Korey Miller’s Post

Health Benefit Costs Reach the Breaking Point for Employers By Paul Pender, MD Melanie Evans and Josh Ulich report in their WSJ article[1] the results of a KFF survey of employers for their health benefits, and the news isn’t encouraging.  Employers’ costs have risen 7% during the last year, and the projections are that 2025 will show even higher increases.  While employers have hesitated to pass on the cost increases to their employees, they cannot continue along this path.  Paying for higher costs each year is unsustainable. Increases in both premiums and deductibles have forced some jobs to be cut to offset employers’ expenses.  Some large employers have scaled back benefits.  Most health plans do not cover weight-loss drugs because of the high cost, despite obesity acting as the major co-morbidity across the diagnostic spectrum.  When will this death spiral of health benefit costs stop? Consider the scenario of health insurance companies working under the provisions of the Affordable Care Act.  As long as they meet the criteria of paying out 80% of premiums, these large healthcare companies keep 20% of the premiums collected for overhead.  Increases in premiums translate to increased profits.  There is little incentive to hold premium costs down.  Add to this formula the rate increases hospital systems have received from health insurance companies, and you have a perfect storm hitting employers and their families.  The average premium cost of a family plan is now above $25,000 per year.  The average deductible per individual runs $1787 in 2024. The answer to spiraling cost is bypassing the middlemen--legacy health insurance companies, Preferred Provider Organizations and brokers--who represent their own interests and not those of the employer or employee.  When self-insured employers contract directly with physicians and hospitals to pay for outcomes rather than volume of services, efficiencies in care delivery are possible.  Quality of care is improved when collaboration among the parties creates efficiencies and when all parties are held accountable for best practices.  The fragmentation and expense of healthcare services in the current system have created a perfect storm for change.  Self-insured employers are looking to new models and partners to deliver a lower healthcare spend and a better experience for their employees. Stay tuned. [1] https://lnkd.in/gvTwNXAR

Direct to employer contracting can help Health Systems improve retention rates, provide better patient experiences and give greater access to providers by eliminating the insurance carrier in the middle. ➡️This model is a powerful and innovative step toward the future of health plans Find out if your Health System is ready to take this step: https://hubs.li/Q02FzX5n0 #Healthcare #DirectContracting #Innovation #HealthSystems

Nudge Health We are the plan administrator of a no-deductible, no-copay DPC-centric health plan with indemnity layer attached to it for emergency hospital care. We provide pre-negotiated fee schedules and tools to help patients contain costs & navigate the healthcare landscape via a cash-based fee-for-service model should it be needed. We offer dental, mental health, prescription, & physician coverage for both patients that require preventative care, as well as to those that require comprehensive managed care for chronic diseases. Unlike health insurance plans, our plans are a relatively fixed cost year-over-year with the ability to opt-in and opt-out of services that are not a requirement for your health plan and goals. We have also made it so that if a patient with a chronic condition becomes stable and has less doctor visits that their premium cost also goes down because we focus on doctor’s average production per patient per appointment. We do this with the goal of driving positive health outcomes with maximum reasonable payout to the servicing provider for their work. We pride ourselves in solving the gap in care for DPC models, high cost of insurance for small employers, and providing affordable access to all forms of care to patients. https://lnkd.in/e5zMM5rJ

More Small and Mid-Sized Companies Embrace Self-Funding. The shift from fully insured to self-insured health plans is gaining momentum, and more small and medium-sized companies are reaping the benefits! Since the Affordable Care Act (ACA) in 2010, the percentage of small employers with at least one self-insured plan has increased from 13% to 16%, while medium-sized companies have seen a rise from 27% to 32%. Why the change? Self-funding offers more flexibility, cost savings, and fewer regulatory headaches. These businesses are taking control of their healthcare, and we’re proud to be part of the solution by delivering stop-loss insurance that helps them succeed. It’s exciting to see this shift happening across our industry, empowering more companies to take charge of their healthcare benefits. Take control of your company’s healthcare—discover the power of self-funding today! #SelfFunding #StopLossInsurance #SmallBusiness #Healthcare

Today’s PPOs Have Become Very Expensive for Employers To Offer PPOs remain as popular today as they were in the early 2000s — though healthcare costs continue to rise. Because of this, today’s PPOs seem to have nothing to do with controlling health plan spending. Instead, they create a false sense of savings for employers and members without providing cost savings or any better quality of care by: Preventing plan members from being balance-billed if they remain “in-network.” Having network size and spread still heavily influence employer decisions on insurance carriers.

