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Making Healthcare Costs Transparent
Feb 15, 2017   08:26 AM
by GM&A Corporate Healthcare Consultants

Making Healthcare Costs Transparent

From business to government to essential services like banking and healthcare, transparency is the name of the game in our current cultural climate. People crave honesty and uprightness from anyone or anything they are invested in, and understandably so. In healthcare, transparency is truly the future – but unfortunately, it’s only a rare few who understand and act upon that principle. When a healthcare consumer has no idea what services cost at his hospital or physicians group, it’s a dismal reality. All he knows is that he gets sick, he gets treated, and he hopes for the best.  

But in the health plan solution we offer, direct contracting, consumers get the exact opposite experience; in other words, they get the transparency they rightfully hope for as a healthcare consumer. That’s because their employer agrees with us upon a set of rates, and both sides are contractually bound to those rates. The employer, normally through its human resources department, makes it clear to the members of the plan what the costs are and we are openly communicating with all parties along the way.

From the healthcare consulting group (that’s us), to the human resources department, to company management and of course to the employees, we are all on the same page when it comes to healthcare costs; that’s the beauty of the direct contracting model. It’s an ecosystem that works really well for an organization that is trying to reduce healthcare costs while keeping the lines of communication open with its employees.

Now, we know what you might ask: “What if someone has an atypical situation with their healthcare?” Well, good news: If there are issues with an employee’s plan – say, there’s something strange, tricky or otherwise unusual about the care he requires for a condition – we are not afraid to get involved. We encourage employers to alert us in these situations, so we can intervene on their behalf to reduce costs for the employee. That’s a whole new layer of transparency, isn’t it?

For questions on reducing your organization’s health plan costs through the direct contracting healthcare model, contact GM&A today. We will be happy to provide you with more information. 

A Solution for the Obamacare Repeal
Feb 15, 2017   08:24 AM
by GM&A Corporate Healthcare Consultants

A Solution for the Obamacare Repeal

As we all know, Republicans on Capitol Hill are currently moving forward with long-anticipated plans for repealing and replacing the Affordable Care Act, more commonly known as Obamacare. Depending on who you listen to, this could mean 1) the end of the end for Americans who have health insurance through the individual Obamacare exchanges in their states, or a 2) new beginning for the Americans who were already covered by employer-sponsored health plans, but were angered over the rising premiums that private insurers have imposed over the past several years.

Which one is it?

So, which one is it? Maybe it’s a little bit of both – and maybe, just maybe, neither side has the answer. “The ACA made changes in every part of the health care system,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, of the Affordable Care Act. “Virtually everyone has been touched by the ACA.” That’s true – and that’s why changes to it could bring about changes that are both positive and negative.

What’s the Solution?

For employers who are struggling to make a decision about what health plan option should be implemented as our lawmakers overhaul the current government solution, we suggest direct contracting. Direct contracting is a private employer health plan solution that is tailor made for mid-sized to large organizations. It can be entirely customizable for an employers’ needs.

Here is just one example: If an employer wishes to continue covering part-time employees (employees who work 30 hours a week who were covered because of the Obamacare employer mandate), they can – and, they can do it more affordably by working with experts who know the healthcare market enough to help them hand-pick the providers in their network.

The Shopping Cart Method

Direct contracting allows employers to choose which aspects of the Affordable Care Act they want to keep. In addition to the employer mandate aspect of Obamacare, employers can choose other parts of the law they wish to retain – such as keeping children on their parents' health plans through age 26. Time has shown this to be one of the most popular provisions of Obamacare, and employers who recognize that are free to make it part of their customized corporate health plan if employee demand requires it. This is the “shopping cart” method of corporate health plans – keeping what you like, passing on what you don’t like – and it works.

Direct contracting can be a welcome solution for the repeal of Obamacare, and employers need to investigate it before a full repeal takes place. To learn more about direct contracting from a firm that provides it as a solution, contact GM&A to request a complimentary health plan consultation.   

Making the Fate of the ACA Irrelevant to You
Feb 15, 2017   08:21 AM
by GM&A Corporate Healthcare Consultants

Making the Fate of the ACA Irrelevant to You

With a new President, and now a new Secretary of Health and Human Services, we’re continuing to hear that the Affordable Care Act will be repealed and replaced – but, if you listen to the people with mouthpieces, “portions” of the act will be retained. Often, they’re speaking of the popular, consumer-friendly aspects of the law such as children staying on their parents’ plans until age 26, etc. But what about the less talked-about parts of the ACA? Here are some aspects of the ACA that lawmakers are considering the fate of:

  • Cost-sharing      subsidies, AKA the money that goes to insurers to help protect low-income      healthcare consumers from paying too much out of pocket
  • The      individual mandate, otherwise known as the ACA’s requirement that every      American obtain health insurance or face a tax penalty
  • Consumer      protections in the ACA, which are the portions of the legislation that      make it a bit too easy for Americans to game the system – in other words,      wait until they get sick or injured to sign up for a healthcare plan (and      on the flip side, make it too easy for them to cancel that plan once they      feel better)

Congress and the new administration has a lot to consider when it comes to repealing and replacing the ACA – but as a consumer, employer or human resources person tasked with deciding how you and those in your organization obtain healthcare, you can avoid having to worry about the fate of the act altogether. How? By finding a privately funded alternative to provide the healthcare coverage you need.

Direct contracting is a completely private solution to the healthcare coverage needs of individuals, public employers, private employers and even non-profit organizations. It can cover the people you’re responsible for affordably and easily, with less red tape and lower overhead costs for those in charge. This is the healthcare solution you’ve been waiting for. To learn more about direct contracting, contact GM&A Healthcare Consultants at (325) 224-3245. We will be glad to answer your questions!

New Year, New Health Plan
Feb 15, 2017   08:19 AM
by GM&A Corporate Healthcare Consultants

New Year, New Health Plan

Now that it’s 2016, we are getting inquires on getting started with direct contracting during the open enrollment period – and that’s a good thing, because the beginning of the year is the best time to inquire. Every healthcare program requires some time to implement, and direct contracting is no exception. The truth is, if a company is serious about getting started with direct contracting for its employer health plan, then everyone should be prepared for the timeline to be up to six months in duration, from start to finish. Keep in mind, the steps include:

Consultation: The first consult is an important appointment that provides the potential client with all the necessary information on the direct contracting healthcare model. If you are interested in being a client, you want to schedule your consultation as early in the new year as possible.

Analysis: Once the client is on board, we perform an analysis of the company’s healthcare data – namely, examining the number of employees and dependents requiring coverage and analyzing their past claims data. This is important because it helps us identify the most appropriate providers to approach with contract proposals.

RFP: Next, we enter the request for proposal (RFP) stage. This is when the right providers are identified and approached with proposals on contracting with your company; it is the stage where the actual healthcare services are secured.

Processing: We then obtain signatures and process the contracts with each provider, ensuring that they are legally binding contracts for the enrollment year.

Preparation: Finally, we prepare for open enrollment. This is a process that requires us to obtain the most up-to-date data on your employees and their dependents so we can get them enrolled during the eligibility period.

As you can see, it takes months to put a complete employer health plan program together. That’s why it is in every client’s best interests to begin the process at the beginning of the year. It’s not too late to inquire now, so we can begin creating and establishing your new company health plan. Contact GM&A to learn more today!

What Will a New HHS Secretary Mean for Your Company Health Plan?
Feb 15, 2017   08:16 AM
by GM&A Corporate Healthcare Consultants

What Will a New HHS Secretary Mean for Your Company Health Plan?

As those who are plugged in to current events may be aware, President-Elect Donald Trump has chosen an outspoken critic of the Affordable Care Act to be the next Secretary of Health and Human Services. Congressman Tom Price (R-GA) is an orthopedic surgeon who has his own decided positions on health care reform – positions that some say may “heal” the weakest parts of the Affordable Care Act.

What are those weak spots? Remember, the ACA will most likely account for $1.8 trillion in new spending over the next decade, while only covering approximately 31 million of the 48 million uninsured Americans. That was not necessarily by design, of course; it is mostly due to employers being forced to restructure due to the law, followed by the reality that around 9 million fewer Americans have enrolled in their state exchanges than the government anticipated. Meanwhile, median health insurance premiums have shot up 116% since 2012. Clearly, there is a lot about the ACA (Obamacare, for those who prefer the colloquial term) that needs to be reformed – so this new cabinet choice is intriguing. But will it be effective?

No one can say for sure, of course. And that’s why, no matter who is appointed to the new presidential cabinet and what their positions are when it comes to regulation and subsidies, companies still need to take the appropriate measures to protect their bottom lines and serve the employees who keep their operations working. For healthcare, one of the best ways to do this is with direct contracting, a model that involves implementing contracts with healthcare providers rather than insurance carriers. If a new HHS secretary ushers in big changes that make a positive impact for employers, that’s great – but for employers that have made smart choices for the health plans they offer, the benefits will be even greater. Learn more about it by calling GM&A at (325) 224-3245.

Obamacare Open Enrollment: Should You Sign Up?
Nov 20, 2016   08:00 AM
by GM&A Corporate Healthcare Consultants

Obamacare Open Enrollment: Should You Sign Up?

According to the Centers for Medicare and Medicaid Services, over 1 million Americans signed up for health insurance plans on the federal government’s HealthCare.gov platform during the first two weeks of this year’s open enrollment period. That includes 250,000 new Obamacare consumers and over 750,000 renewing their current Obamacare plans. With that in mind, should you enroll in your state’s Obamacare exchange this open enrollment period? That’s a decision only you can make for yourself, but what we can tell you is this: If you don’t have access to a health plan through your employer, Obamacare isn’t necessarily the only option you have for coverage. 

What if you could contract directly with healthcare providers, rather than worrying about the foibles of the mixing government subsidies with the health insurance industry altogether? It is possible, not just for employers but also for individuals in some cases – and direct contracting is what makes it possible. Direct contracting is a service that people can take advantage of if they are interested in exploring their options for healthcare coverage, not just to save costs, but also in order to gain more control over their own care. It can be especially useful for people who need to see specialists, or people who require ancillary healthcare supplies to support certain conditions: wheelchairs, shower chairs, walkers, etc. If you speak with a healthcare consultant who facilitates direct contracting services, you are under no obligation to proceed with contract negotiations – but you just might find yourself  excited about the money you can save.

To find out if you can cut your personal healthcare costs with direct contracting, contact GM&A Healthcare Consultants to request a complimentary consultation. You’re under no obligation to purchase; this can be an informative meeting to discuss your personal healthcare expenses and ways to address them. If Obamacare is something you’d rather avoid, then there’s no better time to make this appointment.  

Alternatives to Traditional Company Health Plans: Now’s the Time
Nov 15, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

Alternatives to Traditional Company Health Plans: Now’s the Time

 

As you know, a lot of changes have come about in our nation over recent days – leading to some volatility in the American stock market, global financial markets and of course, the public discourse. Meanwhile, employers and their human resources professionals still have organizations to run. They can’t afford to stop and reflect for too long; even in the eye of the storm, they have to keep moving forward. Of course, one of the most urgent matters on their agendas this time of year is wrapping up their duties for the annual open enrollment.

