🎙Spencer Smith, CSFS®

The ongoing financial impact of Covid on healthcare organizations is a reality worth considering. This article from Modern Healthcare sheds light on the challenges faced due to supply chain disruptions. Understanding this dynamic risk factor is crucial, and HUB International's EPS strategy offers specific tools and data points to navigate these complexities effectively. #healthcare #riskmanagement #logistics

4

A recent study by OneAmerica highlights the growing need for long-term care planning as costs surge and consumer confidence remains low. With 74% of respondents believing they will require long-term care, only 33% feel adequately prepared, underscoring the importance of early and informed planning to safeguard finances and ease family burdens. There are several ways to plan for the future costs and burdens of aging, from traditional partnership-certified policies to hybrid policies combining life insurance or annuities with a qualified rider for long-term care to even short-term cash indemnity policies. Having a plan is essential to ensure access to quality care, protect income and assets, and reduce the burdens on those you love. The best time to plan is before you retire. Get free and accurate quotes from all the top companies from one trusted source - www.mccannltc.net Discover the cost of care where you live at https://lnkd.in/gHqTMyrD If your loved one needs quality care now, use the LTC NEWS Caregiver Directory -www.ltcnews.com/care If you're a Long-Term Care Insurance professional seeking a home, consider joining forces with Platinum LTC Solutions. Insurance agents, CPAs, lawyers, and financial planners, let's collaborate to assist your clients nationwide. Contact for more information — https://lnkd.in/gAhJgmjg https://lnkd.in/gBJ7vEzf

1

Umbrella Insurance Covers Worst-Case Scenarios. There Are Now More of Them: The extra insurance meant to cover extreme situations for which regular car and home policies aren’t enough is now needed more often. https://ow.ly/m7PU30sFqSW

1

Check out our latest blog on Talking CAHPS, more specifically on the Health Outcomes Survey which measures patients experience.

10

Since when did health insurance companies received thier “MD’s”? This is a long article but a fascinating read. We wonder why healthcare costs continue to escalate and premiums are unaffordable? Well, when you have insurance companies being able to add diagnosis’s and conditions to a members healthcare record which allows them to receive more money for treatment - oh and by the way these members don’t have these illnesses…rocket science not needed here! While this seems like its a “Medicare” problem - it’s happening everywhere. In your commercial and group health plan too. Providers trying to charge patients for negotiated discounts, millions of dollars in fake billings, pharmacy rebates being used to increase insurance company profits versus going back to the companies footing these bills or the patients using the drugs. Insurance companies and the organizations that own physician groups and hospitals have figured out how to game the system to increase profits - not deliver better health outcomes. I do believe that there are a lot of great professionals in the medical field that honestly want to improve the lives of people that they treat - they unfortunately now mostly work for companies that don’t really care much about that.

6

2 Comments

CFOs: Your healthcare strategy could be costing you more than necessary. In our experience there are four key approaches that are changing healthcare network cost management: 1. Look beyond simple discounts and focus on the true claims cost 2. Exploring direct contracting 3. Leveraging Centers of Excellence 4. Considering reference-based pricing These aren't theoretical concepts - they're practical strategies that forward-thinking companies are using right now to optimize their healthcare spend. What's your take on these approaches? Have you implemented any of them? Share your experiences in the comments. #HealthcareCosts #CFOInsights #EmployeeBenefits #CostOptimization

4

How many times did Aetna executives say they are cutting supplemental benefits on their earnings call? I count 6 times! Interesting to hear how the improved star ratings is a tailwind generally, but will also prevent them from cutting certain benefits on those plans. They called out dental specifically as driving high utilization, and also specified some of what they are going to be cutting. The biggest take-away that all of the market movement in MA is hammering home is that long-term medical claims at scale are not as predictable as they need to be for the current MA business model to work well with public markets. The MA plans could actually manage the cost of care down and still get hurt with the way things play out, but meanwhile when you guess incorrectly on medical trend or outlier shifts in the broader healthcare economy, there is no real way to make up the profit no matter how many providers you own. The last few years had an arms race to grow MA membership and everyone in the ecosystem played a role. Carriers in more aggressive plans, Agents asking for more aggressive comp, marketers driving more aggressive advertising and regulators with more aggressive new regulations. Right now there is a backward arms race happening at every major MA carrier, and competitive intel is being traded like gold.

95

12 Comments

In this episode, the discussion revolves around the challenges inherent in the American healthcare system, as Butch Zemar critiques its structure and operations. The conversation touches upon various issues, including rising costs, affordability, and fraudulent billing practices, shedding light on the systemic flaws perpetuating these problems. The impact of the Affordable Care Act (ACA) is attributed to increased costs and reduced commissions for health insurance providers due to its implementation. He argues that while consumer demand plays a role, systemic issues such as abuse and neglect within the healthcare system significantly contribute to the unaffordable costs that consumers and providers bear. A key theme throughout the health insurance is the lack of transparency and accountability in healthcare billing practices. Butch discusses how providers often maximize charges, leading to unexpectedly high bills for patients, while also highlighting instances of billing mistakes and hidden fees encountered in personal experiences and interactions with clients. The discussion extends to strategies for small businesses to mitigate healthcare costs and increase revenue. It is important to learn the healthcare process, asking questions, and negotiating with providers to achieve cost savings. This podcast includes actionable advice tailored to businesses of varying sizes, urging employers to evaluate loyalty to insurers and brokers to ensure they are providing leverage to control costs effectively. In essence, the episode serves as a call to action for stakeholders within the healthcare system to prioritize transparency, accountability, and fair practices. By challenging assumptions, advocating for fair fees, and exploring alternative cost-saving strategies, Butch Zemar offers a roadmap for navigating the complex seas of healthcare in America, ultimately aiming to empower employers to take control of their healthcare expenses and improve the financial well-being of their businesses. For more information, please contact us at EliteBenefits.net or call 708-535-3006.

6

Payers move to ditch deductibles The trend of health insurers launching products without traditional deductibles is accelerating, reflecting a broader shift toward consumer-centric healthcare. As member expectations evolve, insurers are increasingly offering plans that emphasize transparency and simplicity. #employeebenefits #newtrends #helpingpeople

6

"Facing increases of 7% to 10%, companies are looking for ways to share costs. Can employees handle higher premiums?" #risingcostofhealthcare #healthcare #healthinsurance #medicalinsurance #employeebenefits #alternativefunding #costshifting #increasedoutofpocketcosts "To be sure, a good number will pass these expenses along, either partially or fully, as higher premiums or adjustments that create more out-of-pocket costs. But that could backfire, experts say, in a workforce that has grown less productive and less engaged due to return-to-office policies and smaller salaries. “Unfortunately, organizations do not realize that they can start with strategies much less disruptive to employees,” says Steve Kapper, head of the National Health and Welfare Benefits practice at Korn Ferry. These include reviewing self-funding options and negotiating better vendor contracts (with pharmacy benefit managers, for instance), as well as implementing care that manages members' underlying health conditions. Healthcare costs are rising largely because people are returning to their typical volumes of healthcare utilization following years of pandemic disruptions, says Seifert. They are no longer deferring procedures like knee and hip replacements, and they’re seeking screenings like colonoscopies and mammograms, as well as pricier treatments, like designer weight-loss medications. Forecasting these costs is complicated by the ongoing collective-bargaining negotiations at many firms, which complicate the math by significantly shifting the details of compensation and benefits."

8

For small businesses, reduced competition means fewer cost-effective health plan options. This puts additional pressure on already tight budgets and makes it harder to offer valuable employee benefits. Fewer health insurers are selling U.S. employers coverage, according to a new U.S. Government Accountability Office report. The GAO is an arm of Congress that helps lawmakers oversee government programs and spending. 1. Decline in Market Competition: Between 2011 and 2022, the number of issuers operating in the large-group market dropped significantly, with the average state seeing a decline from 12 to 8 issuers. Similarly, the small-group market experienced a sharper decline, from 13 to 6 issuers on average per state, indicating reduced competition.  2. Increased Market Concentration: The number of states with highly concentrated markets—where a single issuer controlled over 80% of enrollment—doubled in the large-group market (from 6 to 12 states) and quintupled in the small-group market (from 3 to 15 states), signaling a trend toward monopolistic market structures.  3. Impact on Consumer Choices and Costs: According to the GAO, these high levels of market concentration may limit consumer choice and potentially drive up premiums, contrary to the Affordable Care Act’s original goal of fostering competition in private health insurance markets. The GAO’s findings show how market concentration can limit consumer choice and potentially drive up premiums—challenging the Affordable Care Act’s original goal of fostering competition. Thanks to #AllisonBell and #BenefitsPro for shedding light on this important issue! Read their full article here: #getdecisely #insuretech #employeebenefits https://lnkd.in/eHiCHiB3

22

As we head into Long-Term Care Insurance Awareness Month here are some staggering stats to consider. #protectingwhatmatters https://lnkd.in/gyXZyDFg

5

3 Comments

Brad Paulis, ASA, MAAA, and Partner at Continuing Care Actuaries will be participating in the LeadingAge / Ziegler CCRC CFO Conference Brad’s session will be on Thursday, April 25 at 11:00 AM CT HCBS Pivot – A Closer Look into Continuing Care at Home This year’s HCBS discussion will pivot to the topic of Continuing Care at Home (CCaH). As organizations look to diversify revenues and service lines, expanding the continuum into people’s homes will take a fresh look in this year’s session. Objectives: 1. Overview of services that are provided for Continuing Care at Home and payor arrangements for CCaH 2. Overview of trends related to this emerging area of care 3. Deep dive into case studies exploring the “Look of CCaH”

3

So many cost containment strategy buzzwords get thrown around within the realm of Health Insurance, it makes you want to ignore all headlines... and yet, because of their potential positive impact for the right group - they definitely shouldn't be ignored. Thanks Michael Shaull, CEBS for a great quick read on two very important strategies to consider. #ReferencedBasedPricing #TieredNetworks

4

A New Approach to Healthcare Cost Control Our recent case study highlights how focusing on managing prescription drug costs, a client achieved a 34% reduction in just three years! Key tactics included partnering with an independent PBM, separating specialty drugs from the health plan, and incentivizing using generic over brand name meds. This approach demonstrates how businesses can significantly reduce health plan costs without compromising employee benefits. Discover how innovative thinking can lead to substantial savings and improved benefits management for your organization: https://dsgbenefits.com/ #HealthcareCosts #PrescriptionDrugs #BenefitsManagement #CostControl

2