Tuesday, October 13, 2020

Digging Deeper Into Self-Funded Plans


Regardless of whether you have been self-insured for decades, just a couple of years, or just considering this approach, there are numerous other ideas, techniques, and strategies available to help eliminate waste and maximize value to both the employer and the employee. We are going to explore two of these approaches:

1. Get the most out of your prescription drug plan.

It’s been our observation that on average, prescription drugs account for 20-25% of the total cost of a medical plan, and that percentage is growing. Due to the confluence of specialty drugs that will be coming to market in the next few years, an aging population, and traditional price inflation, it is likely that prescription benefits may account for as much as 40% of total medical spend by 2022.

With approximately 7,000 new drugs coming to market, many of which are specialty products, it will become critical to minimize prescription plan spend. One strategy to consider is ensuring that specialty drugs are delivered through the most cost-effective channel. Today, many of these specialty medicines are dispensed on an outpatient basis at a hospital because they require special handling, administration or monitoring.

When these specialty drugs are dispensed at a hospital or specialty pharmacy, the claims are usually covered under the medical benefit. A more cost-effective approach is to carve out these products, where appropriate, and require that they flow through the pharmacy benefit, often times yielding considerable savings in both the cost and administration of the medication. Many of these products can just as easily be administered in a physician’s office or even in the member’s home while being monitored by a physician’s assistant or nurse. The savings from simply managing the site of care of these products can often times be thousands, if not tens of thousands, of dollars.

To avoid needless overspending for identical medication, ensure that your pharmacy benefit manager has a specialty prescription program in place requiring that these drugs be obtained through the pharmacy benefit and can be administered in an alternative site of care whenever possible.

Another technique to help control prescription costs has nothing to do with plan design. Virtually all brand name pharmaceutical manufacturers provide rebates to PBMs. Unless the employer is savvy enough to negotiate up front, many PBMs and third-party administrators retain these rebates rather than passing them on to the employer. Depending on a group’s utilization and drug mix, it would not be unusual for these rebates to represent 20% of total prescription spend. Negotiating with the PBM to pass on these rebates (in whole or in part) to the employer can have a significant impact on lowering prescription spend. In fact, rebates on specialty drugs, as discussed above, can represent thousands of dollars per script.

In addition to negotiating for rebates with a PBM, you should also ask to allow for a periodic (annual or semi-annual) audit of the PBM’s performance to ensure that all discounts, fees and rebates have been accounted for accurately. Without the ability to audit, there is no way to validate the performance of the PBM.

2. Explore the possibilities of telemedicine.

Many insurance carriers who offer self-funded services have recently introduced telemedicine as an option. The shortfall of this arrangement is that they usually are only available to participants in the self-funded plan rather than including all eligible employees. In addition, under these “bundled” telemedicine arrangements, the member is usually charged approximately $40 each time the service is used.

The value proposition of telemedicine is that it improves productivity by giving employees immediate 24/7 access to board-certified physicians who can diagnose and write prescriptions for common conditions such as pink eye, allergies, sinus infections, and urinary tract infections. Without telemedicine, many employees would have to wait to see a physician or would seek care from more costly resources such as urgent care or the emergency room. These employees would also miss time from work in order to be diagnosed.

In addition to saving time and improving productivity, the employer further benefits by eliminating those physician, emergency room or urgent care claims from their medical plan. Because of the productivity savings, we often encourage employers to partner with an independent telemedicine provider to make this benefit available to all eligible employees, not just those enrolled in the medical plan. In fact, this arrangement can be designed so that the members pay nothing to access this service, increasing utilization of telemedicine providers while simultaneously eliminating claims from the self-funded plan.

These strategies unequivocally represent a win-win outcome for both the employer and the employee, and they represent just two ways employers can squeeze more value out of self-insuring.

Controlling healthcare costs has been an ongoing challenge for virtually every employer. Implementing strategies that achieve this objective while providing enhancements for your employees is an outstanding, highly sought-after and rare accomplishment.

