Posts Tagged ‘health insurance’

5 Tips For Implementing A Group Benefits Plan

Tuesday, January 24th, 2017

The post below is a guest blog from Jordan Whichard, IV, GBA who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

If you operate a startup company, or your established business has recently grown larger than 50 employees, one of the most daunting items on your 2017 to-do list may be implementing a group benefits plan for the first time.  Starting a benefits plan from scratch can be an intimidating – not to mention time-consuming – process, especially without a partner to help you understand the background and minutiae of it all. Here are some tips if you find yourself staring down a brand new group benefit plan in 2017:

  1. Know your timeline and stick to it

Whether you want your benefits plan to begin in June or January, you’ll want to begin the process at least six months in advance of your anticipated start date. That will give you ample time to evaluate different benefit options, plan designs, funding platforms, and other factors that you will need to consider. Medical carriers will generally be able to offer early numbers about three months prior to your effective date.  You’ll want to approach the carriers as close as possible to that date in order to start understanding your potential rates.

  1. Firm up your census

Changes in your workforce are bound to happen, especially if you operate a rapidly growing business.  But beware, medical carriers reserve the right to re-rate your population if your census changes by more than 10% between the date of the quote and the date of final implementation.  If possible, holding your workforce numbers relatively stable for several months before your first open enrollment will help alleviate any stress that a re-rate would generate.

  1. Know your population

All workforces are different, but knowing your employees wants and needs can be a big help when designing your first benefit plan.  A brief employee survey could be a valuable tool in determining what benefits your employees are most interested in.  By the same token, many benefit plans have participation requirements – a percentage required to guarantee rates in the first year.  If you have less than that, the benefits may be more expensive than originally thought.

  1. Beware individual underwriting

Depending on the size of your group, some medical carriers may require individual employees to go through an underwriting process to help the carriers determine the risk associated with your group. If you have a stable workforce and know everyone wants coverage, that may not be a problem; but groups with a geographically or economically diverse workforce will want to think twice before committing to the individual underwriting process. Either way, you should understand that the first numbers a carrier presents may not necessarily be their final proposal!

  1. Tie it all together

Once you have all of your plans in place, you’ll want to make sure that the benefits are working effectively for you and your employees.  Ensure that the appropriate plans are written under Section 125 of the IRS code so that employees are able to pay their premiums before any taxes are deducted from their paychecks.

If these tips sound like things that you’d like explained or explored further, contact a consultant at HCW today.  Implementing the plan is just the beginning – next comes developing your long-term strategy, ensuring regulatory compliance, and managing your costs. We’re ready to help guide you through the process from start to finish.

Marketplace Premiums Will Continue To Trend Upward In 2017

Tuesday, July 19th, 2016

marketplaceblogThe post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

Now is the time when insurance carriers will begin determining premium pricing for their individual plans and filing for approval with state departments of insurance.  Undoubtedly, their goal will be to offer plans that meet the needs of most, maintain competitive pricing, and avoid losses associated with not being able to underwrite or deny coverage during the Annual Enrollment Period (AEP) or Special Enrollment Periods (SEP).  The Kaiser Family Foundation discusses some of the challenges that insurers will continue to face when determining rates for the upcoming calendar year.  One challenge that is of interest continues to be those individuals that remain uninsured.  The Kaiser article indicates that these uninsured individuals are generally healthier and their enrollment would help to offset costs as they are expected to have a fewer health care claims.  The Individual Mandate provision of the ACA requires everyone to have coverage, or else face a penalty.  In 2016, that penalty is $695 or 2.5% of household income, whichever is greater.  In 2017, these penalties will be adjusted upward for inflation.  As these penalties continue to rise it will be interesting to see how many people continue to remain uninsured and if their eventual compliance with the Individual Mandate actually has a positive impact on rates.

In North Carolina, the pricing challenge becomes more difficult in 2017 as one major carrier, United Healthcare, is pulling their individual plans from the Marketplace (where individuals can receive a federal subsidy for insurance premiums) as they have decided to no longer participate in this state. This will leave our state with only 1 major carrier offering subsidy-eligible plans, Blue Cross Blue Shield of North Carolina.   This may put additional pricing pressure on BCBSNC and drive their premiums even higher.  They have already been forced to make dramatic network changes in an effort to keep pricing at acceptable levels with both their members as well as the NC Department of Insurance.  Time will tell if these changes create more stability in premium pricing.