 

No matter what happens to be going on in government, there’s no time to waste when it comes to improving your organization’s employee benefits – chief among them, the company health plan. As you know, there’s a lot of talk that the incoming presidential administration wants to “repeal and replace” the Affordable Care Act; maybe it will happen, maybe it won’t. Maybe it will only partially happen. If you’re an employer, you can’t afford to stand by and wait to find out.  

 

Right now, before any sweeping changes are enacted, employers need to start looking into alternatives to save costs on their company health plans. For many of those employers, one of the most promising alternatives to traditional health plans will be direct contracting. Direct contracting is a service that is an alternative to traditional company health plans. It can bring about the money-saving changes your company plan needs without compromising on the care your employees receive. It sounds simple, because it is; all the best things are.

 

A winning campaign usually has a simple message, and ours is no exception: Corporate health plans are too expensive. With direct contracting, GM&A can help lower your company health plan costs while ensuring your employees receive uninterrupted care. If you’re interested in learning more, contact us to request a complimentary benefits consultation.      

Privatizing Single Payer Healthcare
Oct 20, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

Privatizing Single Payer Healthcare

There are less than two weeks until the presidential election, and the final debate included some discussion on healthcare – specifically, which candidate would “repeal and replace” the Affordable Care Act and which one would simply amend the existing law. Remember, though: If the existing law were to be altered, the result would still be some form of a single payer system that would cost taxpayers just as much money as the ACA already does (whether it’s in the form of higher premiums for covered individuals or higher taxes across the board). Meanwhile, repealing and replacing is not as easy as it sounds. Either way, America has a hard road ahead of itself when it comes to perfecting its healthcare system.

In the meantime, we urge employers to look at the private market healthcare solution we offer at GM&A. It is almost a form of single payer, only the “payer” is a private entity that simplifies processes, lowers costs and improves care – not a government bureaucracy that complicates, charges and delays.

Our method, direct contracting, gives employers the opportunity to affordably cover their employees with healthcare plans that make sense for the organization and everyone in it. It is designed to make it easier for employers to comply with the existing Affordable Care Act, while still helping them drive down costs. It even gives them the ability to create a customized network of providers in their local area, as opposed to subjecting them to only one or two providers to choose from. No presidential candidate can feasibly promise that to anyone, but a private entity can; GM&A can.

We have a message for employers throughout the United States: If you are tired of the political back-and-forth on healthcare, contact GM&A to request a no-obligation health plan consultation. We will be happy to speak with you!

HR Malpractice | Failing to Do Right by the Company Can Cost Everyone
Oct 14, 2016   07:30 AM
by GM&A Corporate Healthcare Consultants

HR Malpractice | Failing to Do Right by the Company Can Cost Everyone

Everyone knows what the term “malpractice” means when it comes to the healthcare industry. But what about other fields – like human resources, for example? It is entirely possible to commit malpractice in a field like that, specifically if the HR administrator is failing to carry out due diligence to find services that are in the company’s best interests – and, the interests of the employees who are receiving those services. A perfect example of this is failing to make sure the company is paying for the most affordable and effective healthcare plans possible.

Why would an HR person do this? Often, the HR administrator works directly with a broker on setting up the company healthcare plan – and often, that broker is tied firmly to an insurance company. There’s nothing inherently wrong with that, but for the fact that the specific insurance company the broker is affiliated with will be sure to incentivize him heavily for getting them business. That means, of course, that the broker may recommend insurance carriers that:

  • Charge more than the company can      afford
  • Don’t offer all the coverage options      the company needs
  • Don’t have enough providers in the      company’s local area

…but the HR administrator will only know that if he or she carries out due diligence to find out what the specific insurance carrier can provide. If all the HR department does is meet with a broker, look at a single insurance carrier and negotiate for the lowest rates before signing on the dotted line on behalf of an entire company – well, that’s hardly in the best interest of the company or its employees. Failing to save the company money, failing to make sure employees get the right coverage…that’s HR malpractice.

Now, compare that to the experience of working with a healthcare consultant that is not tied to any specific insurance carrier. At GM&A, we give the HR administrators we consult the opportunity to reduce costs for the companies they work for by forming their own customized healthcare networks. The providers are in the company’s local area, and the plans are set up to cover the needs of the company based on its employees’ own past claims. And on a regular basis, we perform audits of our clients’ cases to make sure no one is being overbilled for care an employee receives. We don’t just help companies get set up with a healthcare plan; we also help them manage it.

Thinking outside the box takes some courage in any field, including human resources. Rather than committing HR malpractice, we at GM&A hope that HR professionals will keep an open mind and consider meeting with us to see what we can do for them. Contact GM&A at (325) 224-3245 to request more information or schedule a complimentary appointment at your location. We service employers throughout the United States.

Aetna Pulls out of Obamacare – What it Means for the Future
Aug 23, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Aetna Pulls out of Obamacare – What it Means for the Future 

As you may have heard, the large insurance provider Aetna is the latest insurer to announce that it is pulling out of several Affordable Care Act state healthcare exchanges. Aetna withdrew from 11 states last week, leaving approximately 167,600 patients without healthcare coverage – many of them in rural areas where access to care was already compromised. In fact, Aetna’s decision has created another fascinatingly gloomy development: Pinal County, Arizona, has just become the first county in the nation to have no Affordable Care Act providers. Which county will be next? We are all but certain that more will follow.

Once again, we see that the Affordable Care Act is doing precisely the opposite of what it was designed to. It was implemented to give Americans healthcare coverage, and yet because of the costly impact it has on insurers and employers, the ACA is actually taking coverage away. If you thought we needed healthcare reform prior to 2009, look at the extent to which we need reform now. As you may know, we at GM&A Healthcare Consultants believe the path to that reform is our direct contracting health plan model.

When healthcare providers (not insurance companies, and certainly not government-implemented exchanges) compete for the business of employers who provide employee benefits, everyone wins. The employer wins by saving money, the employee wins by getting outstanding coverage from local providers that were chosen specifically for their network, and providers win because they get paid quickly and fairly. Direct contracting can and should be the future of American healthcare. It’s time to get on board this train now, because if the news about Aetna is any indication, the Affordable Care Act catastrophe is only posed to get worse.

Large Employers: Start Planning for 2018 (Yes, 2018!)
Aug 08, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Large Employers: Start Planning for 2018 (Yes, 2018!)

When you’re a large employer of 1,000 employees or more and you’re interested in finding a new company health plan that can help your organization’s bottom line, you can’t afford to delay the process. If the goal is to offer a new plan in time for open enrollment of the next year, there’s bad news: Believe it or not, you’re already behind.  

In our experience, too many companies are unaware how long the process of transitioning to a new company health plan can be. While some employers are still considering their options for 2017, the reality is that it’s already time to start planning for 2018. Yes, 2018!

Too Late for 2017?

Does that mean it’s too late to develop a new company health plan for 2017? It may very well be, but you’ll never until you speak with a corporate healthcare consultant who can advise you. GM&A is a corporate healthcare consulting group that can provide an alternative way of reducing costs to your company health plan; we call that alternative method direct contracting, and it’s one of the simplest (yet most effective) health plan models you’ll ever encounter.

Regardless, industry limitations being what they are means that it takes us multiple months to put a direct contracting plan together for a large employer client. We have to meet with you, look at your company health care claims data and then begin putting a plan together that can be incorporated before the final stage, open enrollment.

What’s the First Step?

It may be too late for 2017, but you’ll only know after you ask – and if it is, then the time to start the process for 2018 is now. Contact GM&A Healthcare Consultants to request a complimentary health plan meeting, at your location anywhere in the U.S., for the decision makers in your organization. We will be glad to show you what direct contracting can do for your company! 

Covered California Raises Premiums – And it isn’t the Only One
Jul 23, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Covered California Raises Premiums – And it isn’t the Only One

Have you heard the latest news on Covered California? Last week, news broke that

California's health insurance exchange will increase its premiums by anywhere from 13 to 17 percent by 2017. This is all thanks to two major insurance companies requesting substantial rate increases from the program: Anthem, which requested a 17 percent increase, and Blue Shield, which is seeking a 20 percent increase.

These premium increases will impact a whopping 1.4 million Californians who currently receive healthcare coverage under the Covered California plan. The good news is, the proposed rate hikes are still subject to review by state regulators. The better news is, consumers can choose not to participate by seeking healthcare alternatives.

Although we primarily work with businesses to provide lower cost coverage to employees, GM&A Healthcare Consultants can also work with consumers who are tired of the rising costs of insuring themselves –not just consumers who insure themselves with a PPO, but also consumers who participate in a state exchange 

Other State Exchanges with Rising Premiums

Although Covered California seems to be getting the bulk of the media coverage when it comes to state exchanges with rising premiums, it isn’t the only state exchange to do so. Take a look at these startling rate increase projections from around the U.S.:

  • Alaska: 9.8 percent rate increase
  • Washington State: 13 percent rate increase
  • New Mexico: 25 percent rate increase


Can you believe it? So no matter where in the country you are: If you rely on a state exchange for your healthcare coverage, expect to see the amount you pay for that coverage to start rising.

What if you’re an employer?

What if you aren’t an employee, but rather an employer that has thus far been unable to cover employees? If so, it’s time to give them a better way than the state exchange. GM&A can help you provide them affordable, high quality coverage with direct contracting. That way, you’ll never lose another employee to a company that provides healthcare benefits! They can stay at your place of business, because you will provide them the coverage they need – all at a cost that is affordable for you.

We were among the many healthcare experts who predicted this would happen in the early days of the Affordable Care Act – and finally, everyone is waking up to the fact that the Affordable Care Act isn’t so affordable after all. There’s a better, more affordable way for employers and employees, and that way is directly contracting with healthcare providers. Ask GM&A for more information!

Reducing Health Plan Costs in Risky Government Jobs
Jul 08, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Reducing Health Plan Costs in Risky Government Jobs

City, county and state governments tend to get a bad rap as employers sometimes, thanks to the incorrect notions some ascribe to – you know, the mischaracterizations that government jobs are for “lazy” people. These generalities are unfair to not only the brave law enforcement officers, firefighters and emergency workers who put their lives on the line every day, but also the highly skilled professionals like city landscapers, equipment handlers and maintenance people who work for their municipalities – people who put their bodies at risk for the local government job they do.

When one of these workers gets injured in the line of duty – be it through a tragic gunshot wound, an unfortunate equipment accident, a fire, an explosion, a vehicle crash or any other various possibilities – that employee automatically becomes an emergency patient that needs both immediate and ongoing treatment. The medical costs of surgery, therapy and follow-up visits for the injured employee can be staggering, and the employer is obligated to pick up the tab. With that in mind, we at GM&A Corporate Healthcare Consultants want to make sure local governments know that direct contracting can help them save on these costs immediately, if they switch their health plans to our cost-effective model of coverage.

Local government employers, from police departments and fire departments to landscape and maintenance departments and more, can take advantage of direct contracting to reduce the costs of covering employees in these high risk fields. Contact GM&A today to find out more; we are happy to meet with local government employers throughout the United States who may be interested in learning how to cover their valuable employees with quality health plans for less money.

