The U.S. Supreme Court decision on the Patient Protection and Affordable Care Act (PPACA) marks a historical event for the healthcare industry.
However, while many will be analyzing what effect the ruling may have on the future of healthcare; one outcome we must focus on is how we can bring value to employer clients.
Potential drivers for healthcare policy:
1.The 2012 election will pave the way for entitlement reform, no matter who is elected.
2.The Supreme Court ruling.
3.The states implementation of PPACA. Even if ACA is ruled unconstitutional, the potential exist that liberal states will implement their own version…about 20.
4.The biggest driver of healthcare in this country over the next several decades will be our national debt.
Both parties are hurling this country toward a fiscal cliff. National health expenditures have reached $2.6 trillion and 49% of that $2.6 trillion is paid by public sector programs. By 2020, national health spending is expected to reach $4.6 trillion and comprise 19.8 percent of GDP, a phenomenon that Warren Buffett describes as a “societal tapeworm.”
The end result will be a blend of alternative funding strategies with a decrease in traditional fee-for-service reimbursement for healthcare. Whether this change occurs two years from now or 10 years, it is coming, and will be led by employers groups, followed by Medicaid, and last in line will be Medicare. The great news is that we as an organization are poised to lead the industry in the changes employers need to improve workforce health and bend the long term healthcare cost curve.
Thursday, June 28, 2012
Tuesday, April 24, 2012
Specialty Drugs & the Containment of Plan Crippling Costs
High-cost specialty pharmaceuticals is one of the fastest growing areas in pharmaceuticals. Today, there are more than 200 specialty drugs available for conditions ranging from Hepatitis C to cancer, with prices ranging from $5,000 to $300,000 per treatment year.
In the mid-1990s, when fewer than 30 specialty drugs were on the market, few employers worried about the impact to their balance sheet. Today, there are more than 200 specialty pharmaceuticals available and a decade from now, that number is anticipated to have grown to more than 400. With an average price tag between $5,000 and $300,000 per year, employers are increasingly aware of the impact these “designer drugs” have on the performance of their Employee Benefit Plan.
AmWINS Has developed a unique insured approach that will significantly mitigate these potentially enormous liabilities. AmWINS Specialty Rx provides for:
• Improved employer cash flow management
• Case Management support
• Elimination of Buy and Bill practices (real dollar savings)
• Potential reduction in overall medical expenditures
Please contact me directly at marc.gilday@amwins.com with questions, or to learn more about how this unique program can help you help your clients.
Be sure to follow the link to read more about this issue in an article that appeared in Health Plan Week -
Friday, April 20, 2012
Express Scripts “The Mega PBM” and Other Acquisitions
After an exhaustive review by the Federal Trade Commission over strong outcry from consumers and competitors alike, Express Scripts, Inc. was given the go ahead to acquire Medco for the bargain price of $29.1 billion.
This has resulted in the creation of the largest Pharmacy Benefit Manager (PBM) in history.
This new Mega Express Scripts PBM will now have control over 30% of the entire US PBM Market. As the company claims it will be able to lower its already low prices, many feel the o[posit will occur.
The now approved merger has also resulted in smaller; more flexible PBM’s to be invited to the table for RFP’s. Additionally, this merger has now opened up the door for many employer groups to get out of their existing contracts as many state attorney generals have already deemed that since the merger was approved, their contracts with Medco are null and void. Plan sponsors should rethink their Rx purchasing strategies going forward.
This has also spurred a merger-frenzy as other managers vie to purchase their former competitors.
AmWINS Rx, one of the country’s highest rated PBM’s is actively participating in come very significant RFP rounds. Unlike a behemoth like Express Scripts, we have better maneuverability, allowing us to customize plans to meet the unique needs of our plan sponsors, and not force plan sponsors to conform to what we want.
If you are in (or about to enter) an RFP, please feel free to contact me directly at 401-734-5963 or via email at marc.gilday@amwins.com to discuss how we can help.
This has resulted in the creation of the largest Pharmacy Benefit Manager (PBM) in history.
This new Mega Express Scripts PBM will now have control over 30% of the entire US PBM Market. As the company claims it will be able to lower its already low prices, many feel the o[posit will occur.
This has also spurred a merger-frenzy as other managers vie to purchase their former competitors.
AmWINS Rx, one of the country’s highest rated PBM’s is actively participating in come very significant RFP rounds. Unlike a behemoth like Express Scripts, we have better maneuverability, allowing us to customize plans to meet the unique needs of our plan sponsors, and not force plan sponsors to conform to what we want.
If you are in (or about to enter) an RFP, please feel free to contact me directly at 401-734-5963 or via email at marc.gilday@amwins.com to discuss how we can help.
