May 2016 Volume 18 Issue 5
Providing Current Information on

Health Insurance Industry Issues and Legislation

Sutter Employers Legal Battle Over Competition and High Prices
In their class-action lawsuit, major employers in California contend that Sutter Health
imposes anticompetitive terms and illegally inflates prices. Firing back, Sutter is now
demanding some companies and unions sign an arbitration agreement for resolving
disputes or pay 95% of billed charges for out-of-network care at Sutter facilities.
Employers are crying foul, but Sutter claims the ultimatum is not designed to keep
them from signing on to the lawsuit. The outcome of the brouhaha could affect selffunded
and other insurers and health systems nationwide.
Free Surgery for Employees Generating Big Savings for All
Optional "Free Surgery" programs are saving innovative employers and their
employees big bucks, up front and on the back end. Employers are negotiating
"bundled payment" agreements with leading hospitals for rates that are 20 to 30%
below what they were previously paying. Additionally, it turns out a large number
of certain types of surgeries are being avoided or postponed saving employers and
their employees even more.
Lessening the Pain of High Cost Specialty Drugs
Expenditures for Specialty Drugs are threatening the entire healthcare system
including Medicare, private insurance and the self-insured. They account for a third
of total drug expenditures and the number just keeps growing. Still, there are a few
solutions that can lessen Specialty Drugs' impact on payers total healthcare spends
and their bottom lines.
HCCI Study Confirms Wide Healthcare Price Variations
A just released Health Care Cost Institute Study (HCCI) found that patients in
some states and in some cities in the same state are paying as much as double
for the same healthcare services. The report also details what people are paying
by state and identifies which of the 240 common services exhibit the widest
price variations.
Three Star Preferred Provider Program Additions
Aultman Speech Therapy
Sumrall, MS 394821

Canton Pathology, Inc.
Canton, OH 44708

Carondelet Home Care Services
Overland Park, KS 66211

Emerge Ministries, Inc.
Akron, OH 44313

Get Real Recovery, Inc.
San Juan Capistrano, CA 92675

Glen Arn, PT
Battle Ground, WA 98604

P1 24 Hour Emergency Rooms
Houston, TX
Rest Ensured Medical
White River Junction, VT 05001

Roy Lester Schneider Hospital
St. Thomas, VI 00802

Selah House Adult
Anderson, IN 46011

Vascular Surgery Associate
Patchogue, NY 11772

Vestal Vol Emerg Squad
Binghamton, NY 139051

Victoria Caruso, MD
Middletown, NY 10940