October 2020 Volume 10 Issue 13
Providing Current Information on

Health Insurance Industry Issues and Legislation

Payors Reconsider Their Benefit Plan Designs
Self-funded plan payors' desire for cost control and predictability is stronger than ever
as profitability is down while healthcare costs continue to rise in today's Covid-19
world. Many are considering moving away from high deductible cost-sharing plans
that have not fulfilled their promise of flattening the medical cost curve by creating a
"skin in the game" effect for employees. Options they are considering include Reference
Based Pricing; defined-contribution; and zero-copay, zero-deductible plans with costs
comparable to those of typical high-deductible plan designs.
Reference Based Pricing - Benefit Design for the Future
More and more self-funded payors are turning to Reference Based Pricing In
their efforts to control costs and increase predictability. While controlling costs
are important, they understand that member acceptance, engagement and
satisfaction are all key to successfully implementing a RBP plan. They are finding
that secure, user friendly apps, like HHC's HPGPS, are an excellent member
engagement and communication tools. For plan enrollees they offer an easy,
convenient way to track and manage their benefits, receive information and
communicate with their plan sponsors. Plan sponsors also know that how balance
bills are handled is critical to an RBP based plans. That's why they are choosing a
RBP company, like HHC Group, that assigns personalized patients advocates, who
communicate with both the member and plan sponsor on a regular basis and work
diligently to achieve a favorable resolution for all involved.
RAND Corporation Compares Private Pay and Medicare Hospital Payments
Private plans are paying almost 2.5 times as much for hospital care as Medicare, according
to a RAND Corporation study of claims from over 3,000 hospitals nationwide. RAND
researchers found wide variations in costs among providers, with payments ranging from
83% to 377% of what Medicare for a typical procedure. Importantly, they determined
that while transparency is shedding light on pricing variations, it is not on its own
impacting them. They concluded that rethinking traditional pricing structures will be
necessary to meaningfully impact healthcare prices.
Preventative Screening for Depression A Huge Saving Opportunity
Depression is costing employers more than 8 times as much in disability wage
replacement per employee than the next highest chronic cost condition. This was
the key conclusions of the Integrated Benefits Institute's (IBI) report on potential cost
savings that preventative screenings generate for employers. IBI found that 91% of
people did not get a recommended screening for depression, the highest of any
chronic health conditions IBU measured. Obesity has the next highest level of missed
screenings at 51%. The report included recommended incentives for employers to use
to encourage employees to get recommended screenings.
RAND Corporation Compares Private Pay and Medicare Hospital Payments
Medicare Reference Based Pricing Claim Negotiation Claim Repricing
Medical Bill Review (Audit), Claims Editing DRG Validation Specialty Drug Cost
Containment Medical Peer Reviews/Independent Reviews, Utilization Reviews
Independent Medical Examinations (IME) Pharmacy Consulting.
H.H.C. Groupis an URAC accredited Independent Review Organization for Internal and
External Reviews.
For additional information about H.H.C. Group and cost containment services, please visit
www.hhcgroup.com or contact Dean Vaden at dvaden@hhcgroup.com or 727-253-0365.
Three Star Preferred Provider Program Additions
Patricia Denton-Edwards LLC
Manhattan, KS 66502

Amanda Selman LLC
Clifton Forge, VA 24422

David Raney
Topeka, KS 66624

Ronald J. Juenemann OD PA
Phillipsburg, KS 67661

Health 360 PC
Temple, TX 76502

FAC Alliance Surgery Center at
Johns Creek :LLC
Suwanee, GA 30024

Tanya R. Jantz DC
Cimarron, KS 67835