Wednesday, April 18, 2012
PPACA may create a Part Time Workforce
An interesting story appeared on the web today, revealing another unlikable possibility of what may happen if ObamaCare is upheld.
As we are beginning to see the financial ramifications of this legislation, particularly in the form of rising Healthcare costs and insurance premiums (which are predicted to increase 150% over the next few years), more employers are contemplating dealing with this by making part time employment the mainstay of their workforce.
Now being discussed as a rational business decision, larger employers will cut loose much of their full time workforce, and off part time positions.
This will put the burden of health insurance (and the associated care costs) on individuals, states and federal governments.
As stated in the article, this entire bill is a good example of good intentions and bad implementation.
This story addresses one other aspect of the benefits business, the need for plans that wrap the expected standard exchange high deductible benefit designs.
AmWINS is one of the largest administrators of limited medical plans, with benefit schedule that can easily be tooled to provide up front coverage to what many believe will be an ever increasing deductible on these plans.
To learn ore or to discuss an existing opportunity, please contact me directly at marc.gilday@amwins.com
Read the story at:
http://www.foxnews.com/opinion/2012/04/17/nation-part-time-employees/
Now being discussed as a rational business decision, larger employers will cut loose much of their full time workforce, and off part time positions.
This will put the burden of health insurance (and the associated care costs) on individuals, states and federal governments.
As stated in the article, this entire bill is a good example of good intentions and bad implementation.
This story addresses one other aspect of the benefits business, the need for plans that wrap the expected standard exchange high deductible benefit designs.
AmWINS is one of the largest administrators of limited medical plans, with benefit schedule that can easily be tooled to provide up front coverage to what many believe will be an ever increasing deductible on these plans.
To learn ore or to discuss an existing opportunity, please contact me directly at marc.gilday@amwins.com
Read the story at:
http://www.foxnews.com/opinion/2012/04/17/nation-part-time-employees/
Monday, April 16, 2012
CA Lawmakers changing Stop Loss rules to benefit Health Insurance Exchanges
As we close in on the 2014 implementation target for the Health Insurance Exchanges, some lawmakers in California are already trying to change the rules and redefine what employers can and cannot do.
CA, lawmakers are drafting new legislation that would essentially block small employer self-funded plans with low attachment points.
The concern is that by allowing low attachment points ($20,000), small employers would be able to significantly save on the cost of such plans if they have healthy populations.
This would of also mean that the Health Insurance Exchanges would be taking on a more risky population (read more expensive), and that would mean that they feel it would not be fair to allow this at the expense of traditional insurers.
It would also mean that employers could bypass and not be forced to include cumbersome State Mandated Benefits, further reducing employer costs.
Many opposed to PPACA have been stating that as exchanges are implemented, plan premiums would increase significantly because more high risk [people would be able to get coverage at the same price as everyone else.
It is expected in June that the Supreme Court will rule on PPACA, and may very well overturn the legislation altogether.
Earlier this year, AmWINS introduced AmWINS Simple Funding (ASF) program, available to employers with as few as 50 employees.
ASF provides flexibility in levels of benefits and choices in Plan design under the direction and control employer groups. Employers can choose from various options for deductible levels, coinsurance, co-pays and upgraded well care and pharmacy benefits; and can make the Plan compatible with tax advantaged high deductible accounts or Health Savings Accounts (HSA).
Email me at marc.gilday@amwins.com for further information on AmWINS Simple Funding and learn how it may save you and your clients significant benefit dollars.
To read to full AIS story, follow the link.
CA, lawmakers are drafting new legislation that would essentially block small employer self-funded plans with low attachment points.
The concern is that by allowing low attachment points ($20,000), small employers would be able to significantly save on the cost of such plans if they have healthy populations.
This would of also mean that the Health Insurance Exchanges would be taking on a more risky population (read more expensive), and that would mean that they feel it would not be fair to allow this at the expense of traditional insurers.
It would also mean that employers could bypass and not be forced to include cumbersome State Mandated Benefits, further reducing employer costs.
Many opposed to PPACA have been stating that as exchanges are implemented, plan premiums would increase significantly because more high risk [people would be able to get coverage at the same price as everyone else.
It is expected in June that the Supreme Court will rule on PPACA, and may very well overturn the legislation altogether.
Earlier this year, AmWINS introduced AmWINS Simple Funding (ASF) program, available to employers with as few as 50 employees.
ASF provides flexibility in levels of benefits and choices in Plan design under the direction and control employer groups. Employers can choose from various options for deductible levels, coinsurance, co-pays and upgraded well care and pharmacy benefits; and can make the Plan compatible with tax advantaged high deductible accounts or Health Savings Accounts (HSA).
Email me at marc.gilday@amwins.com for further information on AmWINS Simple Funding and learn how it may save you and your clients significant benefit dollars.
To read to full AIS story, follow the link.
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