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