During the EMI Pool Meetings this week, as EMI was discussing their telehealth utilization, they flashed a slide across the screen (below). The slide was a basic illustration of utilization trends, and diagnosis. The slide illustrates the increase in telehealth utilization over the last year, which was predictable, but what was stunning to me was the sheer increase in depression and mental health diagnosis that were reported. Like everyone, given the conditions over the last year, depression and mental health utilization were bound to increase, I just did not realize the extent to which that increase would be. |
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If there is any good news to share, it is that services like telehealth, and EAP programs are available to help those in need, who can’t physically sit in front of someone who can provide those services that are desperately needed. Telehealth service are almost always baked into a medical plan, but EAP plans are not always. Especially full service EAP plans. Is now the time to start quoting EAP products as frequently as we quote dental and vision?
As things start to loosen up, and things are slowly creeping back to that new normal everyone talks about, the question becomes; how do we get ready to re-enter the physical work place safely? Are we mentally ready to replace the stresses of working from home (and yes, there are some), to the stresses of traffic, making up for lost time due to commuting, and being with people in proximity again (and yes, there are stresses with that to)? How will Companies help employees mitigate that stress? How will leaders prepare themselves to help their employees re-enter the work force?
Humana has put out a really nice brochure (link below) on work place re-entry that we wanted to share with you. This is a great “jumping off point” document, especially for those small companies that do not have the resources for specific departments or expensive consultants to help guide them through this process.
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As far as our business is concerned, we are watching the claims trends. We believe that claim costs are going to spike as individuals who had put off medically necessary, but not urgent procedures, go back to the hospital or specialist to start or resume care. How did carriers prepare for this eventuality? We will all find out together. And as always, we will report back on interesting or alarming trends that we see. |
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EMI held their semi-annual Pool meetings over the last several weeks. These meetings are to provide updates on new EMI benefits and services, health care reform updates, and to review the claims data of each Pool.
Two of the Pools, Charter School Benefit Alliance and Public Service Health Benefits, have annual renewals on 7-1-2021. The results of the claim review generated pool renewals of:
Public Service Health Benefits: -1.87%
Charter School Benefit Alliance: +5.81%
With industry trends requiring renewals for commercial carriers at 8-15%, these results are stellar, and answer the Pool promise to create rate stability.
I have attached an historical overview of the Pools performance to illustrate this success.
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Speaking of success, EMI announced last week a surplus of $37,566.86 in the Non Profit Pool for the 2019 plan year.
When a Pool runs well below target loss ratios, there is an opportunity for the Pool to receive a refund, or surplus in the premium that was paid. That Pool's surplus is then passed on to the member groups of that Pool weighted on the percentage of premium they have contributed to the overall premium amount. The surplus is paid at 100%, 3 months after the runout period (12 months), and is paid regardless of how poorly an individual group has performed, or whether they are still insured with EMI.
So, a group that had performed poorly from a claim’s perspective in that plan year, and would have otherwise received a large increase, or would not have received a surplus amount if they were not in a pooled arrangement, would receive a surplus if the Pool ran well enough to receive a surplus.
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Effective for 7/1 effective dates, EMI will begin offering the Aetna ASA network as an option.
EMI currently offers the CIGNA PPO and Local Plus networks, along with the Blue Cross Statewide PPO network.
From a pricing perspective, quotes with the Blue Cross Network will be the most cost effective, followed by the Aetna ASA network, and then the CIGNA Network. The pricing differential will be approximately 2% between each network.
But all three networks bring value depending on the situation of the Group. For example, Groups that have an Arizona only population would probably be more attracted to the Blue Cross network, whereas groups with multiple locations, might benefit more from the CIGNA or Aetna network depending on how many employees are out of State, and where those out of State locations are. We can help guide you to the most cost effective network with the best reach.
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In January’s newsletter, we introduced you to EMI’s new digital wellness platform “Be Well” powered by WebMD. Be Well delivers a comprehensive wellness tool directly to your smartphone. The Be Well platform helps you define individual goals based on health risk assessments, biometric screenings and claim utilization information. Whether you want to track personal health, engage a personal health coach, manage specific health conditions or just improve on your existing healthy habits, Be Well puts all of those tools at your fingertips with an easy to read dashboard for information on the run.
This new digital wellness platform is just a part of a larger strategic cost management segment designed to keep members healthy, help members track conditions when they are sick, and help them access the type of care that is appropriate, convenient and cost effective. And when conditions get to a chronic or acute state, EMI is there to help manage the quality and cost through Acute Care Management and Disease Management programs.
All designed to provide the utmost quality in care to ensure a speedy recovery, while managing the associated cost. When cost are contained, the patient saves money by paying less in out of pocket cost.
EMI summarizes this strategy quite nicely in the attached EMI Health Wellness Playbook. Let me know if you have questions, or would like to know more.
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Tying Hospital Reimbursement to Medicare Rates Could Reduce Spending by $325 Billion:
That’s billion, with a “B”. This is the essence of referenced based pricing plans (RBP).
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IRS Issues Clarifies, Expands on COVID-Related Cafeteria Plan Relief and CARES Act Changes: |
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This study in a nationwide mass vaccination setting suggests that the BNT162b2 mRNA vaccine is effective for a wide range of Covid-19–related outcomes, a finding consistent with that of the randomized trial.
As mass vaccination campaigns against coronavirus disease 2019 (Covid-19) commence worldwide, vaccine effectiveness needs to be assessed for a range of outcomes across diverse populations in a noncontrolled setting. In this study, data from Israel’s largest health care organization were used to evaluate the effectiveness of the BNT162b2 mRNA vaccine.
All persons who were newly vaccinated during the period from December 20, 2020, to February 1, 2021, were matched to unvaccinated controls in a 1:1 ratio according to demographic and clinical characteristics. Study outcomes included documented infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), symptomatic Covid-19, Covid-19–related hospitalization, severe illness, and death. We estimated vaccine effectiveness for each outcome as one minus the risk ratio, using the Kaplan–Meier estimator.
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