1. "Be careful about reading health books. You may die of a misprint."---Mark Twain
Mr. Twain's quote presents a good segue into my commentary....... You may have noticed a few months lapse in
my newsletter delivery. Concerned that healthcare reform news was drowning the market at such a rapid pace, I
chose not to fuel the fire on similar topics and certainly not get caught in sharing information unless through a
trusted source. Wrong information at this stage of the Health Care Reform process may not cause you to die, but
it could have a lasting impact on your benefit program, its perceived value, or cost a compliance penalty.
The Supreme Court is still tight lipped and there are too many speculations and predictions to share on which way
the healthcare market will go pending this decision, not to mention November's election.
I chose instead to research new material. A special request was made for information that can be shared (either
through link or cut and paste) on an employee level that can help communicate, educate, and build
better consumer-centric awareness needed to help control cost.
With that in mind I've added the topic "Know Your Employee Benefits" to the existing group:
Know Your Employee Benefits- Tips to become a better consumer of healthcare
Financial- Analytics, Trends, Surveys and Strategies
Legal- Compliance, Legislative Updates and Impacts
Human Resource Center- Benefit Trends: State and Federal Mandates
Worksite Wellness Initiatives-Trends in Employer Health Initiatives
Industry Spotlights- News impacting a specific industry
Horton Workshops- Notice of Train the Trainer Seminars and Webinars
I hope you find this month's issue and new format of interest.
Sincerely,
Mike
Our Mission: To Help Our Clients Drive Down Cost, Employer Workload and Anxiety
__________________________________________________________________________________________
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
2. Know Your Employee Benefits
10 Easy Ways to Stretch Your Health Care Dollars
To quote Benjamin Franklin, "An investment in knowledge pays the best interest." Since Health Insurance 101 is
not taught in school, at any academic level, we need to intervene. We can control the cost of healthcare far better
if employees understand how it works before a claim.
With that in mind "Know Your Employee Benefits" will feature key educational newsletters for you to share with
your employees.
This issue's feature, '10 Easy Ways to Stretch Your Health Care Dollars'reviews the following: Understand how
your benefit plan works; Use of in-network providers; Only go to the hospital emergency room for true
emergencies; Carefully check all medical bills; Live a healthy lifestyle; Make careful decisions about prescription
drugs and more. Click here for a copy.
Financial
Healthcare Costs for American Families in 2012 Exceed $ 20,000
Milliman, Inc. released their 2012 Health Index citing a typical American family of four receiving healthcare
through an employer-sponsored Preferred Provider Organization (PPO) plan costs $ 20,728 nationwide, in
Chicago, $ 23,551.
Some good news amongst the data was that the average increase this year was just below 7%, the lowest since
they started doing the analysis. Good as that is, by my calculations, inflating the $ 23,551 over the next 6 years at
7%, a family plan would have a projected premium of $ 35,343 which is $ 7,843 over the Cadillac tax threshold of
$ 27,500 due to start in 2018. The plan would be charged a non-deductible excise tax of $ 3,137 per family that
year.
For an overview of cost drivers, geographical cost differences, cost sharing and PPACA impacts, click herefor the
full report.
Explaining High Health Care Spending in the United States
With Healthcare Reform at its midpoint of change and temporarily stalled by a Supreme Court intervention, many
are asking questions about what other countries do and how our costs compare.
A study worth the read was published by Commonwealth Fund, a private foundation aiming to promote high
performing health care with improved quality, better access and greater efficiencies.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
3. A few key findings from the study titled: Explaining High Health Care Spending in the United States: An
International Comparison of Supply, Utilization, Prices and Quality include:
Healthcare accounts for 17% of the U.S. economy, compared with 12% or less in all other countries. It is
a key component in an industrialized country's economy providing a major source of employment for
highly skilled workers. In addition, product and technology innovation creates new markets.
In all industrialized countries with the exception of the United States, health care affordability is ensured
through universal insurance-based or tax-financed systems.
In the U.S. public funds provide insurance programs like Medicare, Medicaid and through a tax policy that
supports employer-sponsored health insurance, Veterans Health Administration and research by the
National Institute of Health.
U.S. health care spending is far greater than any other industrialized country, as much as 3 times the per
capita of Japan with far worse outcomes.
U.S. has a smaller elderly population and fewer smokers, but higher obesity rates. Prices for drugs, office
visits and procedures are highest in the U.S.
The U.S. has below-average supply and utilization of physicians and hospital beds. There are 2.4
physicians per 1,000 of population vs. as many as 3.8 in Switzerland and 4.0 in
Norway. Remarkably, Japan had the least number of physicians at 2.2 per 1,000 but also had the most
doctor consults with 13.2 per capita vs. 3.9 in the U.S.
For a copy of the full report click here.