As 2017 approaches, those with individual insurance plans will be anxious to see what their premium increases will be for the next year.  Double-digit increases in the 20-30% range would not be a surprise as insurance carriers may still be trying to offset losses from prior years.  State Departments of Insurance will be responsible for approving any increase requests and plan design changes, as the carriers will most likely adjust benefit levels to maximum premium savings.  Regarding the Marketplace departure of United Healthcare in 2017, small group employers need to understand that UHC will continue to offer group-based plans.  With moving away from the Marketplace, UHC is looking 2-3 years to the future to ensure that they will continue to be competitive with individual plans outside of the Marketplace, as well as with their small group plans.  In North Carolina, will BCBSNC follow suit?  Time will tell.

Pharmacies, Big Pharma, and Rising Prescription Prices

Tuesday, June 28th, 2016

The post below is a guest blog from Steve Byrd who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

Rising health costsA key trend among medical plans lately has been the move away from traditional pharmacy tiers. In the traditional model, generics — regardless of cost — reside under the least expensive copay tiers on your medical plan. In contrast, brand- name medications reside under the higher, more expensive copay tiers.  For many years this model was the norm, and most consumers became very familiar with it.  However, continued pressure to reduce cost has forced insurers to re-evaluate this traditional view.  It is expected by some, that by the year 2024, pharmacy costs will equal half of our overall medical costs.

Many brand name medications are coming off of their patents, creating opportunity for generics to evolve.  Traditionally, these generics have offered great savings over their brand name counterparts. However, many of generics are now entering the market at prices much higher than historical levels, creating new pressure on insurers to hold down costs.

In response to these increasing costs, insurers are re-evaluating their pharmacy tiering.  Generic medications are being treated no differently than brand name medications; These drugs are being tiered based on their overall cost regardless of their designation as a brand or generic medication.  Pharmacy pricing changes are catching many people off-guard.  They don’t understand why their generic medication, which used to be offered in a more affordable tier on, might now be Tier 3 or Tier 4 on their carrier’s formulary.  Consumers are having to work even harder to understand their carrier’s pharmacy benefits. They are having more direct conversations with their providers and pharmacists to try to minimize their out-of-pocket costs, which are increasing with no end in sight.

If insurance carriers are going to be able to offer competitive priced medical plans, gaining better control over rising pharmacy costs is critical.  Pharmacy expenses account for a significant portion the average person’s overall medical expenses, and both consumers and carriers are feeling the pain.  One insurance carrier is even suing its Pharmacy Benefit Manager for $3 billion over questioned pharmacy charges.

Fortunately for consumers, there are many new Rx tools popping up that can help members navigate their benefits. Goodrx.com and healthiestyou.com are good examples. A recent Consumer Reports article provides additional guidance on ways consumers can save on pharmacy costs. Consumers also need to evaluate options at their local pharmacies, as they can often find some of the higher priced generics offered at lower costs through a local pharmacy’s prescription plan.

As healthcare spending continues to increase, and pharmacy costs continue to become a larger portion of the cost, more pressure will be applied towards controlling pharmaceutical costs. Consumers will continue to see changes to their pharmacy benefits and their carriers designated carrier’s prescription formulary.

 

To Cover Spouses… or Not?

Tuesday, January 21st, 2014

The post below is a guest blog from Ellen Tucker who serves as Principal, Health & Welfare Consultant  for CAI’s employee benefits partner Hill, Chesson & Woody.

Family CoverageHave you considered eliminating the availability of spousal coverage to your employees if their spouse is able to obtain insurance through their own employer? If so, you are not the only company to consider this approach as a way to manage healthcare costs. In August, UPS officials announced that they will eliminate coverage for many working spouses of non-union employees, affecting approximately 15,000 individuals.

The company specifically cited rising healthcare claims costs and healthcare reform costs as the reason behind its decision. This change will lead to a savings of around $60 million for UPS, according to a company spokesperson.

While healthcare reform requires that large employers cover dependent children to age 26, there is no requirement for employers to cover spouses. At the same time, if the employee coverage is considered affordable and the spouse is eligible for coverage, the spouse will not qualify for a subsidy through the health insurance exchange.

Currently, spousal eligibility policies take one of the following approaches:

  1. Coverage available for all spouses regardless of whether or not they work or have access to other health insurance.
  2. A surcharge for coverage of a working spouse if the spouse’s employer offers health insurance.
  3. Exclusion from coverage under the employer’s plan if coverage is available through the spouse’s employer.