Covering Employees with a Pre-Existing Condition – For Less
Jun 22, 2016   07:45 AM
by GM&A Corporate Healthcare Consultants

Covering Employees with a Pre-Existing Condition – For Less

We are sometimes asked by employers whether we can do anything to help them offset the cost of covering an employee with a pre-existing medical condition. The answer is yes, we can – by helping the organization switch to the direct contracting health plan model. Here are some of the pre-existing conditions we are referring to:

  • Diabetes, which affects 9.3% of      Americans
  • Asthma, which affects 25 million      people or 8% of Americans
  • Heart disease, which is the leading      cause of death for both men and women
  • Cancer (37% of cancer survivors make      a work adjustment, but many remain employed)

Taking all of this into account, it makes sense for employers to find ways to cover valuable employees for less when they are affected by a pre-existing condition. Here’s how direct contracting can help.

In cases like these, GM&A acts a broker that negotiates lower rates with the providers that the affected employees rely on. Whether it’s an oncology practice, a hospital with outstanding cancer treatment or a heart specialist, we can work with them on lowering costs so they can remain part of your network – but at a rate you can afford as a benefits provider. Then, your talented employees can be covered affordably and you’ll no longer be inclined to find their conditions “expensive.” This is just another way that direct contracting can be incredibly valuable for an organization, whether it is a private or public employer.

To learn more, contact GM&A to request a complimentary health plan “checkup.” This is a free phone appointment – or in person, for large employers – that outlines all the benefits of switching your health plan to our direct contracting service. We can be reached at (325) 224-3245.

Corporate Wellness Plans: Worth the Cost?
Jun 14, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Corporate Wellness Plans: Worth the Cost?

Corporate wellness programs seem like the thing to do when you’re an up-and-coming company striving to create a reputation of being that progressive employer everyone wants to work for. These programs certainly look good at first glance; after all, they foster camaraderie among employees who participate and encourage staff members to work towards their short and long-term health goals. But do they really make sense for the employer?

The human resources experts we talk to tell us that the big myth about corporate wellness programs is that they boost employee retention. “They really don’t,” one expert said recently. “When you consider how frequently today’s young professionals move from job to job, pouring resources into a company wellness program is hardly worth the investment.” And older employees? “They don’t always value these programs either,” the expert told us. “They tend to be more self-conscious about their wellness goals and would prefer to work on those things privately. Older professionals are very guarded about their personal lives now, especially when they’re new to a company.”

So no, corporate wellness programs don’t actually help companies retain employees. But do they save employers money? As corporate health plan experts, we have found the answer to be no. Companies that implement these programs spend more money on them than they’re worth: incentivizing employees with cash bonuses, gadgets and even vacations. Then there’s the loss in productivity that comes from employees sneaking in longer lunches for group walks, holding scheduled meetings to discuss their weight loss efforts, etc. It’s a slippery slope that many employers regret stepping on in the first place.

What we have found will save employers money on covering their employees, though, is the direct contracting healthcare model. By directly contracting with medical providers, employers can save up to 30% a year on healthcare costs. Letting the employees be in charge of their own health and using your resources to improve their coverage is a win-win. To learn more, contact GM&A at (325) 224-3245 for a free health plan consultation.

Why Public Employers Need Direct Contracting Health Plans
May 25, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Why Public Employers Need Direct Contracting Health Plans

Self-insured healthcare plans are a popular option for public agencies that need to cover employees, but wish to avoid working with a third-party administrator. In fact, the state of California counts 2.2 million public workers that are covered by self-funded insurance policies. And on a smaller scale, 3,579 California public agencies self-insure their worker’s compensation liabilities. You know the saying: As California goes, so goes the nation. If that’s true, then self-funded health plans are where the nation’s public employers are going.

As we have previously explained, Kaiser Permanente has released studies that show self-funded healthcare plans can save employers up to $700 per member per year. That’s an incredible savings for a large employer – specifically for a public agency, where hundreds of people may be on the payroll and the agency is obligated to monitor costs because of oversight and taxpayer concerns.

But while these self-insured health plans can be great, there are ways to make them even better. One of those ways is with the direct contracting health plan model. When there is a contract in place directly with the healthcare provider, employers have access to discussions with providers that just aren’t available in a traditional insurance model. In short, it’s easier to find out what you’re paying for and how much you’re paying for it because providers have a direct relationship with you – the employer. Not the insurance company, not a third-party administrator…but the agency that it is providing healthcare services to. In public sectors, that’s crucial – because as any public employer knows, the public is always paying attention to where the money goes.

Public employers that take advantage of both self-funded health plans and direct contracting simultaneously enjoy a more transparent relationship with healthcare providers. There’s less red tape, fewer layers of bureaucracy – in fact, there is little to no bureaucracy at all. Direct contracting is simple healthcare coverage, the way things should be. To learn more, contact GM&A for a free health plan checkup. We will be glad to explain more to you.

Direct Contracting: A Completely New Payment System in Healthcare
May 24, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting: A Completely New Payment System in Healthcare

By now, many of us realize that the Affordable Care Act was simply a bandage applied to a healthcare coverage system that was already spiraling into failure. For all the work that was done in Washington, D.C. to pass it in 2009, the ACA was really nothing more than a “best we can do right now” initiative. In states like Colorado and Oregon, residents are torn between supporting proposed legislation that would allegedly cover everyone vs. deciding that the universal healthcare model at the federal level - the ACA, also known as Obamacare - is simply not working, and therefore it would not work at the state level either.

Maybe that’s the reason why many healthcare experts are currently advocating for a completely new payment system. They don’t always offer specifics, though, and that’s where we come in. GM&A has over a decade of success with the direct contracting system, an innovative healthcare payment model that always ensures the two most important healthcare goals are accomplished: 1.) patients get covered, and 2.) providers get paid. It’s not insurance, but it complements insurance services so that providers are paid upfront rather than reimbursed (unless a different customized plan is chosen; there are numerous options for health plan customization). It’s not government subsidized, but it is a system that employers can use to meet their newfound Obamacare obligations for covering employees while still remaining profitable.

Unlike the ACA, direct contracting gets the job done. It’s not a bandage; it’s a solution. It’s the “completely new payment system” that healthcare experts are advocating for. To learn more, contact GM&A to request a complimentary health plan consultation (also known as a health plan checkup). We will be glad to speak with you.

Single-Payer in Colorado? Subsidies vs. Direct Contracting
May 12, 2016   11:11 AM
by GM&A Corporate Healthcare Consultants

Single-Payer in Colorado? Subsidies vs. Direct Contracting

Voters in the state of Colorado will vote this November on a proposed amendment to the state’s constitution – one that would make Colorado the second state to complete its attempt at a single-payer, state-subsidized healthcare system. The proposed system, “Colorado Care,” would be operated solely by the state’s government and funded by its taxpayers.

The fiscal impact of such an endeavor, if it were to pass into law? Colorado Care would increase the state income tax to 14.63 percent, which includes a 6.67 percent tax on the total payroll of all employers and a 3.33 payroll tax on employees – and, an increase that is exempt from Colorado’s Taxpayer’s Bill of Rights law (in other words, residents would not be given the opportunity to approve any future tax increases related to Colorado Care that would inevitably incur). And if an (unlikely) surplus ever accumulated, taxpayers would not receive a refund.

Sounds like a raw deal for the residents of Colorado.

In fact, Vermont’s single-payer healthcare model is already showing signs of unsustainability. The state’s Green Mountain Care program already needs an additional $1.6 billion in new revenues to keep it going, and that’s just for a single year.

And we haven’t even begun to touch on the manner in which Colorado Care would seriously compromise the quality of healthcare in the state. At the state level, the best doctors will leave the Colorado in favor of states where they stand a chance of getting paid. It’s happening in Vermont now. At the federal level, Obamacare is setting America on a slippery slope course toward care healthcare rationing – and counties like Canada have been there for years. Single-payer systems don’t work when the single payer is the government; history has proven it.

A much better alternative is the direct contracting model, which involves private businesses employers or a local government agency employer such as school districts, cities and counties directly contracting with healthcare providers as part of their employee benefit packages. This isn’t single-payer; the employee will contribute, just as employees do in traditional coverage models. Regardless, it’s a far superior model to single-payer subsidies: better care, immediate cost adjustments when savings can be achieved, and of course, endless plan customizations. Which option sounds better to you? To learn more, contact GM&A for a free healthcare consultation.

Private Exchanges vs. Direct Contracting
Apr 25, 2016   12:07 PM
by GM&A Corporate Healthcare Consultants

Private Exchanges vs. Direct Contracting

Private exchanges have become a hot ticket in healthcare over the past few years, thanks to the Affordable Care Act making the “exchange” a household word. Unlike the ACA’s public exchanges, a private exchange is owned and managed by a private entity rather than a government agency. It is essentially a marketplace for selling healthcare plans; when an employer joins a private exchange, employees choose from the handful of insurance carriers that are authorized to participate. Employees may also be able to purchase extra coverage in a private exchange, including:

  • Disability coverage
  • Supplemental plans
  • Long-term care insurance

The idea behind private exchanges is that they offer lower healthcare costs to the employer because they are set up to include defined contributions. They also are supposed to have fewer administration costs than traditional employer-sponsored plans; administrators are typically insurance agencies, private healthcare consultants or (in the case of self-insured employers) third-party administrators. And of course, proponents of the private exchange model say that they offer employees more health insurance options than other benefits models.

It sounds great, doesn’t it? But we have an even better option.

When it comes to top-notch healthcare benefits, direct contracting has all of these things and more. While most employers are still waiting to find out if they are saving any money by switching to a private exchange, GM&A is showing employers how they can start saving by 30% or more immediately by switching to direct contracting. We are also able to show employers that direct contracting offers truly consumer-driven care, because the private networks we form for our clients uses the claims data of the company’s own employees. It’s the best form of customized coverage available.

While private exchanges only hit the scene in 2009, GM&A has been providing direct contracting services for over a decade – so we have a proven model that employers can trust for the long-term. To learn more, contact us for a free health plan analysis.

Lowering Per-Member-Per-Month Healthcare Costs
Apr 21, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Lowering Per-Member-Per-Month Healthcare Costs

Employers: When was the last time you thought about how much you pay every month to cover your employees? Here’s a slice of truth that might be hard to swallow: In 2015, U.S. employers paid an average of $486 per month for each covered employee. If you cover 10 employees, that’s $4,860 per month; if you cover 100 employees (as many of the companies that contact us for a health plan analysis do), that’s $48,600 per month. Staggering, isn’t it?

One of the questions we may hear from someone who sees that data is, “But that’s just the national average, right? The cost must be lower in my state.” Not necessarily. In the state of Texas, the per-member-per-month average is $478 per month – just $8 less than the national average. To find the average per-member-per-month cost figure for your state, use the Kaiser Family Foundation calculator – and prepare to be shocked at how much you are paying per month to cover each individual employee.

Now, here’s the good news: You don’t have to pay that much! With GM&A’s direct contracting health plan service, you can pay an average of $260 per-member-per-month. That’s it! Multiply that by your number of covered employees and see if you like that figure better!

Direct contracting slashes the per-member-per-month cost of covering employees by at least 30%, and it offers employers a customized network of providers that meet the needs of employees. This is the best possible way to insure your workforce with affordable healthcare. To start paying less now – per employee, per month, all year long – contact GM&A to request a free health plan analysis. We look forward to showing you more!

As Insurers Pull out of Exchanges; Obamacare Alternative
Apr 18, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

As Insurers Pull out of Exchanges, an Obamacare Alternative

Here’s yet another aspect of the Affordable Care Act (ACA) that the federal government didn’t account for: the financial sustainability of the state exchanges. As major media outlets have reported, health insurance companies are warning are losing money so quickly from their participation in the Obamacare exchanges that they are compelled to pull out.

The most prominent example took place in April 2016, when United Health Group – the largest health insurer in the United States – announced that it will be withdrawing from the Obamacare exchanges in most states. Following United Health’s lead, other insurers are saying they may need to follow suit.

What the Experts Say

When the Kaiser Family Foundation speaks, we in the healthcare consulting community listen. Here’s what the foundation has to say about the sustainability of the Obamacare exchanges. “Something has to give,” said Larry Levitt, an ACA expert at the Kaiser Family Foundation. “Either insurers will drop out or insurers will raise premiums.” But even if those premiums increase in 2017, there’s no guarantee that the insurers will recoup their losses; plus, patients will be inevitably forced to change doctors (there’s no “you can keep your doctor, you can keep your plan” in this scenario). And if the insurers drop out of Obamacare, there is virtually no possibility that the exchanges will sustain themselves.

Not coincidentally, United Health pulled out of Obamacare exchanges the day after the Kaiser Family Foundation analysis report. In order for insurance companies to remain profitable, there is no way they can participate in the Obamacare state exchanges for the long-term. Clearly, there is a deep need for an Obamacare alternative.

Other Serious Problems

Of course, the Affordable Care Act is only compulsory for those who are not covered by an employer or individual health plan. According to a March 2016 Blue Cross/Blue Shield Association report, new ACA/Obamacare enrollees have 22% higher medical costs than those covered by employer health plans. That said, it is still preferable to have coverage from one’s employer – but as employers know, covering employees comes with all kinds of caveats in the Obamacare era.

A Real Obamacare Alternative

The only viable way for employers to avoid the burdens imposed on them by the Affordable Care Act is to seek out an alternative solution like direct contracting. Direct contracting is a healthcare model that gives employers an affordable way to cover their employees, while giving employees a customized network of providers to choose from. This is the best Obamacare alternative there is. Contact GM&A to request a free health plan analysis; we will be glad to tell you more.  

A Free Healthcare Seminar for Employers!
Apr 15, 2016   02:30 PM
by GM&A Corporate Healthcare Consultants

A Free Healthcare Seminar for Employers!

We at GM&A are excited to announce a limited time offer to large scale employers. As healthcare consultants specializing in direct contracting - a service that can save employers up to 30% per year in healthcare costs, and one that delivers better care services to employees as patients - we are launching an offer to present a complimentary educational seminar, onsite at the location of any large employer that is interested.

If you are a decision-maker at a large employer, public or private, the GM&A team will fly to any location in the U.S. to provide this free seminar to your employees. We feel it is a valuable thing to offer not only your executives, management and HR, but your entire company - all employees. Why? Because the employer health plan affects all employees!

During this complimentary presentation, your organization can learn:

  • Why traditional health insurance and health plan models are phasing out
  • Why direct contracting is the healthcare delivery model of the future
  • How GM&A’s proprietary software can use the claims information of an organization's employees to analyze what the parameters of your coverage should be - and, how that can save the employer money
  • What healthcare services may not be covered by your current plan - but can be covered in a direct contracting plan

As stated, this is a complimentary seminar that can be highly valuable for any large employer interested in saving money while still delivering a high quality employer-sponsored health plan to employees.

Best of all, there is no obligation; we are happy to present to you with no commitment required on your part. We understand that employers may look at a variety of options, and we are just one piece of the puzzle. That’s why we would like the opportunity to present to you, follow up with you to answer your questions and let you tell us how we can best meet your needs. Contact GM&A today to learn more! We can be reached at (325) 224-3245.

What is a Health Plan Checkup?
Apr 01, 2016   02:30 PM
by GM&A Corporate Healthcare Consultants

What is a Health Plan Checkup?

Believe it or not, it isn’t an exam in your physician’s office. It’s an entirely different kind of checkup – more of an analysis, really. And, to make a more important point: It’s designed primarily for employers who provide health insurance to employees and self-insured individuals.

A periodic health plan checkup is an analysis of your current health plan, whether it’s the plan you provide for your employees or the plan you insure for yourself and your family. More often than not, it’s self-insured employers who will need this type of analysis. During this appointment, we will help you:

  • Analyze new trends for insurers and providers
  • Make informed projections about the future
  • Identify ways you can save more money on your health plan

Think this is a waste of time? Think again! On any service that requires a large investment, you should want to sit down and analyze where the money is being spent, in addition to examining ways to save more money in the coming year. Some employers wait until the open enrollment period to do this, but in reality, a health plan checkup can happen any time of year.

For instance, school district employers may want to do their health plan check up now before the end of the school year – in time to make any necessary adjustments before breaking for summer. That way, there can be a fresh start when school picks back up in the fall. For any business that slows down in the summer, now is a great time to schedule a health plan checkup so that things are squared away before you start thinking about vacations.

Last of all, employers and individuals who still haven’t taken advantage of direct contracting can make their appointments for health plan checkups. To make an appointment for your health plan check up, contact GM&A. No matter what your current health plan is, we will be glad to examine it and identify ways where you can save money by directly contracting with healthcare providers.

Direct Contracting in Healthcare | Real Value for Employers
Mar 24, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting in Healthcare | Real Value for Employers

Direct contracting is not a "new" healthcare service; at GM&A, we’ve been doing it since 1999. But for a variety of reasons, mainstream HMOs and PPOs continue to be the default organizations for servicing corporate health plans. One of those reasons, we believe, is recognition. If the decision makers at a given employer have never heard about the concept of establishing direct contracts with healthcare providers, they may be inclined to reject looking into it any further when someone brings it to their attention. A common, instinctive reaction is, "If direct contracting so great, why isn’t everyone doing it?"

We understand that – and the truth is, we don’t want every employer to do it. If they did, then providers might not be as willing to negotiate with us on behalf of our clients. A healthcare provider’s willingness to contract with our clients for deeply discounted services is dependent on direct contracting staying out of the mainstream. It’s the law of supply and demand: If there is enormous demand for direct contracting and it eventually becomes the norm, providers will respond to the demand by raising prices – just because they can. It happened with HMOs, and it can happen to direct contracting if the service begins to permeate the healthcare marketplace.

The good news for employers is that direct contracting is still a valuable, niche service that can save them an enormous amount of money. At GM&A, our research shows that our clients’ healthcare costs reduce by an average of 30% by switching to a health plan that relies on direct contracts. That isn’t the only benefit; direct contracting healthcare services also allow employers to have the valuable cost and performance discussions that just aren’t possible when going the "traditional" health plan route. If an employer wants to know why a healthcare claim was filed by a specific employee, that information is obtainable when there is a direct contracting relationship.

An employer that wants to see hard data on its employees’ health claims isn’t going to get it with a traditional plan; with direct contracting, though, virtually anything is possible. Acting as a broker between provider and employer, GM&A can request the facts and figures the employer needs to make practical, cost-conscious health plan decisions. It’s real value that no other type of health plan provides.

Political Candidates and Healthcare | Who’s Best for Your Corporate Health Plan Costs?
Mar 21, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Political Candidates and Healthcare | Who’s Best for Your Corporate Health Plan Costs?

One of the biggest misconceptions we have heard from potential clients lately is the idea that one political party or the other can "save" them from healthcare cost ruin. If you’re a CEO, CFO or HR professional, we want you to hear this: It really doesn’t matter who wins the election this year when it comes to saving money on your company’s health plan. No matter what anyone says, none of the candidates would have any control as President over the rising costs of healthcare. Was there something to be done about it before the Affordable Care Act? To an extent, yes. But now, what’s done is done. Repealing the ACA, if that were to happen (which is unlikely), would not bring about the sweeping healthcare cost changes that politicians promise it would. It’s just too late for that now.

Here’s what can be done, though, no matter who wins the election. You, as a corporate leader, can implement a company health plan model that saves money year after year. It’s called direct contracting, and it’s the only guaranteed way to reduce your current health care expenditures by 30%. By contracting directly with physicians, hospitals and other providers, you can save substantially on your company health plan while keeping the coverage in place for your employees.

There’s a lot to worry about in an election season – but your company health plan costs shouldn’t be one of those things. No matter what party you’re a member, you can remove healthcare costs from your list of reasons to vote for any particular candidate because it’s all the same. What isn’t the same is direct contracting. It’s a service that can save companies on their healthcare costs time and time again.

The Freedom of Owning Your Healthcare Network
Mar 09, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

The Freedom of Owning Your Healthcare Network

As we see it, one of the most appealing benefits of direct contracting is the flexibility it offers. It comes down to owning your own network, which is exactly what our clients do when they choose the direct contracting healthcare management model. Just as owning your own home or business has its benefits, owning your own healthcare network does too – and secondary to cost, the greatest advantage is the flexibility.

As your direct contracting healthcare consultants, we are entirely different than an insurance company (the healthcare network model you may be used to dealing with). For example, if you need to make a change to the plan – virtually any change – then we can do it, any time of the year. We don’t have to wait until, say, a Blue Cross, Blue Shield or other insurance contract expires. Because you are contracting directly with providers, that gives you the say about your company health plan!

From directors to managers to the human resources department, that benefits administrators greatly – and those benefits will quickly trickle down to the employees covered by the plan. Think about it: If there’s a popular doctor the employees would like to add, you can do that for them immediately. This is just another way direct contracting helps with your benefits package and employee retention. When you own your own network, it just makes life easier for everyone involved.

And of course, the cost benefit to the company can’t be underestimated here. If we find a way to save your company money in the middle of the year – anytime of the year at all – we can make that change right away so you can start saving right away. We don’t have to wait for the end of the year, open enrollment or any other milestone. That’s the freedom that owning your own network offers, and it’s only available with direct contracting. Have questions? Call GM&A today; we will be glad to answer them!

ACA Compliance for Colleges and Universities
Feb 16, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

ACA Compliance for Colleges and Universities

These days, everyone’s talking about the push for more affordable tuition, student loan forgiveness and other breaks for college students – but what about the healthcare coverage concerns of higher education? The good news for college students is that their institutions may offer student health insurance, which typically involves the school paying at least some of the premiums for them. The bad news? Colleges and universities face some real issues when it comes to complying with the Affordable Care Act, not the least of which is the new red tape involved with administering student health plans.

For students who work for the school, it gets even more complicated because the premium reduction arrangement that comes with the student health plan is considered an employer payment plan (EPP) – and that’s a violation of the Affordable Care Act. Why? In short, the government doesn’t want college and university employees participating in student health plans because it is viewed as a form of insurance coverage "double dipping."

ACA Compliance for Colleges | A New Grace Period

In fact, this has become such a concern that as recently as February 5, three federal agencies (the Department of Labor, the Treasury Department and the Department of Health and Human Services) released Notice 2016-17: a federal provision of temporary transitional relief specifically for student health plans that offer premium reduction arrangements for school employees. The provision states that for plan years beginning before January 1, 2017, school employees who participate in student health plans with premium reductions will not receive a penalty. The idea is to give students time to make alternative arrangements and bring their plans into ACA compliance.

Avoiding Penalties for ACA Non-Compliance

For colleges that fail to comply during this grace period, there will be an excise tax of $100 per day, and that’s for each affected employee. If numerous students are employed by the school, those fees can add up quickly!

For colleges and universities that employ students, this issue must be addressed immediately. School administrators are encouraged to contact GM&A to inquire about ACA compliance for colleges now. We can help you determine the best course of action to get in compliance with the ACA and help you avoid stiff government penalties.

Zika Virus in Texas: New Consequences Emerge - Can the Zika Virus in Texas Raise Healthcare Costs?
Feb 09, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Zika Virus in Texas: New Consequences Emerge 

Another week, another barrage of media coverage on the Zika virus – but today, we want to present another side of the story that some people may not have considered: the economic impact of Zika here in the United States, specifically when it comes to healthcare.

As you may be aware, the Zika virus starts with symptoms that are not unlike some other commonplace illnesses: fever, rash, joint pain and conjunctivitis (pink eye). But if a woman affected by Zika virus is pregnant or becomes pregnant, the virus can cause a birth defect called microcephaly, a serious defect of the brain. The effects on the patient’s child include brain damage, unusually small head size and other irreversible developmental consequences.

For the adults transmitting it, the Zika virus has short-term effects – but for any children conceived during the transmission, the damage is permanent.

Can the Zika Virus in Texas Raise Healthcare Costs?

Now, there have sadly been three cases of Zika virus confirmed in Texas. This is not media hype: Officials have confirmed that the third case of the Zika virus was confirmed in Dallas County on February 10. The first was reported on February 2, when Dallas County Health and Human Services reported the first case of sexual transmission of Zika in the county (Zika is an insect-borne disease, but may be sexually transmitted as well).

So today, the Zika virus is not just a South American problem; it is a global problem that American employers have to be prepared to address in their corporate health plans. Make no mistake, it will affect American health plans. As was the case when West Nile virus became a concern in parts of the U.S., health insurers in areas where the disease is present may raise their rates to address the emergency. It’s just one more thing for employers to think about as they examine their healthcare costs and make decisions about the way they will cover employees.

If you are in an area affected by the Zika virus (Texas or otherwise), it’s time to examine how that may affect your corporate healthcare costs. GM&A is a firm dedicated to providing knowledgeable, valuable healthcare consultation to employers like you. Contact us to see how we can help.

Direct Contracting with Pharmaceutical Companies
Feb 01, 2016   07:00 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting with Pharmaceutical Companies

One of the questions we receive frequently is, “Can pharmaceutical entities benefit from direct contracting?” The answer is yes, many of them can. While GM&A can’t partner with every pharmaceutical channel, we can and do provide our direct contracting service to some. The fact is, the rising cost of drugs is getting out of hand and it is becoming increasingly difficult for some insurance companies to offer those drugs at an affordable cost to patients. By negotiating with the pharmaceutical companies, GM&A can help get control over that.

Yes, negotiating. When it comes to big pharma, the thing no one wants to talk about is that there is often a great deal of leeway; generally speaking, the “prices” are not really the prices. Drugs are marked up hundreds of times over – particularly specialty drugs, which now account for 27.7% of total pharmacy spending in America. Perhaps that’s one of the reasons why co-pays greater than $60 have increased by 229% since 2010. *

So, why would they negotiate? While the pharmaceutical companies do have to make a profit, they also have to find price points that work for insurance companies and providers – as these are the means to the end users (also known as patients). And that’s what motivates them to work with negotiators like GM&A.

As stated, we can’t partner with every single pharmaceutical company – although we are actively seeking more to partner with now, and welcome their inquiries. Aside from that, what we can provide on a broader scale is an overall health plan, which includes negotiating for more affordable pharmacy co-pays. We’re living in a medicated age; there is a drug for everything, and that’s an incredible thing. That’s why it’s so important to partner with a health plan

*Source: Independent Health Specialty RX Report

New Year, New Health Plan
Jan 12, 2016   07:35 AM
by GM&A Corporate Healthcare Consultants

Now that it’s 2016, we are getting inquires on getting started with direct contracting during the open enrollment period – and that’s a good thing, because the beginning of the year is the best time to inquire. Every healthcare program requires some time to implement, and direct contracting is no exception. The truth is, if a company is serious about getting started with direct contracting for its employer health plan, then everyone should be prepared for the timeline to be up to six months in duration, from start to finish. Keep in mind, the steps include:

Consultation:

The first consult is an important appointment that provides the potential client with all the necessary information on the direct contracting healthcare model. If you are interested in being a client, you want to schedule your consultation as early in the new year as possible.

Analysis:

Once the client is on board, we perform an analysis of the company’s healthcare data – namely, examining the number of employees and dependents requiring coverage and analyzing their past claims data. This is important because it helps us identify the most appropriate providers to approach with contract proposals.

RFP:

Next, we enter the request for proposal (RFP) stage. This is when the right providers are identified and approached with proposals on contracting with your company; it is the stage where the actual healthcare services are secured.

Processing:

We then obtain signatures and process the contracts with each provider, ensuring that they are legally binding contracts for the enrollment year.

Preparation:

Finally, we prepare for open enrollment. This is a process that requires us to obtain the most up-to-date data on your employees and their dependents so we can get them enrolled during the eligibility period.

As you can see, it takes months to put a complete employer health plan program together. That’s why it is in every client’s best interests to begin the process at the beginning of the year. It’s not too late to inquire now, so we can begin creating and establishing your new company health plan. Contact GM&A to learn more today!

Pardon the Interruption...
Dec 16, 2015   07:35 AM
by GM&A Corporate Healthcare Consultants

Pardon the Interruption…

…But it’s time for a promotional break! This is an important one, because if you’re in the healthcare consulting industry or certain categories of benefits fulfillment, we just might have the lifeline you’ve been waiting for. Here goes!

We’ve said it before, and we’ll say it again: GM&A is happy to partner with other entities. Who are they? They’re benefits providers, facilitators, brokers and consultants of all types.

When we say “partner,” here’s what that means: On the front end, any partner of ours can sell its services to an employer or other large group. On the back end, we will provide the service. We’ll do the audits, we’ll worry about all the compliance and we’ll process the employee claims as they come in. We’ll even handle the Affordable Care Act regulations – a big plus in the new world of healthcare. In addition to working with brokers and consultants, we are also ready and able to help with vision benefits, pharmaceuticals and other fulfillment needs.

After attending the Dallas Fort Worth Business Group on Health (DFWBGH) last week and meeting so many potential partners at the 11th Annual Benefits & Wellness Forum, we know there is a gaping hole that only we can fill. If you are a broker, consultant or other firm that is in need of back end fulfillment, we’re the ones to call for turnkey, full service direct contracting. This is the future of healthcare service, and we know how to provide it.

GM&A had a drawing for two Apple Watches at the DFWBGH Forum and we would like to congratulate our two winners, Margret Wise from The City of Fort Worth, and Kristen Ramirez from Holmes Murphey! GM&A also would like to wish everyone Happy Holidays and a Prosperious Happy New Year!

To learn more, contact Hurb Vandenhoogen, GM&A Vice President of Corporate Accounts, at (858) 775-9170.

 

Premiums to Rise for Federal Workers
Nov 06, 2015   10:00 AM
by GM&A Corporate Healthcare Consultants

Another week, another news report to dismay healthcare consumers – this time, federal employees. The Washington Post reports that in 2016, enrollee premiums for federal workers and retirees will rise by 7.4 percent on average, and overall premiums will increase by an average of 6.4 percent. If those seem like small figures, think about it this way: That is the largest increase since 2011. Wow!

Fortunately, the government still pays about 70 percent of the total premium for its employees (even more for U.S. Postal Service workers, though not postal retirees). Regardless, a 7.4 premium increase is no small change. Here’s how it breaks down: Non-postal employees will pay an average of $89.59 per year more for Self Only coverage, $203.40 more per year for Family Coverage and $192.71 more for Self Plus One. For employees who switch to the Self Plus One program, their premiums will only rise by 4.9 percent – a somewhat more manageable figure. Self Plus One, however, is exclusively for earners who only need coverage for themselves and one family member (i.e. a spouse or one child).

The good news is that federal employees have a chance to turn this around for themselves. Open enrollment season for federal workers starts November 9 and continues through December 14; throughout that time, they can change plans or levels of enrollment for the following year. That means it’s the only opportunity they have to look at other plans in search of lower costs, or to switch from a family coverage plan to a Self Plus One program.

It’s important to recognize that within the averages listed above, there is a great deal of variation among health plans. For federal government employees, there are about 250 participating plans total, with each state having its own selection of plans from that pool. Rather than combing through the fine print themselves, federal personnel departments can take advantage of a direct contracting plan that utilizes the most affordable premiums on the market. If you are a federal personnel manager, a GM&A healthcare consultant will be glad to tell you more during a complimentary health plan consultation.  

Questions on Open Enrollment and the Cadillac Tax
Oct 28, 2015   02:00 PM
by GM&A Corporate Healthcare Consultants

As we have explained before, the ACA imposes a “Cadillac tax” intended to supplement benefits for the uninsured. The idea is that by forcing employers to pay a 40% excise tax on the cost of any premium health plans they may offer employees, the ACA can be funded by employers who “can afford” to help pay for it.

Is it fair? Definitely not. And with the 2016 open enrollment season starting on November 1, this is the time for employers to make the changes they need to make in order to circumvent the Cadillac tax. In fact, GM&A is among those healthcare consultants who believe this may be employers’ last chance to make the changes that are necessary if they want to avoid this penalty.

Why is that? Because although the Cadillac tax technically stays latent until 2018, it can take years to make the required changes on the employer’s part. Adjustments to the company health plan have to be made in small increments, so as not to alarm employees. Remember, maintaining consistency in your company health plan is important for employee retention – so in order to get ready for the Cadillac tax implementation of 2018, those changes have to start now.

How do you do it? You mean, how do you start implementing changes now in the 2016 open enrollment season? First, recognize that the Cadillac tax will be imposed on health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. This means you will want to slowly lower employee contributions and premiums, while still attempting to provide your employees with coverage that is parallel to what is currently offered. Does that sound like something you can do?

It might not – but when we introduce you to direct contracting, that’s exactly what GM&A can help you with. By negotiating directly with providers and hospitals, we create a customized health plan network for our employer clients; the result is lower premiums for the employer and consistently good benefits for employees.