Call SHN to explore your options. It is time to get our health care expenses under control. Don’t worry. SHN will do all of the work while your plan saves additional dollars.

Solidarity Health Network, Inc.

4853 Galaxy Parkway, Suite K

Cleveland, OH 44128

Phone: 216-831-1220

Toll-Free: (888) 338-7677


Email us: info@shninc.org

How To Coronavirus-Proof Your Home — and Your Life

In just a few weeks, the new coronavirus has made serious inroads into American communities, even as its global death toll grows. Many health experts are saying that the opportunity to contain the spread of the virus is over; now, it's time to do what we can to mitigate what the World Health Organization is now deeming a pandemic.

Many people are worried about what they should do as the situation develops. Should they hunker down at home—and is there anything they should do there to prepare?

Here are several things you can do to protect your home and your family from the virus—and to be ready if it crops up in your community.

Stock up on supplies

Photo by Hamilton-Gray Design, Inc.

Curbing your exposure to the coronavirus starts with limiting your exposure to people who might be carrying it. In other words, stay home! As you would with a severe weather event, it's suggested you stock up on enough food to last for a couple of weeks, according to the American Red Cross.

Pantry staples are easy to pick up and store, including cereal, crackers, pasta, rice, frozen veggies, and canned goods (beans, tuna). And don't forget toilet paper, as well as laundry and dish detergent.

Soups and Gatorade are worth adding to your cart, too, since staying hydrated will be important if anyone in the family falls sick. If you have a baby on board, also make sure you have enough formula and diapers on hand.

How to fight coronavirus germs at home

Photo by Carmel Builders

While not much is yet known about how long COVID-19 can survive on surfaces, Stephen Morse, a professor of epidemiology at Columbia University Medical Center, told NPR that based on previous coronaviruses (yes, this isn't the first), he thinks that COVID-19 can be killed by most household cleaners, including bleach, alcohol, or even plain old soap and water. The reason: This coronavirus is surrounded by a lipid covering that soap can break down.

As a result, wiping down counters, doorknobs, faucets, cellphones, and other areas that often come in contact with people's hands can go a long way toward preventing the spread of germs and sickness in the home.

"Viruses can persist on surfaces, so anything you can do to keep them clean is a help, including the use of bleach solutions and disinfecting wipes," says Bill Carroll, an adjunct professor of chemistry at Indiana University.

The same germ-prevention advice holds for your hands and mouth.

"Alcohol in hand sanitizers helps, but washing your hands often, for at least 20 seconds, is better," Carroll urges. "Try not to touch your eyes, nose, or mouth with dirty hands, and always cover your mouth when you cough."

Last but not definitely least, make sure to wash your hands with soap and water frequently, for 20 seconds at a time. In fact, make a habit of washing your hands as soon as you walk in your front door.

Check your medicine cabinet


If you take a certain medication daily, it's smart to make sure you have enough in your cabinet.

"I don't think you'll need six months' worth, but an extra month or two is a hedge against potential supply-chain shortages," says Carroll. Pick up other medicine cabinet basics you might be missing, such as acetaminophen, ibuprofen, and bandages.

As for wearing face masks outside the house, that probably helps as much as covering your mouth when you cough, says Carroll. That is, if it turns out you're the sick one, you'll be reducing other people's exposure to a degree, but it won't do much for your own risk from others.

"Unless the mask is capable of filtering viruses and tightly fitted to prevent inhaling air around it, it's not of much use, and it doesn't protect you if you rub your eyes, because it's not a full face shield," he explains.


Consider working remotely

As fear of the effects of the coronavirus has spread, some businesses are urging employees to work from home, especially if their work involves travel to Europe or Asia. If you think you might need to work remotely in the coming weeks or months, take stock of your home office and be sure it has all you need. Order enough paper, ink, toner, and other work supplies, so you can be productive in case you need to work there.

Lie low if you're sick

Got a bug? Whether it's the seasonal flu or something worse, it's always best to stay home.



