Friday, March 5, 2010

Wellness Program Integration

AMF Risk Management Solutions is pleased to market Primarily Care of RI's new turnkey solution wellness program "HealtheDividends". HealtheDividends will be offered as an option for employers alongside the AMF High Deductible Aggregate Wrap product.

Please contact an AMF representative for more information on how these two products can save employers money, as well as create a healthier population.

(617)770-0917 EXT. 301 or 315

Blue Cross Blue Shield of MA - 2009 Net Loss of $149.2 Million

According to a Blue Cross Blue Shield of Massachusetts recent news release the combined companies of Blue Cross Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. have lost a bundle of money on its 2009 calendar year. The combined after-federal tax net loss totaled $149.2 million.

Allen Maltz, Blue Cross Blue Shield of Massachusetts, Inc.’s chief financial officer attributes their losses to: “the result of an adverse employment market which reduced membership; increased utilization of medical services due to the seasonal and H1N1 flu; a rise in elective procedures such as knee, hip and back surgeries, and in behavioral health utilization; as well as higher than anticipated costs associated with merging the individual and small group markets”. As a result, the cost of premiums will sky rocket in the upcoming year with reports from seminars being an average increase of 30%.

Blue Cross Blue Shield of Massachusetts, Inc is the leading private health plan in Massachusetts, with 2,924,133 members; however, it will be interesting in the upcoming months to follow to see if they retain the business with the staggering increases.

Tuesday, February 23, 2010

How To Steady Upcoming Health Cost Increases

According to a study done by Mercer in a national survey of employer-sponsored health plans, "health plan costs rose at the slowest pace in a decade last year". The study was conducted to include 2,914 employers of all sizes. "The average per-employee cost of health benefits rose just 5.5% to $8,945". Mercer anticipates 2010 to prove similar in trend. In additional studies done by Towers Perrin, they predict by studying 300 large employers that the annual cost for active employee-only coverage is $5,124, the annual cost for employee-plus-one-dependent coverage is $10,500, and the annual cost for family coverage is $15,084.

So what does this mean for employers today? Well, studies point to cost saving success by implementing health management strategies as well as making the switch to account-based health plans. One of the big factors in controlling cost was the movement of small employers into low cost consumer-directed health plans. By raising the PPO deductibles, the employers picked up savings in the premiums. In addition, there has been a large focus on workforce health. Many companies have transitioned into wellness programs such as Primarily Care's HealtheDividends program. Many employers are learning that there are real savings to be had by bettering the health of their population. "Nearly three-fourths of employers that have measured the ROI in wellness programs say they are content with the year-over-year savings, lower utilization rate or improved health risks".

Another strategy many large employers are using is using health management incentives. Employers are finding that cost can be further contained with smoking cessation, routine primary care physician visits and scheduled doctors visits with emphasis on follow up care.

Consumer Driven Health Plans have become the focus on a lot of employers over the past year. Many employers are seeing the benefit in offering this type of program. "In 2009, CDHP offerings among employers with 10-499 employees increased from 9% to 15%, Mercer's research shows". There is opportunity to save by purchasing stop loss insurance on a high deductible health plan. It allows the buyer to obtain the most premium savings possible by electing the higher deductible; however, with the insurance, if claims run well, the employer has everything to gain and it will cost no more than the otherwise fully insured renewal premium. Another development in our product line includes the coupling of a mini-med or limited medical plan with our U.S. Health Options product. If the maximum plan expense for each participant is $20,000, the employee will be able to stretch their benefit dollars much greater as we can negotiate nationally many common procedures at a price that would be paid 100% by the plan.

Towers Perrin also offers a number of other strategies to combat the rising cost of health care for employees as well:

- Employers provide employee incentives. The employees must be motivated to join health wellness programs, biometric screenings and health risk assessments in order for a real change in cost.

- Social networking - employers are implementing these campaigns as they realize it can impact employee health and well-being. Blogs are a great way to communicate and create an open forum for discussion on health awareness issues and recommendations for a healthy lifestyle.

- Use of a health advocate - helps to manage a chronic condition or serious illness. By personalizing the experience the employee is provided with lifestyle coaching and integration of disability with medical care management.