The great thing about open enrollment is that it offers employers a clean slate when they need it. This is the time when enrollees have an opportunity to seek out plans with lower costs, and we can help them do it. Remember, though: The open enrollment period is November 1 to January 31. After that, employers are stuck with their current plans for another year. That’s why the early part of open enrollment is the time to start learning about your options; contact GM&A for a complimentary health plan consultation.

Getting Affordable Mental Health Coverage for Employees
Oct 13, 2015   07:00 AM
by GM&A Corporate Healthcare Consultants

Getting Affordable Mental Health Coverage for Employees

Every employer is asked the question at some point: “Does our company plan cover mental health treatment?” If you’re an employer that hasn’t been asked this yet, you will be – so before you get caught in the headlights without a good answer, here’s what you need to know.

Providing affordable mental health coverage is the law, but only if physical health coverage is also provided (which it will be now, thanks to the Affordable Care Act). Many Americans do not realize that there was a law passed in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (more commonly known as the “mental health parity law”).

The mental health parity law requires employers who provide health insurance to also cover services for mental health, behavioral health and substance-use disorders – and, it requires that coverage to be comparable to the physical health coverage provided in the plan. How do we know most Americans aren’t familiar with this law? Because the American Psychological Association reports that more than 90 percent of Americans don’t know about it.

Here’s a practical application of the mental health parity law. Say an employer-sponsored healthcare plan includes a $20 copay for office visits to a medical doctor. Under that plan, it would be unacceptable for visits to a mental health professional to require a $40 copay – because that is twice the cost. It’s not on par with the other copay (hence the term “parity”).

Additionally, the law has significantly reduced – maybe even eliminated – annual limits on the number of mental health visits allowed each year. However, employers should note that insurance companies are still allowed to impose limits on visits deemed not “medically necessary.” That’s something to keep in mind.

Because of the mental health parity law, employers need to be connected to a healthcare system that makes it easy to cover mental health treatment. Direct contracting can provide a way to do that, because it involves negotiating the lowest rates directly with providers. GM&A can do this with mental health providers the same way we do with medical service providers. Contact us today to learn more.

Is Your ACA Compliance Soultion Enough?
Sep 22, 2015   07:00 AM
by GM&A Corporate Healthcare Consultants

As the Affordable Care Act (ACA) becomes the new normal in healthcare, many employers are forgetting about the flood of penalties that may come their way over the next few years if they fall short on ACA compliance. And even those who are aware of the compliance issues they face may not be doing enough.

Some employers, understanding that ACA compliance is here to stay, are taking advantage of compliance firms and they are wise to do so. However, some ACA compliance solutions merely track and report employee health plan claims – firms that fail to handle exchange appeals, provide audit representation or deliver any of the other important services that are now necessary in the post-ACA era. Tracking and reporting are good, but those services should be the tip of the iceberg. They help employers avoid tax penalties, sure – but there’s a lot more to ACA compliance than that.

To start, ACA compliance requires accuracy. Employers, ask yourself: Does your ACA compliance solution address the following problems?

  • Controlled group/common ownership
  • High variable hour workforce
  • Multiple payroll systems with      varying data points

If they don’t, the reality is that the work they are doing on your behalf may not be accurate – and that means you may not be avoiding penalties at all. The fact is, the IRS is budgeted to hire almost 500 new full-time employees in 2016 to fulfill the “new audit requirements related to the shared employer responsibility payment.” In other words, they will be auditing companies and are already making plans to do so. Perhaps more alarmingly, the Congressional Budget Office projects that the federal government will generate $9 billion in ACA compliance penalties from employers alone in 2016.

So when you are searching for an ACA compliance solution, make sure you look beyond the slick website and promises of monthly reports. You need a compliance firm that has experience in all aspects of employer health plan maintenance, both before and after the ACA. Compliance requires knowledge, and GM&A has it. To learn more, contact us today!

Avoiding the Cadillac Tax on Health Plans
Sep 10, 2015   07:30 AM
by GM&A Corporate Healthcare Consultants

Have you heard about these so-called “Cadillac” medical plans? This is the government’s name for health plans that are above $10,200 per individual and $27,500 for family coverage; the idea behind calling them “Cadillac” is that they can be thought of as medical plans for the “rich.”

Part of the Affordable Care Act outlines what ACA proponents call the “Cadillac tax,” which is a tax the government believes will help fund benefits to the uninsured under the ACA. It will force employers to pay a 40% tax on the cost of any Cadillac health plans they offer their employees.

When the Cadillac Tax Goes into Effect

When the Cadillac tax starts in 2018, it is estimated that one in four employers could be affected by the regulation. In other words, 25% of employers would be compelled to change their benefit structures; that means offering fewer benefits and less coverage to their employees. Does that sound fair? Of course not.

And as if that wasn’t significant enough, a study by The Kaiser Family Foundation reported that the Cadillac tax could impact even more employers as their costs rise – nearly one third of the nation’s employers by 2023 and 42% of employers by 2028, if those employers’ plans remain unchanged and health benefit costs continue to rise as they have been.

To avoid being “penalized” (that’s essentially what is happening), many employers are already raising their co-payments and deductibles – and, they’re also shaving away some of the coverage they were previously offering. Part of that is giving their employees more restrictive provider lists, a move that some employees may not be happy with (and understandably so).

A Solution to the Cadillac Tax on Health Plans

How can Cadillac health plan penalties like these be avoided? If employers choose a benefits model like direct contracting, they can circumvent much of this catastrophe. Direct contracting lets employers provide the coverage, benefits and high quality providers of a Cadillac health plan without the high cost; dollar for dollar, what direct contracting offers is equal or greater to what is available in a Cadillac health plan. But because they don’t pay the high cost, the plans don’t need to qualify as “Cadillac” – and therefore, the Cadillac tax can be avoided.

This is the best possible way for employers to deal with the Cadillac tax healthcare crisis! For more information, contact GM&A. We will be happy to discuss direct contracting with you.

Healthcare and the New Economy
Aug 18, 2015   08:00 AM
by GM&A Corporate Healthcare Consultants

Everyone likes to talk about the “new economy” and all the new advantages that come with it: easier access to travel accommodations, transportation and even personal income are all great examples that people are becoming more familiar with. But the truth is, there are some downsides to the new economy as well, one of them being higher medical costs. In fact, the costs of actual medical care seem to be growing more quickly than the cost of insurance; according to many experts, this indicates that inflation will affect healthcare costs even more in the coming years.

Speaking of experts, how do they calculate the rising costs of healthcare? It appears that three factors are involved. To gauge whether healthcare costs will increase, economists and healthcare statisticians measure:

  • Increases in total healthcare      spending
  • The cost of providing health      insurance
  • The rise in prices charged for      actual medical care

Adding substance to the claim that healthcare costs will accelerate even more with time, a new U.S. Commerce Department report shows that medical spending grew 100% more quickly than the American economy itself in the second quarter of 2015. Plus, the data showed that healthcare spending rose by 4.9 percent compared to the same quarter in 2014. The Affordable Care Act is partially to blame, sure – but it’s not the only factor.

Another player is rising prescription drug costs, as new drugs for hepatitis C, cancer and multiple sclerosis have all entered the market recently. Of course, these aren’t just new drugs; they’re also expensive. Couple that with the rise of America’s aging population (according to The New York Times, 40 cents of every dollar spent on healthcare will go to beneficiaries of Medicare and Medicaid), and you have a formula for higher healthcare costs in America.

What can be gleaned from this? Americans need to find new ways to save money on healthcare, and that starts with employers. Because employers are the primary purchasers of healthcare plans, it is incumbent on them to explore untapped health plan options. One of them is direct contracting, which can save employers money by contracting directly with providers – not insurance company middlemen. If you are tasked with finding an innovative, money-saving healthcare option for your company, contact GM&A to inquire. We will be happy to explain direct contracting to you.

Direct Contracting and Ancillary Services
Jul 28, 2015   03:00 PM
by GM&A Corporate Healthcare Consultants

Direct Contracting and Ancillary Services

Providing basic healthcare for employees can be costly enough; when those who are covered by your company plan need ancillary services to support treatment, it can be even more expensive. That’s why we recommend that employers consider adding these services into their direct contracting plans, so they can reduce health plan costs for their companies and give employees one less thing to worry about. Some of the ancillary medical services we can include in an employer’s healthcare network include:

  • Dental and orthodontic treatment
  • Optical (optometry and ophthalmology) services
  • Chiropractic care

Of course, we can also ensure that ancillary medical devices are covered in your direct contracting health plan. Some of the devices employers may consider covering under the company plan include:

  • Hearing aid devices
  • Sleep apnea treatment devices (CPAP)
  • Back and orthopedic braces

If there are other devices you are interested in adding to your plan, please let us know right away so we can begin the process of finding the best providers to add to the network. We can negotiate the maximum possible discount for any ancillary medical devices you would like to include in your direct contracting healthcare plan, and we can find providers located near you so that employees can receive their treatment as close to home as possible (of course, this also minimizes the amount of time they spend away from work – a win-win).

Ensuring that ancillary medical services and devices are covered in the company health plan is a great way to keep employees happy, retain them for longer periods of time, and improve the health and well-being of your workforce. Direct contracting is the best way to provide these services; if you are interested in discussing this option, contact a GM&A healthcare consultant to request a complimentary corporate health plan consultation.

Direct Contracting for Healthcare
Jun 24, 2015   08:00 AM
by GM&A Corporate Healthcare Consultants

Direct Contracting for Healthcare: Risks vs. Rewards

From time to time, we are asked, “What are the risks of direct contracting for healthcare?” It may sound trivial to say that there aren’t any – but yes, that’s exactly what we’re saying. As healthcare consultants to so many companies that have benefited from it, we here at GM&A truly believe the risks of direct contracting are virtually non-existent when compared to taking part in traditional health plans, such as PPOs.

Why are Direct Contracting Health Plans Better?

Remember, direct contracting involves entering into direct relationships with providers, without all the bureaucracy and middlemen of traditional healthcare. That means lower costs for employers, in addition to better, faster and more affordable healthcare for their employees.

Without direct contracting, you miss out on the cost reduction benefits and better care for everyone who is in your network – the healthcare network your company has created especially for its employees and their families. So the truth is, the real risk is not taking advantage of direct contracting.

Direct Contracting vs. PPO Plans

Some will say that if you go the traditional health plan route, you’ll get more services. First, that’s not necessarily true. We have seen some very critical care services – including life-saving surgeries, transplants and neo-natal care – provided in a superior manner for our direct contracting clients. Patients who have been unable to affordably receive these services via the former company health plan are now receiving them in the manner they deserve, and naturally, they couldn’t be happier. Second, it doesn’t matter how many services you get with a traditional PPO plan; your costs will be inherently more because you haven’t made competition work in the marketplace.

All in all, direct contracting is just the more sensible way to provide a company health plan. To learn more, contact GM&A to request a complimentary company health plan consultation. We will be glad to answer your questions.

What is a Private Exchange?
Jun 22, 2015   08:00 AM
by GM&A Corporate Healthcare Consultants

And more importantly, why are so many employers getting on board with it as a way of providing healthcare to their employees?

