From the Desk of Mike Wojcik June Newsletter
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From the Desk of Mike Wojcik June Newsletter Document Transcript

  • 1. "A journey of a thousand miles begins with a single step" -- ConfuciusBased on the 5-4 ruling of the Supreme Court upholding the Individual Mandate, our country took the next steptoward implementing the Patient Protection and Affordable Care Act (PPACA). The only section of thelegislation ruled unconstitutional is the enforcement of Medicaid expansion which was designed to give the federalgovernment the ability to withhold Medicaid funding from states for noncompliance.The Patient Protection and Affordable Care Act is intended to provide insurance to over 30 million uninsured orunderinsured individuals and ultimately help employers control one of their largest expenses by bending the costcurve. The later goal being anxiously awaited.Although it may seem like we traveled a thousand miles already with PPACA, the majority of changes take placein 2014. The law could still be impacted by near term elections but as it stands now, the current implementationtimeline stands. Click here for the implementation timeline.We look forward to assisting our clients with interpretation, communication and implementation of the law. Ofparticular interest, we look forward to sharing the many innovations about to hit the market as we journey into thenew Healthcare Frontier.This months newsletter follows our new format sharing information in the following key categories:  Know Your Employee Benefits- Tips to become a better consumer of healthcare  Financial- Analytics, Trend, Surveys and Strategies  Legal- Compliance, Legislative Updates and Impacts  Human Resource- Benefit Trends: State and Federal Mandates  Worksite Wellness Initiatives- Trends in Employer Health Initiatives  Industry Spotlights- News Impacting a Specific Industry  Horton Workshops- Notice of Train the Trainer Seminars and WebinarsHealth and Prosperity,MikeOur Mission: To Help Our Clients Drive Down Cost, Employer Workload and Anxiety__________________________________________________________________________________________ ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
  • 2. Know Your Employee BenefitsMedical Care Choices- Tips for Managing Your Health Care ExpensesA great newsletter to share with your employees to describe the impact they can have on your plan.Some excerpts include: The role you play in managing health care costs is simple: Spend your health caredollars wisely. Each time you go to a medical provider or receive medical services you generate a claim that mustbe paid for through your employee health benefits. Essentially, the costs of your claims, and all your coworkersclaims, determine the price you and your employer pay for your health benefits. In the end, decisions you makedirectly affect the year-to-year increases in your health benefits cost.Other topics include: Making Wise Choices, Office Visits, Urgent Care, Emergency Room Care.Feel free to include in your next employee communication. Click here for a full copy.FinancialBlue Cross CDHP Study Confirms Behavioral Change- Lowers HealthcareSpending SignificantlyHealth Care Service Corporation (HCSC), parent of Blue Cross Blue Shield of Illinois, Texas, Oklahoma and NewMexico recently conducted a unique study of members who migrated from traditional plans to Consumer DrivenHealth Plans (HSA and HRA).HCSC studied 5 years of data which showed behavioral change in the following areas in which members reducedhealthcare spending significantly:  Were 4% more likely to take advantage of preventive services  Reduced healthcare spending by an aggregate of more than 12%  Were 10% more likely to fill their prescriptions with generics  Spent 24% less on inpatient hospital services  Spent 8% less on outpatient services  Had a 12% decrease in emergency room visitsIf the employer group switched completely to the CDHP model with no other plan option choices, there were evengreater reductions. The CDHP program enrollment surpassed 1.5 million members this year which has grown bydouble digit increases for the past six years. ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
  • 3. Health Care Cost InstitutesInaugural Health Care Cost and Utilization ReportHealth Care Cost Institute was created in September 2011 to provide comprehensive data on health care costsand promote independent, nonpartisan research to analyze what influences use and cost of health care servicesin the United States. Summarized in its first report is de-identified data voluntarily provided by Aetna, Humana,Kaiser Permanente and United Healthcare, four of the nations largest insurers.The group studied claims back to 2001 and most recently 3 billion claims on members younger than 65 coveredby employer sponsored plans in 2010. HCCI studies claims by four categories of service: inpatient facility,outpatient facility, professional procedure and prescription drug. They also compare subcategories for primaryphysician and specialist claims, and generic vs. name brand prescriptions.Prices were found to increase across all categories of service, with outpatient services experiencing the fastestgrowth. Unlike other reports, the group found increased spending mostly due to unit price increases rather thanchanges in quantity or intensity of services. Comparing 2009 vs. 2010 revealed:  6.4% increase in average price for inpatient surgical admission $25,469 vs. $27,100  8.9% increase in average facility price for outpatient surgery $3,163 vs. $3,443  11% increase in the average facility price of an emergency room visit is $1,195 vs. $1,327  13% increase in average price per brand name drug  6.3% decrease in average generic drug prescriptionA future report from HCCI will target findings on the Mental Health and Substance Abuse (MHSA)category. Though a small component of total health care spending, this category has shown an increase inutilization, length of stays and facility price increases.For a complete copy of the report click here.LegalHealthcare Reform News AlertThe Supreme Court Decision will be the impetus for fueling the next wave of Healthcare Reform. To helpinterpret the decision and the impact it will have on individuals, small and large employers, The Horton Group isoffering the following schedule of Webinar and Seminars from experts in the industry. Click here forschedules. For a copy of the Supreme Court ruling, click here ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