- Technology - Always a positive aspect in getting information to patients faster as well as improving health and engaging consumers. New applications play an important role in transferring personal health records and monitoring biometrics.

With these changes as indicated by the Mercer study, we are seeing the benefit of these consumer driven health plans and realizing the potential of a healthy lifestyle. Much of the cost of health care is influenced directly by the way we live our lives and the value we put on our health and wellness. The programs offer structured support when correctly implemented and utilized; however, in the end it is always the ultimate responsibility of the plan participants. Creating education and awareness about these big issues is just as important as the programs created to follow through.

For further information on AMF Risk Management Solutions' products and cost containment ideas please feel free to contact Matt McKelvey, (617)770-0917 EXT 301,

Thursday, February 4, 2010

Health Care Reform - Medical Monopolies

Over the past year, The Obama administration’s push for health insurance reform has used insurance companies as the scapegoat. Insurance companies have been part of the problem for sure. They have stymied competition by “cutting deals with providers” to pay exorbitant charges for services. Collusion between insurance companies and hospitals was highlighted in a Boston Globe investigative article a short time ago. It works like this: The CEO of Blue Cross Blue Shield got together with the CEO of Partners Healthcare and agreed to pay the hospital a lot more money for services if the hospital would agree to provide Blue Cross Blue Shield with its “best discounts” off these inflated charges. This verbal agreement resulted in Blue Cross Blue Shield essentially eliminating, or at least putting at a great disadvantage, its competitors.

It is my belief that this type of arrangement has gone on all around the U.S., resulting in minimal competition and higher prices for medical care. As a result, see the example below of a recent medical claim from a hospital in Lubbock, Texas. Due to HIPPA regulations, I will not disclose the patient’s name or medical condition.

This inpatient stay was for a total of 52 days. The average length of stay nationwide for this condition is 29 days. Total billed charges were $1,016,000. The HealthSmart PPO discount of 40% brought the claim down to $610,000. Sounds like a great deal, right? Not so.

This claim was sent out to a company called NCN for further review. NCN can determine the hospital’s true cost of providing services through the hospital’s own numbers, in reports they provide to Medicare. NCN determined that this stay cost the hospital $134,600. The amount that Medicare would have reimbursed would have been $132,562. The U.S. average cost based on 14,688 studied cases would have been $64,864.

In summary, this Lubbock Texas hospital marked up the cost of care from seven to fifteen times what it should have been. Our Congress should focus on this type of abuse by having hospitals and other providers post their prices for all services in advance to afford consumers and insurers to shop for the best value. The price for services should not be different for consumers or insurers. One competitive price for all patients would greatly reduce the cost of healthcare for all without the government spending one tax dollar. Couple this with malpractice reform and combine with a health savings account and we have a model that works and breaks up the insurance company/medical provider monopoly. This is a solution we cannot afford to go without.

If you believe the above solution will help us all, please forward this e-mail to your Congressional Representative for your state and encourage them to offer true competition based medical reform without spending any more tax dollars. If enough concerned citizens do this, we can make healthcare more affordable for all.

Please click here to find your Congressional Representative’s contact information:

Please click here to find your state Senator’s contact information:

Thursday, December 10, 2009

The Buzz: Wellness Programs & High Deductible Health Plans

There are many benefits to implementing a wellness program for your employees, coupled with a high deductible health plan. A lot of attention has been placed recently on the pros and cons of implementing a wellness program as part of your group health care plan. Many large employers have put these types of programs in place in order to create a healthier population that will eventually lead to a reduction in claims and lower health care cost. Some have even gone so far as to add free work out facilities in their office building to promote getting in shape and creating healthier lifestyles. Work site wellness programs with the correct incentives can help support healthy behaviors.

It is argued that wellness programs can be effective in the early detection and prevention of serious diseases. Many wellness programs encourage and stress the importance of routine check ups in order to provide early intervention. A recent study indicated that an obese employee costs the employer an additional $2,400 in medical expenditures each year. Another large problem that has been oftentimes controversial is smoking. Smoking can increase the cost of health care $2,700 annually per employee. By providing some resources, education and services to assist in smoking cessation the employer can gain by creating a healthier population. Furthermore, up to 70% of claims cost is related to behavioral factors.