Here’s the first answer: Private exchanges are a natural extension of the new healthcare economy, which includes the online healthcare marketplace. Much like the federal government’s Healthcare.gov service has public healthcare exchanges in most states (and residents of those states can apply to pay for coverage under those exchanges), corporations can have private exchanges of healthcare plans that are available to employers. So, think of a private exchange as a privately owned version of the government’s healthcare model.

As an employer, you can participate in employee healthcare plans under these exchanges. A private exchange works alongside a variety of third party insurance companies to provide healthcare services. Another way to think of it is as a contractor/sub-contractor relationship. An umbrella organization that operates a private exchange acts as a contractor, and the private exchange is akin to a sub-contractor.  

Perhaps you have heard that some large consulting firms are acting as umbrella organizations that offer private health insurance exchanges. This is true, and it’s also true that GM&A is doing the same thing via our direct contracting model. We have created private exchanges for many employers so that everyone – employers and employees – can reduce their out-of-pocket costs. By partnering with the insurance companies that participate in our private exchange, we act as an appointed producer of your company’s healthcare plan and it benefits everyone: you, the employer; the provider, who administers the care; and the end users, which are your employees.

We can help your company provide coverage for full time and part time employees, in addition to existing retirees of your company if applicable. If you need a cost-effective healthcare solution for your company, it’s hard to beat the cost savings, personalization and flexibility of the private exchange model. To learn more, feel free to contact us for a complimentary health plan consultation.

Encouraging a Healthier Workforce
Jun 22, 2015   08:00 AM
by GM&A Corporate Healthcare Consultants

There are many ways employers can facilitate a healthier workplace environment, so that employees have fewer trips to the doctor, more productive work hours and less time spent away from their jobs. Here are some ideas for creating a culture of health at your place of business.

1. Allow work station snacking and lunches. When employers tell their staff they aren’t allowed to eat at their desks, they are essentially forcing them to go out for lunch – which means fattier, less nutritious lunches that take their toll on the body. By allowing workers to eat at their desks if they like, employers are encouraging staff to bring healthy sandwiches, salads and other low-calorie lunches from home.

2. Encourage workplace movement. When employees are tethered to their desks, they feel sleepier, act more sluggish and burn fewer calories. So as long as they are still meeting their goals and staying on task, why not allow them the freedom to move as they need to? Employers can even post suggestions for workstation exercises in the break room, or hold fun “movement meetings” on a weekly basis. This is a great way to liven up the company culture while helping employees stay healthy.

3. Reward weight loss. Lots of large companies have programs that reward employees for hitting their weight loss goals; why can’t you do the same at your business? While it may not be possible to provide free gym memberships, it might be reasonable to hold an annual weight loss competition with a coveted gift card as a prize. Organized weight loss groups have long been part of professional culture anyways, so it just makes sense for employers to encourage them.

By creating a workplace culture that encourages vitality, employers can improve the overall health of their workforce and minimize healthcare costs. Try these tips for encouraging a healthier workforce; we believe they will make a noticeable difference. 

Software that Shows the Real Cost of Care
Jun 19, 2015   02:23 PM
by GM&A Corporate Healthcare Consultants

One thing that employers may not understand is that technology can help them determine how much they should be paying for their employee health plans. With the right software, an employer can see exactly what the real cost of covering each employee is versus what the providers in the network are charging them. Providers need to make money, of course, so no one should expect to pay only the real cost of care – but if employers can see which providers have the smallest margins between real cost and cost of treatment, that can help them put together a network that will cost less out of pocket for both themselves and their employees.

But how can an employer have access to software like this? It is typically only available from a reputable healthcare consultant – specifically, a consultant that is independent of any insurer or network. At GM&A, one of the ways we help employers create customized health plan networks for employees is with our proprietary software; this software is designed exclusively for the purpose of analyzing real cost vs. cost of treatment, so employers can see the contrast and choose providers that have the narrowest margins (a.k.a., the lowest cost).

Furthermore, we can use the actual data from the employees’ own claims to create the most accurate calculations possible (yes, this is legal; federal law grants ownership of claims information to the employer in those cases). With the numbers right in front of them, employers can see exactly what they would pay if those specific providers were in the network. This is high-level healthcare consultation service that employers can benefit from substantially, particularly if they have been affected by the Affordable Care Act and are seeking the most affordable way to provide medical benefits to employees. Contact us if you would like to schedule a complimentary employer healthcare consultation.

The High Cost of Risk Aversion
May 05, 2015   04:30 PM
by GM&A Corporate Healthcare Consultants

Thanks to federal legislation making healthcare costs rise for everyone, there is a bigger affordability gap than ever in healthcare. As a result, many corporations are noting that their employees are opting to avoid risks more than they did previously because they fear having to pay for treatment if they get hurt or become sick. That may seem like a good thing on its face, because it implies that fewer people are jumping out of planes and doing things that most of us consider highly risky. But risk aversion is much more than that. In some cases, people are becoming unenthusiastic about healthy activities, simply to avoid the risk involved. Those risks include:

Exercising. “I can’t afford for my knee to go out,” or “my back can’t handle it, and I can’t handle the co-pay if it acts up” are common healthcare cost excuses for avoiding exercise. That means fewer walks, jogs and trips to the gym – and more pounds packed on, thereby exacerbating the problem.

Going outdoors. With summer approaching, many people have sun exposure risks on their minds. Although they know, logically, that applying sunscreen can minimize their skin cancer risks, some people in our hyper-cautious culture are leery of going outside at all – and they pass that fear along to their children. It may or may not be cost related, but it’s a fear that has many people cutting back on the healthy practice of enjoying the sunshine.

Swimming. This is another summer activity that has been on the decline in recent years. Some of it is safety, but much of it is also connected to healthcare costs. “I can’t afford for my child to get an ear infection” is a common excuse among today’s parents when it comes to keeping kids out of the pool. It’s a shame, and it has only aggravated the childhood obesity epidemic.

Employers can encourage healthier habits among their employees by implementing a company healthcare plan that keeps premiums and deductibles low while still providing great coverage and a wide range of providers in the local area. That’s what direct contracting is all about. Ask us for a complimentary health plan analysis to learn more.

Direct Contractng: Should Employees Get a Vote?
Apr 17, 2015   11:26 AM
by GM&A Corporate Healthcare Consultants

As summer approaches, employers start to look at any new health plan options that may be available so that they can be prepared in the fall when re-enrollment time rolls around. For unionized employers, members often get the opportunity to vote on whether to keep their current company health plan. That begs the question, should non-unionized employers get the chance to do the same thing? And if so, should the employees have the chance to vote on a new model of health coverage altogether, like the direct contracting system?

That would seem to make sense. After all, what employee wouldn’t like the opportunity to vote for lower deductibles, lower out of pocket costs and access to better healthcare providers – not to mention more access to important healthcare services like life-saving surgeries, transplants and other specialized care?

Employers have nothing to be afraid of when it comes to giving employees a vote, because the direct contracting model will save them money, too – and on an equally important matter, it can also help them retain their key employees for another year. There is ample documentation to suggest that quality medical coverage plays a big role in employee retention, and that is the case across the board: at large employers, small employers and for employees of all ages. People know that good healthcare coverage is a valuable thing to have in life, now more than ever because healthcare has been thrust into the national spotlight like never before.

If you are an employer that is mulling your options for the 2015-16 health plan enrollment period, consider offering your employees a vote on the matter after you have learned more about direct contracting and given them the opportunity to learn more about it, too. You may be pleasantly surprise by the results.

Telemedicine: The Future of Healthcare?
Apr 03, 2015   02:30 PM
by GM&A Corporate Healthcare Consultants

One of the biggest ways that healthcare is going non-traditional is with the new phenomenon of telemedicine, which is the use of medical information exchanged from one site to another via electronic communications. In a practical application, telemedicine could involve any of these scenarios:

  • Patients sending their list of      symptoms to their provider via email or electronic form
  • “Phone appointments” with      physicians, which include symptom analysis and diagnosis
  • Lab results being delivered via      phone or email
  • Prescriptions being emailed by the      provider, then printed by the patient for fulfillment at a local pharmacy
  • Prescriptions being emailed by the      provider to the patient, and then fulfilled/mailed to the patient

Why should employers know about telemedicine? Because experts are calling it a possible new strategy for reducing health insurance costs. This makes sense, as receiving clinical services remotely can reduce the amount of time employees spend away from work. It can also improve access to healthcare services for employers in rural areas. If the employer partners with a network that offers telemedicine, it can greatly improve the chances of retaining local employees. The last thing any employer wants is to lose its staff because the location offered poor access to healthcare.  

Is telemedicine perfect? No, at least not yet; some of the potential problems experts have pointed to include legal and regulatory issues at the state level, privacy concerns and low physician buy-in – not to mention the potential for claims reimbursement issues. “Telemedicine reimbursement claims are treated differently from in-person care by physicians,” one recent study revealed. “Barriers to reimbursement include greater denials for (telemedicine) services than for in-person services, billing and coding issues, and a pre-authorization requirement for telemedicine services not needed for traditional care.” This should be expected in the early adoption stage, but as telemedicine becomes more mainstream, it seems natural that insurance companies will create streamlined models for reimbursing physicians who provide telemedicine services.

For employers that want to improve access for employees and watch out for the company’s bottom line, embracing telemedicine is one new strategy that may pay off. GM&A gladly works with providers who deliver telemedicine services; if you are one such provider, feel free to contact us.

Mar 20, 2015   02:30 PM
by GM&A Corporate Healthcare Consultants

That’s the question many healthcare providers are asking now, in light of the fact that everyone from recognizable retailers to Internet titans have descended upon the industry to disrupt the way healthcare services are provided. It’s understandable for providers to feel bewildered by the newfound boldness of the healthcare consumer (what we used to call the “patient”); however, it’s important to understand that said boldness is not necessarily the consumer’s fault. As stated, other entities have come on the scene in recent years. They are intent on wreaking havoc on the way providers do business – and patients, hoping to save some money, are just doing their due diligence by researching all their options. Some of the ways that healthcare has become consumerized include new, non-traditional business models such as:

  • Clinics setting up shop in grocery chain      stores
  • Medical tourism for surgeries and      tests
  • Online diagnostics and consultation     

Of course, no one is saying these healthcare business models are recommended – but they are popular, and they cater to a new generation of patients that have grown up believing convenience is a right in their life, rather than a bonus. That belief would especially apply to their healthcare. Now that members of this generation are starting to have children of their own, they will naturally expect that their kids will have access to the same conveniences; in fact, they probably expect healthcare to become even more convenient as time goes on. As more and more providers begin to satisfy these expectations, the providers who fail to deliver the same convenience will be shut out.

So, how can providers make sure they don’t get left behind? True, it may not be practical to set up shop in a supermarket – but what about offering online access to medical records? This is a feature that many parents of young children appreciate. Extended hours are another amenity that providers can consider; it’s not non-traditional, but it’s certainly convenient, and it can help providers retain some of their more consumer-minded patients.

Providers that need guidance in the new, consumer-driven healthcare landscape may benefit from a consultation with a healthcare consultant. GM&A gladly speaks with providers that request this guidance; feel free to contact us today with your questions.

