Preventive Care that Actually Saves Money… Dental

Toothbrush and toothpaste in the bathroom close up.

Over the last two decades, the healthcare industry has tied itself in knots in order to validate the business case behind preventive medical care. And although preventive care services offer a variety of benefits – social and humanitarian, for example – the data seems almost conclusive that economics is not quite one of them. Too… [Read More]

Frustration of Fraudulent Claims

Folder with close up on the word claims and a note where it is written under investigation. Concept of insurance fraud, 3d Illustration

It’s a well-documented reality across nearly all lines of insurance coverage that fraudulent claims account for 5–10% of total claims processed. And despite the industry’s best efforts to combat fraudulent activity, it’s largely accepted as a “cost of doing business” in the world of insurance. What has frustrated several of my self-funded clients however, is… [Read More]

Are Drugs Cheaper Using Cash?

The concept of paid medicine with pills on a money background

This past weekend, a far-reaching exposé was published by the New York Times and ProPublica highlighting how, in many instances, individual members can save money paying cash when compared to using their insurance for their generic prescriptions. While this is not a new issue, the investigation reviewed the top one hundred prescribed medications, finding that 40% of the time… [Read More]

Why Employers Should Practice Medicine

Assorted Medical Insignias Logotypes Template Set. Line Art Vector Elements.

Every businessperson will tell you that the key to reducing costs in any industry vertical is by reducing the amount of friction in the transaction. Friction is created every time an additional party is brought to the transaction because that party will likely have its own profit incentive, thereby increasing the cost of the product… [Read More]

The Softening and Widening Stop Loss Market

Vintage processing of an open for business sign in small town America.

For the last several years, we’ve highlighted the dramatic market trend of employers adopting self-funding and the rationale supporting the move. As premium dollars have left the insured medical market, lots of those dollars have moved to the reinsurance markets with employers offloading the tail risk associated with their self-funded arrangements. Meeting the demand have… [Read More]

Anthem Gets Tough with Hospitals

Anthem Gets Tough with Hospitals2

One of the greatest frustrations our self-funded (and to a lesser extent, fully-insured) clients voice is that – despite the hundreds of thousands or millions of dollars they pay the insurers to assist in managing their health plan spend – too often it appears the insurers are complicit in the rising healthcare spend by not… [Read More]

Zombie Apocalypse: Health Insurer’s Tax

Zombie Apocalypse Health Insurers Tax

In 2014, fully-insured employer plans were greeted with a nasty surprise – the Health Insurance Providers Fee. The insured’s already massive healthcare costs were being further inflated 1.5–2% due to the new tax congress levied on insurers, which was based upon each carrier’s market share in the health insurance market. Of course that $8 billion… [Read More]

A Look Back at Private Exchanges

A Look Back at Private Exchanges

It’s been about 5 years since we posted our thoughts about the likely adoption of private exchanges. At the time, consultants and Wall Street analysts were touting these exchanges as the greatest innovation in employer benefits since 401(k)s. Many suggested that by 2018 more than 20%, and perhaps as many as 50%, of employers would… [Read More]

Decoding Network Disruption

Decoding Network Disruption

One of the most critical factors an employer considers when deciding to change medical (or dental) carriers is network disruption. And rightfully so. Improvement or deterioration in the network penetration rate can have a profound impact on the underpinnings of the program. First and foremost, members will be influenced by any change in network coverage…. [Read More]

Insurers’ Dark Secret: Shared Savings and Facility R&C

Insurers Dark Secret - Shared Savings and Facility R&C

If you ask any self-funded employer “how is your insurer making money given that you, the client, are paying the claims and taking the risk in lieu of traditional premium payments?” the majority would respond that the insurer’s profits must be in the administrative fee. If pharmacy is carved into the plan some would suggest… [Read More]