When researching whether to eliminate eligibility for spouses with access to other coverage, UPS found that 35 percent of other companies it surveyed plan to do so next year.

Many companies are following the second approach and requiring employees to pay a surcharge for covering their working spouse. These surcharges typically range from $20 up to the entire cost of covering the spouse. A Towers Watson survey this year found that 20 percent of more than 600 participating companies charge an average of $100 a month for spouses to be covered.

Employers are facing increasing medical costs and are looking for ways to manage these costs.  There is even more focus on escalating costs due to healthcare reform, as employers have seen pre-existing condition exclusions go away, the elimination of a lifetime benefit limit, the requirement to cover dependent children to age 26, the requirement to cover preventive care at 100%, and the implementation of reform fees.  Employers are making plan design changes and/or contribution changes to pass on more costs to employees, focusing on robust wellness programs including tobacco cessation and BMI, and also making changes to spousal coverage.  Awareness and benchmarking to other employer eligibility practices will help to determine if this is a viable strategy to control costs and attract new employees.

Self funded companies and fully insured companies with more than 100 employees can determine the claims cost for spouses on their healthcare plan.  If the employer wants to mitigate this cost, there are several approaches that can be taken.  One approach is to increase the payroll deductions for employee/spouse and family coverage. This affects all spouses regardless of whether they have access to other coverage.  Another approach is to charge a spousal surcharge for working spouses with access to coverage through their own employer.  The most impactful method is to eliminate spousal coverage for spouses with access to coverage, or to eliminate spousal coverage and only cover employees and dependent children.  Currently, fully insured companies do not have the option to drop spouses entirely, but this may change in the future since these spouses will be able to obtain coverage through the health insurance exchange.

Whether an employer adds a surcharge or eliminates coverage for working spouses, any change to spousal coverage will result in pushback from employees. Employers need to determine whether they are willing and financially able to provide coverage to spouses who have access to coverage through their own employer, along with other strategies they can pursue to address the rising cost of health insurance.

While implementing a spousal surcharge has become more common, and the amount of the surcharge has been increasing, eliminating eligibility for spouses with access to their own employer’s coverage has not been a widespread trend. As healthcare costs continue to increase, however, more employers may eliminate spousal coverage for spouses with access to other coverage in 2014 and beyond. This decision should be made as part of an overall benefit strategy.

If a change to spousal coverage eligibility or cost is going to be implemented, inform employees about the change as soon as possible, so their working spouses have the opportunity to investigate all of their options. Avoid waiting until an open enrollment period, as that can cause confusion and put stress on employees.

If the choice is made to add a surcharge or discontinue coverage, explain the reasons why it is occurring. For example, discuss how the expected savings will preserve benefits for employees, and that it will help the company meet its overall budget. This information should be communicated clearly to all affected employees.

Hill, Chesson & Woody can provide further assistance for employers who want specific advice on strategies to address healthcare cost.

Photo credit: Andrey Popov

Long Term Care Insurance – A Changing Landscape

Tuesday, September 4th, 2012

The post below is a guest blog from CAI’s employee benefits partner, HCW Employee Benefit Services.

For people who are unable to fully perform activities of daily living due to chronic or disabling conditions, long term care provides the range of care and support services needed over an extended period of time.

One way to protect an individual’s ability to pay for these services is through the purchase of a long term care (LTC) insurance policy.  These policies, which have historically been purchased individually or provided through an employer, can help offset the expenses associated with nursing home care, home healthcare, personal and adult daycare.

The projected need for long term care is staggering.  In 1994, 7.3 million Americans needed LTC at an average cost of nearly $43,800 per year.  In 2000, the numbers increased to 9 million Americans with need at a cost of $55,750 per year. By 2030, estimates show that more than 23 million Americans will need long term care at a cost of nearly $300,000 per year!

The recent healthcare reform legislation attempted to address this escalating need through a provision called the Community Living Assistance Services and Support Act (CLASS).  After performing a deeper actuarial review of the numbers, the United States government pulled the plug on the CLASS Act due to an unsustainable funding model.