Employer-sponsored insurance (ESI) covers around 180 million people, accounting for more than $1 trillion in health spending annually. However, significant challenges in cost, quality, and equity persist. In Milken Institute's latest survey, "Reimagining the Future of Employer-Sponsored Health Care to Drive Value," the findings show the need for employers to explore opportunities to improve health outcomes. Highlights from the survey posted by @Scott Wooldridge at BenefitsPRO indicate that average health insurance premiums increased by 7% for single coverage and nearly 25% for families. Despite significant healthcare spending, outcomes in the U.S. fall short compared to peer countries, with the lowest life expectancy and highest rates of avoidable deaths, maternal and infant mortality, and suicide. At PeopleOne Health, we believe employers should drive affordable healthcare through accountable care strategies such as expanding preventive care, improving primary care access, and prioritizing whole-person health, benefiting both employees and beneficiaries. Read more from Milken Institute's latest survey: https://bit.ly/3RT1ddm #Healthcare #EmployerSponsoredInsurance #AccountableCare

A recent survey by HealthEdge reveals that one-third of U.S. healthcare consumers are likely to switch insurers next year. Conducted among over 3,500 participants with various types of healthcare plans, the survey highlights significant consumer dissatisfaction. The primary issues driving potential switches are cost-related, with 51% of respondents seeking reduced out-of-pocket expenses and 47% desiring lower monthly premiums. Additionally, consumers are demanding increased personalization, better transparency regarding financial responsibilities, and a seamless digital experience from their insurers. Satisfaction was also assessed in areas such as benefits, coverage, personalized support, and preventative care. The report emphasizes that the competitive and dynamic health insurance market is forcing insurers to innovate in member engagement and satisfaction. Consumers' expectations for personalized, high-touch experiences, similar to those in other sectors of their lives, are influencing these trends. The findings underscore the need for health plans to adapt to meet evolving consumer demands. Our credentialing team is ready to assist providers with comprehensive credentialing and contracting services, ensuring smooth onboarding and compliance. We offer expert support, personalized guidance, and efficient processes to meet all regulatory requirements, helping providers focus on patient care while we handle administrative complexities. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Managed Healthcare Executive

The average cost of a hospital stay in Texas per day? Over $3,000, according to a 2022 study from the Kaiser Family Foundation. Unexpected medical bills are enough to overwhelm anyone. Seeing a high price, on top of other bills, on top of dealing with life, is a lot to handle. Sometimes, it's important to remember to take a step back, breathe, and don't let anxiety take over. Here's how to transform fear into proactive planning: 🧠 Understand what and how much exactly is covered. Get familiar with the health insurance plan's deductible, co-pays, and out-of-pocket maximums. 📢 Have an emergency fund! This may sound like a broken record, but there is a reason this is repeated so much and can be a lifesaver. Best practice includes saving at least three to six months' worth of expenses. 💵 Consider higher deductible health plans with an HSA. HSAs allow pre-tax dollars to be contributed specifically for qualified medical expenses. 💯 Keep it transparent. Discuss costs with a doctor upfront. Understanding the potential charges leads to better-informed decisions when it comes to healthcare. Don't hesitate to reach out to Scott & White Employees Credit Union for any assistance with navigating medical costs.

Employers navigating rising health benefit costs with innovative strategies: - Focusing on cost management without burdening employees financially - Encouraging high-quality care and intensive care management Small vs. large employers: - Small businesses faced higher cost increases and average health insurance costs - Large employers' self-funding advantage and resources for effective health program management Impact of prescription drugs: - Pharmacy benefit costs surged by 8.4% in 2023, shaping future cost trends - Ongoing developments in the pharmaceutical market driving long-term implications Affordability remains a priority: - Large employers avoiding cost shifts to employees through deductibles or OOP maximums - Providing diverse medical plan choices for varying financial needs Stay informed on the changing landscape of employer-sponsored health plans! https://lnkd.in/gu-P7hvX

Our healthcare system is broken in many ways, but there’s an ugly truth that is less talked about. Private health insurance is failing American workers. The prevalence of high-deductible health plans and ever-increasing out-of-pocket costs means that three-quarters of workers are worried about being able to afford the care they need. It’s making the “valued employees” of thousands of American businesses sicker. And when their health issues can’t be put off any longer, it costs the employee and employer more in the long run. If that doesn’t scream for disruption and a new approach, what does? Solving what’s wrong with private health insurance may seem impossible, but that’s precisely why it’s ripe for bold innovation, for those of us willing to push the boundaries for something better. Disruptors and entrepreneurs in multiple industries have shared that true innovation comes from challenging conventional wisdom and pursuing ideas that others deem impossible or too risky. You can’t simply copy or modify existing models to make meaningful changes. A groundbreaking idea must challenge the status quo to create something better. As a result, innovation often arises when daring to tackle what is considered unachievable. https://lnkd.in/dN4eayHy #healthcaresystems #healthcare #healthcareaccess #healthcareprofessionals #healthcareproviders #healthcareinnovations #healthcaretechnology #healthcareworkers #healthinsurance #technology #innovation #employee #employer