Deep Dive Roundtable Makes a Splash

Deep Dive Roundtable Makes a Splash

We believe employers who know their numbers make better plan decisions. We also believe there is value in employers talking to each other about their respective challenges and solutions.

These are the fundamental principles behind our annual “Deep Dive” Roundtable in Columbus. It’s a simple concept really — as plan managers, it’s important to understand what’s driving costs. But tracking and analyzing health plan performance data can occasionally get lost in the recurring waves of vendor implementations and renewals, wellness events, open enrollment, HRIS system changes, or whatever else is the benefits priority of the quarter. (more…)

Right to Try: Beneath the Surface

Right to Try: Beneath the Surface

A bill allowing patients with serious illnesses to try unproven experimental treatments has been approved by Congress and is now on its way for signature by a supportive President.

For the sake of this discussion, let’s put aside some of the safety and ethical concerns. On the surface, everything may seem palatable from a plan sponsor perspective. But that’s until you start pondering some of the potential issues lurking beneath the surface. (more…)

Back to the Future: Is it Time to Bring Back R&C?

Back to the Future: Is it Time to Bring Back R&C?

Most if not all medical third-party administrators (TPAs) use “shared savings” programs to reduce the cost of non-network claims.

In the absence of a shared savings program, plans pay billed charges without any discounts after members pay the higher non-network copay/coinsurance. But with shared savings programs, TPAs use secondary (aka “blind”) networks, or negotiate directly with providers for discounts. And in return for their efforts, TPAs usually keep 25% to 35% of the savings. Are you following? (more…)

Are Benefits a Popularity Contest?

Are Benefits a Popularity Contest?

We recently wrapped up a series of roundtable meetings in various cities where we discussed results from an employer survey we conducted on Plan Design Considerations & Innovations. Attendees at each of the roundtables enjoyed spirited discussion of the survey findings in general and of specific plan management strategies. (more…)

Seeing Clearly: The Cost of a Miracle Cure

Seeing Clearly: The Cost of a Miracle Cure

Preparing to pay for a new era of effective gene therapy

Could you imagine seeing stars in the night sky for the first time or even the site of your own parents’ faces after ten or even twenty years of significant visual impairment? The Food and Drug Advisory Committee heard personal testaments like these from patients explaining their miraculous results as part of two experimental gene therapy trials.

More than 25 years in the making, the FDA approved Luxturna® (voretigene neparvovec-rzyl), the first gene therapy for an inherited disorder involving a progressive form of blindness, typically starting in early childhood. Currently, no pharmaceutical alternative is available for these patients. (more…)