Unrelated to the reform attempts to address LTC, there is a lot of turmoil in the private LTC insurance marketplace today.  Due to a low return on investment caused by low interest rates and the unknown future cost of medical care for those with LTC plans, many insurance carriers have recently left the marketplace:

  • Unum and John Hancock have exited the group market
  • Guardian and MetLife have left the LTC market completely
  • Prudential exited the individual market

This financial uncertainty and lack of providers has left many employers unsure about whether they want to offer group LTC insurance at all. At a minimum, they are wondering if they should wait until they improve their comfort level with the product and the market turmoil subsides.

HCW Viewpoint

From an individual’s point of view, there is little doubt a great need for long term care insurance still exists.  In fact, about 70 percent of individuals will need some type of long term care assistance after turning age 65. However, only 10 percent of seniors have LTC policies, and only 15 percent of all employers currently offer a long term care insurance plan.

But, just because there is an “individual” need for long term care insurance, that doesn’t mean that employers should jump into the waters headfirst and integrate LTC coverage into their benefit offering.  As with other benefits provided, it’s important to determine what you are trying to accomplish by offering group LTC coverage and how this fits into your overall benefit strategy.

Some helpful questions to ask may include:

  • Are your employees asking your organization to provide LTC coverage?
  • Are your competitors offering coverage?
  • If you elect to provide LTC insurance, how will you position it to increase its perceived value with employees?
  • Can you determine the right product and coverage mix of group and individual LTC coverage to sustain the associated costs over the long haul?

The unknown financial risk in this market, coupled with low returns on investment, have led insurance carriers to modify their plan designs away from generous, unlimited-benefit duration plans to plans with maximum-year payouts.  Additionally, insurance carriers are moving to simplified underwriting (where several medical questions are asked) in order to better manage their risk.  These trends lead to a more conservative approach and should help stabilize the LTC market.

Also, with a timely purchase of LTC insurance, individuals may find the right combination of coverage and premium with the right carrier.  It is important to understand how LTC insurance fits into their overall retirement planning.  This is true whether employees are seeking an individual policy or supplementing an employer-sponsored base plan with additional coverage.

Even as several carriers are no longer offering LTC coverage, there are a few carriers that have been more optimistic in their approach.    If interest rates rise and the economy rises with them, we may see more competition with more carriers willing to enter (or re-enter) the LTC marketplace.  It’s key to seek advice specific to your organization’s goals to ensure that you have the most up-to-date information in the ever-changing landscape of LTC insurance.

Photo Source: Muffett

The 2011/2012 NC Healthcare Benefits & Cost Survey Offers Employers Local Data

Tuesday, April 3rd, 2012

Employers in North Carolina are curious to know how their benefit plan design and premium costs compare to other local companies. The NC Healthcare Benefits & Cost Survey shares local benchmark data from North Carolina companies, which differs from most benchmark surveys that focus on national data.

CAI and HCW co-developed the 2011/2012 NC Healthcare & Benefits Cost Survey. The state-wide, annual health plan benchmark survey offers North Carolina employers information that is most critical in managing their employee benefits plan.

More than 700 N.C. companies participated in the survey with a majority of participants located in the Research Triangle region of the state. Small to medium-sized employers with less than 1,000 employees nationwide accounted for the majority of survey participants.

The survey also captures organizations from several different industries to give employers multiple views for benefit and policy trends. The top five industry groups include Durable Manufacturing; Professional, Scientific and Technical; Healthcare and Social Assistance; Finance, Insurance, Real Estate, Rental and Leasing; and Non-Durable Manufacturing.

Of the survey participants, 539 employers reported offering a Traditional Plan only, 76 employers offered a Consumer-Driven Health Plan (CDHP) only, and 100 employers reported offering both. Below are key insights from the two different plans.

Key Findings: Traditional Plans

  • 22 percent of employers with traditional plans offer a non-rollover Health Reimbursement Account (HRA)
  • 76 percent of employers with a traditional plan have a PPO plan, 18 percent have a POS plan and 4 percent have an HMO plan
  • Average Health Plan premium cost for single coverage is $5,436.36 per year
  • Average Health plan premium cost for family coverage is $15,595.08 per year
  • Employer contributes to 83 percent of single-coverage premium costs
  • Employer contributes to 54 percent of family-coverage premium costs

Key Findings: Consumer-Driven Health Plans (CDHP)

  • 77 percent of employers with  a CDHP have a Health Savings Account (HAS)
  • 23 percent of employers with a CDHP have a rollover Health Reimbursement Account (HRA)
  • Average Health Plan premium cost for single coverage is $4,701.72 per month
  • Average Health plan premium cost for family coverage is $13,312.92 per month
  • Employer contributes to 85 percent of single-coverage premium costs
  • Employer contributes to 56 percent of family-coverage premium costs

Please find more information on NC healthcare benefits and costs from the local survey here.

