September 2017 Volume 19 Issue 9
Providing Current Information on

Health Insurance Industry Issues and Legislation

Employers Expanding Strategies for Controlling Healthcare Costs
In their ongoing efforts to control healthcare costs, more and more employers are
implementing programs to help their employees understand their benefits, their
treatment options, and where they can go to get the care they need at a good
price. They are also implementing programs to reign in specialty pharma costs, the
biggest contributor to increased healthcare costs
Generic Drug Prices Going Down, Really?
With the recent consolidation of the Generic drug industry, many thought prices
would rise. Instead, overall, they have fallen. Generic drug prices in the US have
been decreasing since at least 2010, according to a report by the Government
Accountability Office. In just the last year, retail drug prices have declined 2.4%, based
on a weighted average of 92 generics that have been on the market for a year or
more. Powerful forces are combining to keep Generic prices in check.
Amazon, Apple, Google - Healthcare Disrupters
Amazon, with its "stealth team 1492", Google, with spinout Verily Life Sciences (VLS),
and Apple are looking to disrupt the healthcare market. Amazon is developing
applications for its existing hardware in hospitals and physician's offices, and is
exploring selling pharmaceuticals. Apple is focusing on tracking health-related
data and VLS is developing tools to collect and organize health data, then creating
interventions and platforms that put insights derived from that health data to use for
more holistic care management.
When Providers Balk, Our Bulldogs Bark
More and more employers with self-funded health plans are turning to reference-based pricing to reduce their overall spend. They like the deep savings and they appreciate the price predictability regardless of which provider the plan member uses.

Of course, some providers may balk at the reimbursement amount even with a clear Explanation of Payment (EOP).

That's okay, because HHC Group's bulldogs will bark when they balk.

For all our plans that utilize reference-based pricing services we're available to address provider appeals from explanation of payment to direct negotiation. And we support these types of appeals whether we reprice all your client's claims, only hospital claims, only physician claims, out-of-network claims, or specialty services claims.

CLICK HERE and see how we bark back at providers who refuse referencebased pricing.

Or reach us directly at 301.963.0762 ext. 163 or by emailing
Mak Anesthesia
Atlanta, GA

Emergency Medicine of Indiana
Fort Wayne, IN

Montgomeryville, PA
Wellness Counselling and
Residential Detox Services
Jensen Beach, FL

Radiologists of North Iowa
Mason City, IA

Dr. Dawn Yohe
Wilton, IA