbia, MO 65203

Buford Eye Surgery Center
Cumming, GA 30041

Eugene Domenico, PHD
Lockport, NY 14004
Karen Roans PTRehab
Jupiter, FL 33477

Kennedy Health System
Newark, NJ 07101

Marcus Loo
New York, New York, 10013

Sam Ghoubrial, Inc.
Wadsworth, OH 44281