Healthcare Reform Likely to Encourage Employers to Consider Self Funding

Tuesday, December 20th, 2011

The post below is a guest blog from Mike Beck who serves as the Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

Provisions of the Patient Protection and Affordable Care Act (PPACA) are causing shifts in the marketplace on all sides of the issue. Insurance carriers, employers, providers and consumers are each reacting to the government’s regulations that are designed to get everyone insured, control costs and improve health outcomes.

Three specific provisions of reform — medical loss ratio, the modified community rating and guaranteed issue of medical plans — will encourage organizations to consider a move away from fully insured funding to self insurance. Currently, only 13 percent of organizations with less than 100 employees fund their employee health plans in a self funded manner.

Because healthcare reform is reducing competition in the market place, an environment of rising healthcare costs is being fostered. Since reinsurance carriers are not bound by loss ratios or modified community ratings, employers with healthy employee demographics that shift from a fully insured medical plan to a self funded plan potentially will be able to improve their cost position and have more plan design flexibility.

Based on the current PPACA regulations, we believe more small employers will explore self funding as an option. Taking into consideration your organization’s demographics, risk tolerance and goals for self funding is a necessary step that will ultimately determine if this type of funding is a viable option to stem the tide of healthcare reform.

For more information or to discuss your organization’s funding type, please call Hill, Chesson & Woody at (919) 403-1986.

Lack of Attention to Extended Leave Policies Can Be Costly

Thursday, October 27th, 2011

The post below is a guest blog from Jenn Hargiss who serves as a Client Coordinator for CAI’s employee benefits partner Hill, Chesson & Woody.

You offer a more generous leave policy than the Federal requirements of the Family Medical Leave Act (FMLA).  Big deal, right?  While this may not sound like anything unreasonable, does your health insurance carrier or reinsurance (stop-loss) vendor agree with your decision to allow employees to continue coverage outside of COBRA under your company health plan for an extended period of time?

Medical Insurance Carriers and reinsurance carriers follow strict federal guidelines, especially with FMLA and COBRA.  If an employer allows an extended leave period, including health plan coverage continuation (Non-COBRA) after the 12-week (or 26 week) FMLA maximum has been exhausted, then the employer loses the protection of the group health plan and reinsurance policies.  In essence, the employer just became fully self-funded; paying all the medical claims incurred under the terms of the medical plan after FMLA was exhausted for each individual.  Ouch! 

If claims are incurred, an employer may end up with many very large, unbudgeted claims and legal expenses.  Plus, an untimely offering of COBRA continuation after the fact may not satisfy the health insurance or reinsurance carrier contract provisions and certainly opens up the employer for expensive COBRA rights violations.

Take action to avoid finding your company in an unfavorable legal and financial position:

  1.  No policy is a bad policy.  What is the company policy?  Understand when health benefits are supposed to end to avoid a dispute should the employee not return to work at the end of the leave.  Not only should the health contracts be reviewed, but also dental, vision, life and disability.
  2. Check your policies, procedures, and handbooks.   Make sure the company is not making promises to continue coverage that doesn’t coordinate with the health insurance and reinsurance contracts.  Make it clear when coverage ends and when COBRA coverage will begin.
  3. Negotiate with the health insurance or reinsurance carrier to amend the contract and add the appropriate language around continuation of coverage after exhausting FMLA if the policy is more generous than Federal Regulations require.
  4. Review contracts annually.  Make sure when changing carriers, the policy is submitted for approval and the new contract is updated with the appropriate language.

Healthcare Reform: Six Critical Questions Employers Need to Answer

Thursday, July 29th, 2010

Last week I wrote about the many consequences of healthcare reform based on the prognostications of medical industry observers.  In this post I’ll share what I expect to happen with healthcare reform and six questions which I think employers need to start finding the answers.

My Prediction

Healthcare reform is so big and far reaching that no one can accurately predict the end result.  The literal language of a new law is never the last word.  Regulators are working hard to add meat to the bones.