Healthiest Award: Healthy culture is crucial for a healthy workplace



By Michael Brady

While specific benefits and special programs can help ensure a healthy workforce, the COVID-19 pandemic has shown that having a healthy culture is crucial to helping organizations and their employees thrive, especially in tumultuous times. Vermont-based Marathon Health operates about 200 on-site health centers for large employers throughout the country. Its mission: help employers build healthy workplaces by giving workers the tools they need to manage their health. Marathon’s employees often say they joined the organization, in large part, because they were attracted to the company’s mission. “I’m employee number three. I’ve been with Marathon Health since we opened the doors. (A sense of mission and purpose) doesn’t get old. It doesn’t get stale,” said Tracy Moran, the company’s vice president of brand and communications. She said the company needs to lead by example if it wants to convince other employers to have a healthier workplace.

Leaders that want to foster such an environment need to put their workers first, experts said. Marathon CEO Jerry Ford believes that if the company takes better care of its employees, they will deliver better care to patients. That will lead to more satisfied customers and, ultimately, the company’s success.

“That philosophy has really held true. We’ve built … a very strong culture of health,” Moran said. “It guides … everything we do.” The COVID-19 pandemic changed what it means to be a healthy workplace. Not only did the outbreak lead to financial and operational issues for employers, but workers also had to adjust to new ways of doing their jobs and coping with challenges in their home lives. It’s led to rising levels of stress and anxiety for everyone. Leading healthcare organizations have taken it upon themselves to give staffers extra help, whether that’s educating them about existing benefits or creating programs to address new challenges.

“We’re providing continued—and in many cases, enhanced—access to telehealth, physical fitness and financial wellness resources, as well as emotional wellness programs and support,” said Karen Ward, senior vice president and chief human resources officer for Blue Cross and Blue Shield of Tennessee. “We also ramped up our at-home fitness offerings and collaborated with our employee assistance program to offer resources that address behavioral health issues such as burnout, substance use disorder, anxiety and depression.”

Marathon created a special fund to help employees affected by the pandemic. Under the program, managers can apply for grants to help their employees fulfill unmet needs created by the outbreak, such as childcare or tutoring. It helps employees through “hard times,” Moran said.

The company is also granting employees more time off on a case-by-case basis if needed, even if they’ve used up all the time off allotted them under the company’s usual policy.

“We’ve been very flexible with people … to make sure they don’t have hardships … due to a PTO policy,” Moran said. Morrison Healthcare, a company that provides food and nutrition services to more than 750 hospitals and health systems, waived telehealth copays for its employees throughout the pandemic because “people didn’t want to go into the doctor’s office,” said Brad Burden, senior director of human resources.

It also created pop-up stores for employees to buy household essentials like milk, eggs, paper towels and other necessities during the pandemic, as well as prepared foods.

“It was very popular and very much appreciated by our associates,” Burden said. Morrison also taught its managers how to use technologies like web conferencing to connect with their employees to help ward off the sense of isolation many workers feel during the pandemic. That might include a virtual happy hour or activities like a trivia contest. It’s a time for employees to connect, not to talk about work.

We all enjoy “participating in those, and I don’t see (them) going away. It’s kind of become a habit,” Burden said. The Tennessee Blues offers support for parents of school-age children by aligning with school systems that serve most of its employees and encouraging workplace etiquette like meeting-free hours among teams to give caretakers more flexibility.

“Soon, we’ll be offering employees two new benefits: a backup childcare and elder care service and a tutoring service,” Ward said.

Experts said employers must communicate with workers throughout the organization, regardless of their seniority, to ensure a healthy culture. It’s important to share what’s changing and why and be open to feedback, especially during an emergency.

“We’ve emphasized how we’re working to balance the needs of our members with the health and safety of our employees,” Ward said. “We’ve also asked employees to tell us what they want and need to be successful in their various roles—not only as employees but as parents, caregivers, students and others they might be filling during this unusual time.” 

Organizations need to have an unwavering commitment to their employees’ well-being if they want to have a healthy workforce because workplace culture is paramount, according to experts. “Many companies have culture statements (but) they don’t carry through in all the actions and behaviors of the organization,” Moran said.