Legal
Study Shows Individual Health Policies Don't Pass the Test
Assuming PPACA continues its course, the market will need to quickly prepare for the 2014 planning cycle with
one of the main issues being plan design requirements. The plans will need to pay at least 60 percent of
subscriber's health expenses and include "essential benefits", still to be finalized by most states, and maximum
out of pocket definitions on individual policies of $ 6,050 for individuals and $ 12,100 for families (defined by HSA
maximums).
As the market exists today, a recent study found that over 51% of all individual plans offered would not meet the
requirement for the state based Insurance Exchange. Group plans tend to be more generous in design so they
are not as much at risk. The study was conducted by The Commonwealth Fund, a New York research foundation
with lead author Jon R. Gabel from the University of Chicago.
PPACA will narrow the gap between individual and group benefit levels. Individual policies will become more
benefit-rich and cover more services than they do currently. The outcome however will mean higher costs.
Insurance premiums in the Insurance Exchange for individual policies will be considerably higher than they are
today. Until costs subside (a prediction suggested based on administrative savings due to a greater number being
insured) affordability could ultimately be a question of subsidies from the government or subsidies from one's
employer.To see a copy of the study click here.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
4. Healthcare Reform News Alert
The Horton Group provides monthly State and Federal Legislative updates including recent rulings on Health
Care Reform (Patient Protection and Affordable Care Act- PPACA).
The current issue includes the following topics: FAQs on Summary of Benefits and Coverage (SBC); Final Rules
on Medical Loss Ratio (MLR) notices; New HSA Savings Account Contribution Limits for 2013; Calculating and
Paying the Comparative Effectiveness Research Fee and Guidance on Federally Facilitated Exchanges. For the
full newsletter click here.
Human Resource Center
Nine (9) Leading Trends in Rx Management
"Benefit providers are investing as never before to help people make better decisions to improve health
outcomes, save money and maintain robust benefits", according to a report from Express Scripts.
The Medco/Express Scripts report "9 Leading Trends in Rx Plans Management" states more than 75 percent of
plan sponsors say behavior-driven conditions are the greatest contributors to plan costs.
Last year non-adherence alone led to more than $317 billion of avoidable medical costs. Eliminating this cost
could have a major impact on Healthcare Reform.
With Pharmacy Benefits accounting for over 21% of overall healthcare costs, you will want to read this report,
click here
Worksite Wellness Initiatives
Americans Work Harder, are More Productive and Miss fewer Workdays.....
But only if you've adopted a Worksite Wellness Culture.
"Forty-one percent of workers agree that having a wellness program encourages them to work harder and
perform better at work", says a Harris Interactive Poll released by the Principal Financial Group. Also reported,
52% of workers (up from 37% last year) said they have more energy to be more productive at work by
participating in a wellness program. Another 35% (up from 28%) said they have missed fewer days of work by
participating in a wellness program.
To review other findings including: Wellness Benefits Employees Desire, Incentives, Program Outcomes and
more click here.
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
5. Industry Spotlights
Some Insurers Paying Patients Who Agree To Get Cheaper Care
In a release from Kaiser Health News: Anthem Blue Cross and Blue Shield has been testing a concept of
providing cash rewards for using lower cost providers. Individuals can receive $ 50 to $ 200 if they get a
diagnostic test or elective procedure at a less expensive facility than the one their doctor may have
recommended. The offer covers 40 services, from standard radiology tests such mammograms and MRIs to such
surgical procedures as hip and knee replacements, hernia repair, bariatric surgery and tonsillectomies.
Physician Salaries Drop This Year
According to an exclusive research report of over 24,000 physicians conducted by Medscape, an authority in the
medical field, 26% of U.S. physicians earned less this year compared with last year. Radiologist, Orthopedics and
Cardiologist still top the list.
The report also found increased dissatisfaction. If given a do-over, 54% of physicians said they would choose
medicine, down from 69% last year. Also, only 41% of physicians said they would choose the same specialty and
25% would choose the same practice setting, down from 50% last year.
To view Medscape's 2012 Physician Compensation Report to find out salaries by specialty and which specialties
are earning more this year click here.
This would probably not be a good time for the PPACA law to follow through on the scheduled 27% Doc Fix cut in
Medicare rates.
Horton Workshops
Horton Workshops are designed to keep busy professionals current on a range of insurance related topics. The
Horton Group engages some of the brightest minds in the country to help you fine-tune your professional skills
and assist in achieving your organizational goals. Our workshops are offered at several convenient locations
throughout the year. In addition, we can present these workshops at your company location or for your
association or trade group.
As always - if you would like to register for a webinar or workshop, please do so via the following
link:http://www.thehortongroup.com/Insurance_Workshops/
ph: (708) 845-3126 • mike.wojcik@thehortongroup.com