Take this to the bank: your renewal and strategy meetings with plan advisors will be 50 to 80 percent different in coming years, and it will include tax, penalty, network, employee household income, essential coverage and plan viability issues you have never confronted.  I believe you can count on rules making it more attractive for some employers to pay the fine and to turn a plan over to the Exchanges, and to make the single-payer option more attractive (or necessary) to the public in future years.

An example is the recently issued rule defining “Grandfathered Plans,” making it unlikely any plan can meet the standard for very long.  Whether this is good or bad is less important than the effect on your own planning process.  Will the Exchanges become viable alternatives accepted by employees as substitutes for legitimate, mainstream employer plans?

I believe we will eventually face bifurcated healthcare: one for most of us defined by the “essential coverage” rules and offered increasingly by Exchanges; and one for some of us defined by supplemental plans providing better access to physicians and non-baseline services.

How to Prepare

An important role for company executives is to ensure a strategy for marketplace competitiveness into the future.  Longer-term thinking will be rewarded.  Begin seeking answers to these questions:

1) Will employer-sponsored healthcare remain a key part of your total rewards plan into the future?  What are the alternatives?

2)  Is it worth the contortions to remain grandfathered if you are likely to lose that status soon?

3) Will new supplemental benefits strategies, or even wage supplements in lieu of coverage, become the differentiator?

4)  If predications of a de facto single payer system come true in the medium term, what is the best transition plan for your workplace?

5) Does your size affect your decision-making?

6)  Is your benefits consultant up to the challenge of teaching you and considering all options and business needs? Put them to the test now and stay informed.

Healthcare reform is one of the major themes to be covered at CAI’s 2010 Compensation and Benefits Conference on Sept. 16-17 in Raleigh.  Please visit www.capital.org/compconf for additional information.

Photo Source: Valerie Everett

Future Effects of Healthcare Reform

Friday, July 23rd, 2010

We are covered in webinars and seminars about the Patient Protection and Affordable Care Act.  I attended several in recent weeks, and the most common answer to audience questions was “We don’t know yet.”  True  as that may be only months after passage, employers will need to make key decisions soon.  Consider these “big picture” predictions by medical industry observers as you think about the future of your group health plan:

  • Higher healthcare costs for employers and most patients, well beyond the additional risk from new enrollees
  • Better access for the previously uninsured with new access impediments for the insured
  • More employers will convert employees to part time to avoid mandates . . .
  • . . .  but watch for regulations complicating the exclusion of part-time workers from plans (remember, the goal is 100% coverage)
  • Much improved data collection and sharing; better use of evidence-based medicine
  • Higher medical equipment and drug costs
  • A rise in concierge medicine, private pay and direct reimbursement plans
  • Breaches in security of electronic personal health data housed in the “cloud”
  • Increased taxes from value added/national sales taxes and such
  • More outcome-based payment schedules
  • Penalties to hospitals for readmissions and hospital-acquired illnesses
  • Increased financial stress at community hospitals
  • “The end of self-insurance” in small- and medium-sized plans due to blunting or deleting its advantages over time
  • Increased subsidization of Exchanges
  • Eventual domination of Insurance Exchanges and Medicare; impractical to remain a “grandfathered” plan under new rules
  • Application of IRC Section 105(h) to non-grandfathered insured plans (discrimination testing and daily excise taxes) making it difficult to exclude categories of full-time employees
  • Micro-networks of physicians providing deeper discounts and limited choices
  • Fewer viable commercial domestic providers over time; more medical tourism overseas
  • Commoditization of healthcare and diminished professional status/pay for office-based physicians
  • Greater use of mid-level practitioners such as Physician Assistants and Nurse Practitioners

Sure, some of these predictions will turn out wrong and others will come into play.  We are taking today’s loose and complex system of doctors, insurers, pharmaceutical and equipment makers, hospitals, network pricing secrecy, etc. and adding significant central direction, data, light-of-day, penalties, incentives, limitations, minimum plan standards, new taxes and regulations.  Yes, the old loose system became unaffordable, but is the regulated one more efficient?  No one ever lost money betting on unintended consequences from large regulatory programs, so let’s hope some of them are good!

Next week I will share my predictions for healthcare reform and some advice for employers on how to prepare.

Note: I am grateful to all the seminar speakers and area professionals for their help, including Todd Yates of Hill, Chesson & Woody, Joel Daniel of Ogletree Deakins and Dr. David Marcinko.

Photo Source: Oldmaison