  • 4. Human ResourceAnticipate Higher Health Plan Enrollment from College DependentsThe Affordable Care Act might be claiming another unintended consequence if parts of the law continue. Collegehealth plans are being forced to update their limited-benefit insurance plans accordingly to meet new ACAguidelines or drop them. According to the Government Accountability Office, 60% of school plans have coverageof $50,000 or less for specific conditions, and almost all have payout caps that they will have to do away with by2014.Premium costs are increasing as much as ten fold to meet the new guidelines. Families will do the math. Withexpanded family options covering dependents to age 26 through employers, more college students will findthemselves on their parents plan.As insured families get larger, their family unit costs will most likely see a spike.Retiree Medical Expenses Grow at Alarming RateIn 2002 Fidelity Investments estimated a 65 year old retired couple would need $160,000 to cover their healthcareexpenses throughout retirement. Today that number is projected to be $240,000. Important to note, this amountdoes not include any costs associated with nursing home care and applies to retirees with traditional Medicareinsurance coverage.Future retirees would be wise to maximize their contributions to 401K plans and HSA programs to anticipatefuture healthcare needs. They should also take advantage of any wellness programs offered by employers todayand practice a healthy life style as a cost containment practice for the future.Worksite Wellness InitiativesInsurers Launch More Anti-Obesity ProgramsSome alarming stats from the Centers for Disease Control and Prevention  More than one-third of U.S. adults (35.7%) are obese.  No state has met the Nations Healthy People 2010 goal to lower obesity prevalence to 15%.  The number of states with an obesity prevalence of 30% or more has increased to 12 states in 2010, from 9 in 2009, and from 0 in 2000!  Obesity related conditions include heart disease, hypertension, stroke, type 2 diabetes and certain types of cancer. ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
  • 5. Insurance companies are searching deep to solve the rapid rise in cost from weight-related illnesses which thisyear is nearing $200 billion. The Institute of Medicine published a report claiming 90 million children, teens andadults are obese. Carriers are trying to figure out how to design coverage to best fit this need. WellPoint andUnited Health Care are two leaders in this field. They are going not just to the doctors which they know are inshort supply, but also developing community efforts. Look for more to be announced on these efforts.This epidemic needs to be addressed on multiple fronts. Whether it is cutting down drink sizes in New York orchanging meals at Disney World or First Lady Michelle Obamas pitch for the new Food Plate replacement of theFood Pyramid or new school menus, we all have an interest in seeing this situation reverse or at least stop in itstracks. For more information, research www.ChooseMyPlate.gov.Industry SpotlightsContaining Healthcare Costs-Proven Strategies for Success in the PublicSector- A Study Conducted by Government Finance Officers Association(GFOA)The GFOA, with a grant from Colonial Life, conducted independent research to identify the most innovative andeffective strategies local governments could employ to contain costs while offering a quality benefit program. Thestudy included a survey of GFOA members, case studies and secondary sources. The findings were approved byan independent panel of GFOA members who were experienced in employee benefit management.Six leverage points were explored that governments could use to manage employee healthcare costs. Withinthose six there were several standout strategies that had the best ROI potential. They included:  Onsite clinics and contractual arrangements with urgent care clinics  Variable premium contributions including a defined contribution model  High-deductible health plan and health savings account  Wellness programs at the workplace  Self-Insurance  Cooperative purchasing (more options will become available through Healthcare Reform)  Value-based insurance design disease managementA report based on the survey, "Containing Healthcare Costs: Proven Strategies for Success in the Public Sector"is available by clicking here. Also watch for an upcoming seminar sponsored by The Horton Group and ColonialLife featuring this GFOA study.Horton Workshops & WebinarsHorton Workshops and Webinars are designed to keep busy professionals current on a range of insurancerelated topics. The Horton Group engages some of the brightest minds in the country to help you fine-tune yourprofessional skills and assist in achieving your organizational goals. Our workshops are offered at several ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
  • 6. convenient locations throughout the year. In addition, many workshops can be offered at your company locationor for your association or trade group.As always - if you would like to register for a webinar or workshop, please do so via the following link:http://www.thehortongroup.com/Insurance_Workshops/ ph: (708) 845-3126 • mike.wojcik@thehortongroup.com