What is a Pharmacy Benefit Manager?
Mar 09, 2015   02:00 PM
by GM&A Corporate Healthcare Consultants

We recently addressed third party administrators that are hired by self-insured employers to process claims, also known as TPAs. Now, we’re here to explain a category of TPA called a pharmacy benefit manager, or PBM. A PBM is typically a TPA of prescription drug programs, tasked with the responsibility of processing and paying out prescription drug claims. Other responsibilities of a PBM include:

  • Creating and updating the formulary (the list of medicines that may be prescribed)
  • Contracting with pharmacies for patients and providers
  • Negotiating prices, including discounts and rebates, with pharmaceutical manufacturers

Although this may be your first time hearing of them, PBMs are not uncommon at all; in fact, the majority of insured Americans receive prescription drug benefits that are administered by PBMs. Direct contracting companies like us like PBMs because we can help the pharmacy chains we contract with get better rates by negotiating with the PBM.

We can also discuss the prospect of our clients getting high quality, generic equivalent drugs and rebates, so that patients (covered employees who work for our employer clients) can get the medications they need at prices that are generally affordable for them. Likewise, our employer clients can pay a fairer price for prescription drug benefits so that their bottom lines will remain intact. This is just another benefit employers can take advantage of when they choose to use direct contracting for health insurance obligations. If you have any questions, feel free to contact GM&A today. We will be glad to explain the ways we can help employers like you negotiate pharmacy benefits.

Self-Funded Healthcare Plans: Are They Right for Your Company?
Mar 02, 2015   03:30 PM
by GM&A Corporate Healthcare Consultants

As you may have heard, self-funded healthcare plans can be a very effective way to mitigate the escalating cost of healthcare in the United States. This is especially the case for large firms with 1,000 or more employees – firms that would otherwise be forced to reduce plan options in the new healthcare frontier we now find ourselves in.

So, how much money can a self-funded healthcare plan save a large employer? According to a Kaiser Permanente study, it may be able to save them up to $700 per employee every year. Yes, per employee! If the company indeed has 1,000 employees, that’s a savings of $700,000 a year. Even for a large, profitable corporation, that’s not pocket change!

As for mid-size firms that cover anywhere from 100 to 1,000 employees, they have been slightly less enthusiastic about choosing self-funded healthcare plans. As it turns out, only 58 percent have chosen to self-fund company healthcare, while 93 percent of companies with 5,000 or more employees choose to self-fund. Why the hesitation? It may be because the cost of administering a self-funded plan, combined with the premium payments necessary to cap their risk with stop loss coverage, is just too big a hill to climb. It may seem too costly, too complicated and just out of the company’s “league,” so to speak – and that’s fine. Self-funded healthcare plans are great, but they aren’t right for every employer.

One option these mid-sized companies may consider is a captive stop loss agreement, which requires them to pool their risk with other insurers in order to attain the critical mass and stability they need to keep benefits secure. This “group purchasing power” adds a much-needed level of protection against catastrophic losses, so it can be ideal for mid-sized businesses.

If you have questions about self-funded healthcare plans or captive stop loss agreements, contact GM&A to request a corporate healthcare consultation. We will be glad to see if we can help.

Working with Healthcare Consultants and Brokers
Feb 09, 2015   01:51 PM
by GM&A Corporate Healthcare Consultants

One question we are frequently asked is whether we work alongside healthcare consultants or third party brokers, if a company that is our client wishes to bring one in for any number of reasons. The answer is yes, we do. Here’s why: We see these professionals as colleagues and partners, not competition. Our business model only succeeds if our clients save money, so we are happy to work with anyone else a company has brought in to help them save money. We can work together to achieve the client’s goal, no matter what that goal is.

Sometimes, the objective of the consultant is to implement a wellness program that will reduce the company’s overall healthcare costs; this is becoming increasingly common, now that the government gives companies a “reward” of sorts in the form of a discount on health insurance premiums, deductibles and other costs; the discounts may be up to 30 percent or more, especially if the programs are designed to help employees quit smoking. This is another development that was introduced in the wake of the Affordable Care Act, so we have been doing this for the past couple of years as companies have begun taking advantage of it.

Other times, the aim of the healthcare consultant or broker is to help its client companies find the best possible health plan for the organization. They take into consideration factors such as the size of the company, demographics of employees (i.e. women of childbearing age, older adults, etc.), in addition to data on the nearest providers. No matter the reason a company has brought in a healthcare consultant or broker, we can work alongside these outside professionals to help the company attain its goal. If your organization is working with a broker or consultant to choose the best health plan, implement a wellness program or accomplish some other healthcare-related tasks, contact GM&A to see how we can help.

The Value of Health Care Consulting
Jan 06, 2015   02:05 PM
by GM&A Corporate Healthcare Consultants

Much has been said over the past couple of years regarding the employer’s obligation to provide healthcare benefits, underscored by the Affordable Care Act and the political push back surrounding it. While it may be true that the law has been helpful to some who did not previously have health care coverage, there are plenty who disagree once they log onto Healthcare.gov and see the high cost of the plans in their state exchanges.

For employers, the government offers an option in the Small Business Health Options Program (SHOP); however, many small business owners are also dismayed to find that the cost of taking advantage of the program is far higher than what they expected it to be. And for local government organizations, the cost is surprisingly higher.

Take our client, the Tyler Independent School District in Tyler, Texas. Tyler ISD wanted a healthcare coverage option for its 17 elementary schools, six middle schools and two high schools. The state plan cost was so high that some in the district feared layoffs would be necessary in order to make up for the cost of providing employees with healthcare – and this was back in 2001, when the economy was stronger and it would be years before the Affordable Care Act was in the picture.

Even then, we were able to negotiate significant discounts with a local provider network for the Tyler ISD health plan. According to district officials, these discounts have resulted in millions of dollars being saved by the school district in the years since the plan was enacted – and, as one spokesperson told us, “The benefits of the state plan are less than our benefits,” and they come “at a higher cost.”

Health care consulting is a service that has become absolutely necessary in 2014. If your business or local government organization is unsure how to cover employees affordably and comprehensively, contact GM&A to see what we can do for you.

How PPO's Became the New "Traditional" Plan
Dec 16, 2014   04:04 PM
by GM&A Corporate Healthcare Consultants

For the past 20 years, preferred provider organization medical plans (PPOs), have been marketed aggressively by insurance carriers as a good alternative to health maintenance organizations (HMOs). Are they really a good alternative to HMOs? In some cases, they can be – but there is an even better way. Better than HMOs and better than PPOs, which over time have gradually become the new “traditional” healthcare plan.

But first, what does a PPO entail? A PPO is a subscription-based medical care arrangement that has contracts with a network of “preferred” providers from which people can choose. With a PPO plan, it is not necessary to select a primary care physician, which means people under PPO plans don’t need to ask for a referral to see other providers in the network (i.e., specialists).

This is one of the primary reasons PPOs are so popular – but another reason is that patients with PPO plans are only responsible for their annual deductibles and the copayments for their visits. The downside with this arrangement is that obtaining healthcare services from a provider that is out of the network will cost the patient a higher amount, and the out-of-network doctor will need to be paid directly. To get reimbursed, the patient has to file a claim with the PPO. An HMO does not have this type of arrangement.

And that’s not the only disadvantage of a PPO plan. Truthfully, PPOs do not necessarily have the widest networks of providers available to patients – although certainly, insurance carriers frequently represent them that way to the employers they market PPO plans to. The direct contracting model actually can deliver a much wider network of providers, and do it at a much lower cost to the employer.

Hospitals and other healthcare providers no longer give deep discounts to employers with PPO plans – but because they did for years, PPOs skyrocketed in popularity, which is why they are now the new “traditional” plan. We have come full circle, and at the expense of both patients and employers. With the direct contracting model of healthcare, there is a wider network for patients to go to, and lower costs for employers. Both of these things are important features in this new healthcare climate. 

Can Technology Help Employers Choose a Healthcare Plan?
Sep 03, 2014   11:17 AM
by GM&A Corporate Healthcare Consultants

Can Technology Help Employers Choose a Healthcare Plan?

It certainly can. One of the ways we help employers choose a healthcare plan for their employees is by using our proprietary software to determine what the real cost of covering each employee would be in a direct contracting scenario.

When we say real cost, we mean that we can show them exactly how much the healthcare being provided actually costs, vs. how much the provider is charging the employer. If the employer is self-insured, as many large companies are, we can use the data from the employees’ claims to determine this calculation because federal law grants ownership of claims information to the employer in those cases.

We use a  case mix adjustment (CMA) to do this. Using a case mix adjustment, we can take the CMA value of a provider and adjust the average cost per patient at that provider, relative to the adjusted average cost for other providers. Once we have those numbers, we can take this claim data, break it down and case mix adjust all the claims. In other words, we can make a fair comparison and show an employer how much they have been paying for healthcare vs. how much the care actually costs – and of course, this information will tell them how much their healthcare costs can be reduced through direct contracting.

Additionally, our technology enables employers to see how much care their providers  actually provide, so that they can make better healthcare decisions for the company. For example, one hospital may appear expensive to the employer but could turn out to actually be the most cost effective provider due to the severity of the care provided. With the technology we use, employers can see the numbers right in front of them, so that they know the right questions to ask.

To learn more about the technology that simplifies healthcare decisions for the employer, contact GM&A today. We will be glad to offer you a consultation to have your questions answered. 

Why is Direct Contracting Good for the Employer?
Aug 12, 2014   09:35 AM
by GM&A Corporate Healthcare Consultants

It’s no secret that the Affordable Care Act (ACA) law has changed the way many employers look at the idea of providing medical coverage to their employees. In the aftermath of all the changes, some companies have opted to stop furnishing medical benefit packages altogether. That’s unfortunate, of course – but there’s good news. Direct contracting, the service that we offer here at GM&A, offers employers a way to continue delivering medical benefit plans to their employees; best of all, direct contracting can do this without making the employer’s health plan costs go up.

How is it done? In a word, competition. In the direct contracting model, providers contract directly with the employer rather than participating in an HMO. The providers can choose their own rates, charging whatever they feel is necessary in order to earn the business of companies. Consequently, many of those providers lower their costs significantly – because (you guessed it!) they know that lower costs are the way to earn the business of those companies. That means employers that choose the direct contracting model can still provide medical benefits, without worrying that the costs are going to skyrocket. Chances are, costs may actually go down!

Now, back to the Affordable Care Act. We all know that the law (which was passed in 2010 but took effect on January 1 of this year) requires companies to pay for more health care services and products than it did before. In fact, one company quite famously took that issue all the way to the Supreme Court recently. Direct contracting doesn’t change any of that; however, the lower cost of doing business with providers helps companies comply with the ACA law more affordably. Yes, the law puts more onus on what companies must cover – but with direct contracting, they can actually afford to comply.

To learn more about direct contracting and the advantages it offers employers, contact GM&A today. We will be glad to answer your questions during a complimentary employer health plan consultation. 

For a Consultation and detailed Health Plan Analysis
Call Hurb VandenHoogen at (858) 775-9170
or email hvandenhoogen@gma-usa.com