Author Archives: Reeve Conover

Future of Healthcare?

I watched the first Democratic debate last evening, and the section on healthcare very carefully. Clearly the intention of the Democratic party is generally to head towards single payor/socialized medicine.

Whether we end up there or not, forced Telemedicine may play a big role going forward. ” The internet makes it possible for specialists on the other side of the globe to participate in complex, delicate surgeries, as well as for surgeons to examine patients being treated by paramedics in an ambulance or on a living room floor. For the article click here.

Would you take unlimited 24/7 access to primary care doctors via smartphone, tablet or computer, with zero out-of-pocket co-pays, if it meant you’d have to pay a lot more money to see your regular doctor in person?”

Lets take this to the next level.

You’ve had a tennis accident and suspect the worst: a broken leg.

A telemedicine doctor-on-demand confirms your fears: You need to see a physician in person. From your phone, you nab an Uber Health ride (HIPAA-safe, affordable and reliable) covered by your CVS/Aetna health plan. 

At a state-of-the-art medical mall, the wait for an X-ray is short. You barely have time to pull out your iPhone and find your secure MyChart health records—data that are owned by you, but protected by blockchain.

Like clockwork, the radiologist’s report appears in the app, an orthopedist casts your leg and you schedule both your follow-up and physical therapy appointments then and there.

Sound like the faraway future? Think again. Healthcare is on the cusp of a technology revolution. Technology is primed to disrupt healthcare more explosively than it has any other industry.

Lower Drug Costs on High Deductible Health Plans

Today, the U.S. Department of the Treasury gave health insurers more flexibility to cover the cost of certain medications and tests for people with common chronic conditions who are enrolled in many high-deductible health plans.

The rule will allow those with HSAs attached to a High Deductible Health Plan (HDHP) to get some drugs covering chronic conditions such as asthma, diabetes, depression and high cholesterol before meeting their deductible.

For the full article click here.

House repeals ACA’s cadillac tax

Finally, this poorly conceived rules seems to be going away. Now for the senate. Click here for the full article.

Federal Judge Upholds Trump Short-term medical plans

A federal judge on Friday upheld the Trump administration’s expansion of health insurance plans that don’t meet ObamaCare’s coverage requirements. 

U.S. District Judge Richard Leon in Washington ruled against the insurance companies that sued the administration in an attempt to block the rules. 

“Not only is any potential negative impact from the 2018 rule minimal, but its benefits are undeniable,” Leon wrote about the regulations. 

The plans aims to “minimize the harm and expense” for individuals who might otherwise decide not to purchase insurance because of high premiums, Leon added. 

The Trump administration issued a regulation last year allowing short-term health care plans to last up to 12 months instead of three. These plans were originally intended as an option for individuals who need to bridge a gap in health insurance coverage. 

Reference Based pricing in action

When Pacific Steel & Recycling CFO Tim Culliton realized his 750 employees were paying too much for healthcare, he knew the company needed a new plan.

So instead of renewing their current fully funded insurance plan, the Great Falls, Montana-based company, fired their third party administrator and switched to a self-funded plan with a PPO network. They also decided to try reference-based pricing — a highly debated method among benefits advisers for curbing employer healthcare costs.

Working side-by-side with their adviser, Scott Haas of USI Insurance Services, the employer instituted a reference-based pricing strategy in January 2014. So far, the program has led to a reduction in the cost basis of medical claims, Haas says. The pair were able to lower the company’s annual health spend to $3.5 million from $8 million, a savings of about $5 million.

“We saw a significant increase in hospital charges,” Culliton says. “We saw a 400% increase in those costs … that caused us to begin to investigate a different payment process. That ultimately was the beginning of us moving to a reference-based pricing program.”

Reference-based pricing refers to pricing outside what is set by traditional insurance carriers. Provider reimbursement is based on a percentage of what Medicare would typically pay the provider which often ranges from 120% to 170% of Medicare reimbursement, according to Business Benefits Group.

Some employers have been using reference based pricing as a way to curb high healthcare costs. But not everyone is entirely convinced. In an interview with Employee Benefit News, Jake Frenz, CEO of the PBM SmithRx says implementing a reference-based pricing model may be easier said than done.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck