Reference-Based Pricing – Coming to a Health Plan Near You?

Man paying bill. Hand black line, holding receipt. Payment of utility, bank, restaurant. Concept business finance. Vector illustration flat minimal design. Report finance, invoice, expenses.

I think you are going to hear more about reference-based pricing. Some history: What stops a provider from charging whatever they want for care? Let’s say a doctor charges $200 to remove a splinter. If the patient were paying, she/he might try to negotiate the charge or get care elsewhere. But they are most often not. The… [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]

Your Employees are Enrolled in a CDHP…Now What?

Healthcare Cost  Medical  Health Coverage

Congratulations on a successful annual enrollment, especially if you introduced a high deductible health plan with a Health Savings Account (HSA) or moved more of your employees to a Consumer-Directed Health Plan (CDHP). That’s a big accomplishment, but your communication job is really just beginning. Here are five great ways to support your employees and help… [Read More]

Will the Cadillac Tax Change the Pay or Play Dynamic?


Last week, I spent a very long day in Washington DC with the National Association of Health Underwriters (NAHU) Principals Council talking about the ACA Excise (formerly “Cadillac”) Tax. Yes, this too, has been relabeled because the tax, as it is drafted, will be touching a lot more than the very richest plans that were… [Read More]

Preventive Service – Or Is It?


Most health insurance plans these days cover “preventive services” at 100% with no member liability. However, as a result of recent changes due to the ACA, there are some unexpected and unwelcomed billing surprises in store: tests and services that used to be covered as preventive may no longer be considered preventive by your insurance… [Read More]

Mid-Market Employers Adopting Multi-Year Cost Management Strategies


More and more mid-market employers (those with 200 – 3000 employees) who previously had been only talking about employing a multi-year strategy to manage their health plan are beginning to implement these changes. This is a fundamental break for many who traditionally managed their plans year-to-year hoping for the best, and for their brokers to… [Read More]

Healthcare Spending Growth Rate at Historic Low…At Least for Now


In an article published yesterday by CMS in the journal Health Affairs, it was reported that U.S. health spending—which is now at $2.9 trillion, or 17.4% of the economy—increased by 3.6% in 2013. That’s the lowest rate since 1960. Commercial health plan enrollment, which had shrunk by 11.2 million Americans due to the economic slowdown,… [Read More]