Some of the additional benefits of a work site wellness program include:

- enhanced recruitment and retention of healthy employees
- decreased rates of illness and injuries
- reduced employee absenteeism
- improved employee relations and morale
- increased productivity
- overall reduction in health care cost

One of the ways that an employer can promote participation in a wellness program is to provide financial incentives to employees who choose to enroll in the program. By creating additional employer contributions on behalf of the employees who join the wellness program, the employer can reward the people who work towards becoming healthier. These differing contribution levels are easily achieved by designing different options in the underlying plan of benefits in a partially self funded high deductible health plan.

The high deductible health plan is a great solution because the employees can maintain their current level of benefits while still carrying a Blue Cross Blue Shield or other fully insured carrier ID card. They will have the same access to their regular providers but the employer can take advantage of cost savings by partially self funding. By electing aggregate wrap stop loss insurance, the employer will pay no more than their fully insured renewal premium in the worst case scenario, but have everything to gain should claims run well. Furthermore, with a Health Savings Account in front of the partially self funded plan, the employees can decide how to best use their benefit dollars. One option is to allow different contributions to the health savings account by the employer depending on the employee's participation in the wellness program.

There are many different ways to design the plan and it can be flexible with the desires of the employer in the benefits he/she would like to offer the employees. The overall goal of both products is to save money on health care cost and promote a healthier environment and attitude. By adding a health savings account, the employees can decide what care and treatment to receive, as well as deciding where the best value is for their money. Consumerism and healthier tendencies are ever important in lobbying for more affordable health care.

Please visit this website for more information about wellness and HDHPs or to request information on obtaining a quote.

Friday, December 4, 2009

Overview of Alarming Sections in the Health Care Reforrm Bill

Page 22 of the HC Bill:  Mandates that the Govt will audit books of all employers that self-insure!!

Page 30 Sec 123 of HC bill:   THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.
Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

Page 42 of HC Bill:  The Health Choices Commissioner will choose your HC benefits for you. You have no choice!

Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise.

Page 58 HC Bill:  Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued!

Page 59 HC Bill lines 21-24:  Govt will have direct access to your bank accounts for elective funds transfer.

Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).

Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.'

Page 85 Line 7 HC Bill:  Specifications of Benefit Levels for Plans -- The Govt will ration your health care!

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services.  (Translation: illegal aliens.)

Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan.

Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!)

Page 102 Lines 12-18 HC Bill:  Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.)

Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly.
Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make.

Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)

Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees AND their families.  (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)

Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll!  (See the last comment in parenthesis.)

Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll.

Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.

Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Page 195 HC Bill: Officers & employees of the GOVT HC Admin..  will have access to ALL Americans' finances and personal records.

Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax."  (Yes, it really says that!)

Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors.  (Low-income and the poor are affected.)

Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in -- you will all be paid the same! (Just TRY to tell me that's not Socialism!)

Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc.  (Literally-- the value of humans.)

Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries.

Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs.

Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!

Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (

Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission -- the Govt will penalize you.

Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!)

Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion.  (The Govt is mandating that hospitals cannot expand.)

Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required.  (Can you say ACORN?)

Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.)

Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc.  (Forcing people into the Govt plan)

Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!'   Unbelievable!

Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee."  (Can you say HC by phone?)

Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult."  (Think senior citizens end-of-life patients.)

Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc.  (And it's mandatory!)

Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources; & nbsp;guiding you in death.. (Also called 'assisted suicide.')

Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life."  (The Govt has a say in how your life ends!)
Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates.

Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.  (AN ORDER TO DIE FROM THE GOVERNMENT?!?)

Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.  (I wouldn't want to stand before God after getting paid for THAT job!)  

Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life!  (Again -- no choice!)

Page 469: Community-Based Home Medical Services = Non-Profit Organizations.  (Hello?  ACORN Medical Services here!?!)

Page 489 Sec 1308: The Govt will cover marriage and family therapy.  (Which means Govt will insert itself into your marriage even.)

Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services.