In Focus

News & Insight from Chelko Consulting
Managing Orphan Drugs in Your Health Plan

Managing Orphan Drugs in Your Health Plan

While the rapid evolution of modern medicine offers innovations in patient care, the resulting advancements are placing a fair amount of stress on our existing service delivery and payment models.

A prime example is orphan drugs — defined by the FDA as drugs and biologics for the safe and effective treatment, diagnosis or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S., or that affect more than 200,000 persons but are not expected to recover the costs of developing and marketing a treatment drug. read more…

Keeping Score: Annual Claims per Employee

Keeping Score: Annual Claims per Employee

Knowing your organization’s number of annual claims per employee is an important piece in understanding its medical cost drivers.

When viewed in conjunction with cost per claim, you can quickly assess if an upward surge in medical claims per employee is due to increased utilization, rising cost of claims, or both. Once that’s determined, you can more effectively address the associated cost drivers.

Let us know if you would like to learn more about how to improve your score in this area. read more…

Keeping Score: What’s Your Rx Spend PMPY?

Keeping Score: What’s Your Rx Spend PMPY?

Prescription drugs can be difficult to manage in a plan, especially if you don’t have a good grasp of all the related metrics.

  • Do you know what you’re spending on every member in a year?
  • How do your Rx numbers compare to our database?
  • Do you know what’s causing the changes in your drug costs year-to-year?

There are several strategies and tools employers can deploy to mitigate rising prescription drug costs. But first you need to track these numbers to get at the root cause.

Let us know if you would like to learn more about how to improve your score in this area.
read more…

Survey Reveals Employer Attitudes Regarding Private Exchanges

Survey Reveals Employer Attitudes Regarding Private Exchanges

The 5th Annual Employer Survey on Private Exchanges indicates exchanges appear to be gaining some traction with post-65 retiree groups, but aren’t driving change when it comes to active employees.

Conducted by the Chelko Consulting Group, in cooperation with the Worldwide Employee Benefits Network (WEB), the annual survey tracks employer attitudes pertaining to the viability of private exchanges as a healthcare coverage strategy for active and retired employee groups. read more…

Keeping Score: Know Your Net Cost

Keeping Score: Know Your Net Cost

Most employers benchmark their gross health plan cost on a per employee per year basis. The net amount employers pay (gross health plan costs minus employee payroll contributions) is also an important measure to track in support of sound plan management. As you can see, the amount can vary from one employer to another by thousands of dollars per employee.

Where do you fall in the range above? Knowing how that number matches up against your budget, benchmark, and last year should be a priority. It goes without saying that having answers to questions like this at your fingertips enables you to better manage your plan.

Let us know if you would like to learn more about answering this question, tracking your numbers, and better managing your plan.
read more…

Mr. President: Please Write a New Prescription for the FDA

Mr. President: Please Write a New Prescription for the FDA

Dear Mr. President:

First of all, congratulations on your stunning victory. You’ve re-written the playbook on how to get elected president. Your campaign strategy and tactics will be studied by scholars and politicians alike for years to come.

What you are now reading is an “open letter.” It’s addressed to you, but also intended to have a wider readership. We know you’re dealing with a number of pressing matters right now, but we want to make sure that you are aware of an important issue impacting the health of our people, and our nation’s finances. read more…

Keeping Score: Ouch! Average Cost per Specialty Drug Script

Keeping Score: Ouch! Average Cost per Specialty Drug Script

Specialty drugs can carry hefty price tags. Our data shows companies see an average specialty drug cost per script of over $5,000 — with that number more than doubling for some. This high per drug cost demonstrates how just a few specialty prescriptions can have a dramatic impact on your plan.

Fortunately, there are several strategies employers can deploy to mitigate rapidly increasing specialty drug costs.
 
How do your plan results compare? Let us know if you would like to learn more about how to improve your score in this area.
read more…

The Painful Truth: Opioids and Your Health Plan

The Painful Truth: Opioids and Your Health Plan

“You know, just about everybody out here is on painkiller drugs. They’ll steal it right out of your mail box.” That’s what one of our consultants was told by his aunt, who resides in semi-rural Portage County, Ohio. The same statement could be made to most benefits managers across the country, whether their aunts reside in a pastoral rural setting, the Ritalin-infested suburbs or the inner city. It may be easy to consider drug abuse – especially of prescription opioids – as “society’s problem.” But it is a problem for nearly all plan sponsors, particularly if it’s not high on their agenda. read more…

Keeping Score: Read This in Case of Emergency

Keeping Score: Read This in Case of Emergency

Emergency room visits can quickly add significant dollars to a plan spend and result in unnecessary or inappropriate care to members. Knowing how you’re performing in this area is essential to good plan management.

Studies have shown that up to 70% of emergency room visits are not for the treatment of true emergencies. At an added cost of $1,000 or so per visit, employers may be overspending up to $150 per plan member per year on unnecessary ER services.

How do your plan results compare? Let us know if you would like to learn more about how to improve your score in this area.
read more…

INSIGHTS & RESOURCES
In Focus Blog
Legislative Updates

CONTACT
Cleveland Office
24651 Center Ridge Rd, Suite 110
Westlake, Ohio 44145

Phone: 440.892.2600
Fax: 440.892.8920
Email: info@chelkogroup.com

Columbus Office
Phone: 614.985.3640

Employee Phone Directory