In New York State It May Be the Right Time to Outsource Your Leave Management Programs

Open Calendar

It’s a pretty big deal – New York State’s introduction of mandatory Paid Family Leave (PFL) coverage has made a mark on U.S. history and the state is now one of five in the country, plus the District of Columbia, to move ahead with these workers’ rights. Ironically, the United States – with all that it has… [Read More]

Extreme Healthcare Chaos

Stethoscope with American Flag Reflection on Wooden Table.

Turmoil by executive order again… On Thursday, President Trump threw two more giant logs on the raging healthcare marketplace fire by ordering the discontinuance of federal funding for cost-sharing subsides for low income Americans and by directing the Secretary of Labor to provide guidance on liberalizing association healthcare plan rules. Cost-sharing subsidies made healthcare affordable… [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]

Getting Creative in Combating Rising Specialty Drug Costs

Pills dollar symbol

High cost drugs are the most significant cost driver in healthcare today. Because of their therapeutic value (they cure illness), it is very difficult to manage the cost of these specialty medications. Prior approval, quantity limits and high cost-sharing have proven to be among the most effective utilization mechanisms. A study published in The Journal… [Read More]

Insurers and PBMs Taking Action on Opioid Abuse 

Opioid health risk and medical crisis with a prescription painkiller addiction epidemic concept as a group of people running away from a dangerous falling bridge of pills as a medicine addict problem with 3D illustration elements.

Pharmacy Benefit Mangers (PBMs), which run the drug plans for health insurers, are paid on the volume of drugs they sell and have been criticized for lack of transparency and focus on profits. Likewise, health insurers are generally focused on controlling claims costs and don’t fully consider the effects of their decisions to limit access… [Read More]

Insurance Carriers Reducing the Cost of Care

Man at the table fills in the form of health insurance. Healthcare concept. Vector illustration flat design style. Life planning. Claim form. Medical equipment, money, prescription medications.

This week I am attending the Cigna National Producer Advisory meeting. I am pleased to say that Cigna, as well as all the national insurance carriers, are busy moving forward the goal of reducing healthcare costs by aligning interests. Physicians will receive additional compensation if results establish quality care, a favorable member experience and affordability… [Read More]

2017 Kaiser Family Foundation Survey Results

medical cost, stethoscope on dollar banknote money. concept of health care costs, finance, health insurance fund.

Kaiser has just published its 2017 annual benefits survey and I think the folks in Washington, D.C. all need a copy. Approximately half of the United States’ non-elderly population gets healthcare coverage through their employer, so this survey reveals what many Americans are experiencing. While employer coverage is far better, in many respects, than the coverage… [Read More]

Healthcare Reform… More of the Same

Healthcare in the Trump Era Takes Its First Step

The Senate is making one last-gasp effort to repeal ACA… Well, not actually repeal, just reconfigure. Lindsey Graham and Bill Cassidy have sponsored a bill, which will be eligible for consideration under budget reconciliation rules (i.e. 51 votes required to pass and not subject to filibuster). Under the bill the amounts paid by the federal… [Read More]