Midwest Business Group on Health’s Post

Employers are paying prices that are at a level over 2.5X Medicare, but the state variation is huge. Looking at you, CA, FL, NY, GA, WI!, SC!--employers paying more than 3X Medicare. The new RAND 5.0 study on hospital prices from RAND is out today and the research team led by Christopher Whaley. Thanks to all the employers and unions who contribute their data to this important study. #pricetransparency #hospitals https://lnkd.in/eRRYYiUy

"Where quality and convenience are comparable, employers can use network and benefit design approaches to move patient volume away from higher-priced, lower-value hospitals and hospital systems and toward lower-priced, higher-value providers. Employers can also use this information to reformulate how contracts are negotiated on their behalf. However, price transparency alone will not lead to changes if employers do not or cannot act upon price information. In some cases, employers might need state or federal policy interventions to rebalance negotiating leverage between hospitals and their health plans. Such interventions could include addressing noncompetitive health care markets, placing limits on payments for out-of-network hospital care, or allowing employers to buy into Medicare or another public option that pays providers prices that are some multiple of what Medicare has set." https://lnkd.in/gdmqaFAq #ESI

Unfortunately, more than half of Americans have opened a letter in the mail only to be shocked about a high-cost healthcare bill they received. Increasingly, self-insured employers are looking to their third-party administrators (TPAs) to help contain these healthcare costs. Here are three ways healthcare navigation, like Amino Health, can help TPAs save their clients money without compromising member experience or quality of care. #healthcarenavigation #thirdpartyadministrators #healthcarecosts

Health system margins are being stretched to the limit due to several factors. The increased administrative burden placed on providers is exacerbating the problem, with 82% of CFOs noting a significant rise in payer denials since pre-pandemic levels. To combat this, 19% of health systems have discontinued at least one Medicare Advantage plan, and 61% are considering dropping Medicare Advantage payers altogether, according to a recent survey. Labor costs are also a major driver of margin pressure, with 96% of health system CFOs citing them as the biggest factor. Nursing is the top driver of labor shortages, according to 99% of CFOs. Other roles, such as lab and radiology technicians, are also experiencing staffing shortages. While most health systems are looking to traditional cost reduction methods such as reducing labor costs and optimizing supply chain, these methods may not be enough to move the needle on margin. Health systems are also paring back on capital and real estate investments (40%), reducing less profitable service lines (32%), and looking to outsource revenue cycle roles (26%). Reducing operational costs is only one piece of the puzzle; health systems need more revenue to truly improve margins. As such, health systems need to explore all available options to increase revenue and improve their bottom line. #healthcaretransformation #healthcarefinance #insurancedenials #staffingshortages #supplychainoptimization #revenuegrowth #servicelineproductivity #hospitaloperatingmargins https://lnkd.in/ecMHKGnz

ICYMI - Centers for Medicare & Medicaid Services (CMS) have updated the Hospital Price Transparency Rule, which requires all hospitals to reveal what they charge for their services and insurer-negotiated rates. This data will now be far more accessible to the public, including self-funded employers who are trying to get the best care for the best price. Why It Matters for Employers: ✔️Informed Decisions: Compare transparency data with your claims data and Medicare rates to avoid overpaying. ✔️Accurate Pricing: Access more precise and dynamic pricing to manage healthcare expenses effectively. Read more from Deanna Cuadra at Employee Benefit News about how to take advantage of this landmark update to save costs and ensure your employees receive transparent and fair healthcare pricing: https://bit.ly/45ZXFM2 #EmployerBenefits #HealthcareTransparency

Do You Have the Information to Support Employees on Medicare? Q: All employees age 65 and older must register for Medicare, right? And, for those employees who are 65 and older, Medicare is the primary payer for healthcare expenses, right? A: NOT REALLY and NOT ALWAYS. When an individual sign up for Medicare it is a personal choice and may be influenced with more information about the optimal time to enroll. However, the deciding factor for when Medicare has primary or secondary responsibility for healthcare expenses depends totally on the COMPANY SIZE of the EMPLOYER. If this is news to you, and you want to learn more about Medicare and the employer responsibility to coordinate healthcare benefits, join Justin White with Senior Health Services for this half-day, informative seminar. Learn more and register today https://ow.ly/4ipl50Punbl . . . #hrhouston #hr #humanresources #HRandMedicare #Medicare #medicareforthoseworkingpastage65 #hrseminar #hrcontinuingeducation #shrmcertification #shrm #shrmcp #shrmscp

Do You Have the Information to Support Employees on Medicare? Q: All employees age 65 and older must register for Medicare, right? And, for those employees who are 65 and older, Medicare is the primary payer for healthcare expenses, right? A: NOT REALLY and NOT ALWAYS. When an individual sign up for Medicare it is a personal choice and may be influenced with more information about the optimal time to enroll. However, the deciding factor for when Medicare has primary or secondary responsibility for healthcare expenses depends totally on the COMPANY SIZE of the EMPLOYER. If this is news to you, and you want to learn more about Medicare and the employer responsibility to coordinate healthcare benefits, join Justin White with Senior Health Services for this half-day, informative seminar. Learn more and register today https://ow.ly/4ipl50Punbl . . . #hrhouston #hr #humanresources #HRandMedicare #Medicare #medicareforthoseworkingpastage65 #hrseminar #hrcontinuingeducation #shrmcertification #shrm #shrmcp #shrmscp

Vermont’s all-payer ACO: it’s improving quality & lowering per capita #healthcare costs. It’s been a 12-year work in progress, supports #healthequity, leans heavily on robust #PrimaryCare & requires a LOT of collaboration. Can it be spread elsewhere?

A look into experts discussing hospital billing and transparency policies aimed at reducing healthcare costs, how hospital concentration decreases care for Medicaid beneficiaries, and more in this week's newsletter. Check out our quick roundup of the issues driving the healthcare reform conversation! https://lnkd.in/eGmv6vhq

A number of other variables are impacting U.S. healthcare costs, including the COVID-19 pandemic, says Tara Krauss, QBE North America’s head of accident and health. “As it relates to the healthcare system, we had a mass exodus of nurses and staff who decided to either retire early or change fields due to the stress factors that were involved in managing the pandemic. Hospitals and provider systems ultimately had to—and continue to—pay more for nurses and other staff.” #covid #pandemic #health #risk https://lnkd.in/g6-Ruhux