In Focus

News & Insight from Chelko Consulting
Showing What’s Possible: A New Standard for High Performance

Showing What’s Possible: A New Standard for High Performance

Roger Bannister’s breaking of the four-minute mile barrier is a significant moment in the history of athletics. The achievement was not only a testament to his athletic prowess but also a demonstration of human determination and the breaking of mental barriers. His record-breaking run sparked a surge of interest and belief in the potential of human athletic performance. read more…

What to Do When You Can’t Attest

What to Do When You Can’t Attest

Among other things, the Consolidated Appropriations Act (CAA) requires group health plans to attest that they are in compliance with the CAA’s gag clause prohibition. TPAs and PBMs seem ready to attest (or sub-attest).

But what’s an employer to do if its plan is not in compliance? And what if the TPA or PBM doesn’t contractually restrict the data, but in practice restricts the data? Is it okay for a TPA or PBM to restrict information as long as they don’t contractually do so? This sure seems contrary to the intent of the law! read more…

To be the Best, Prepare for the Worst

To be the Best, Prepare for the Worst

Whether we’re talking stop loss premiums, skyrocketing Rx costs, or even a fictitious avian flu outbreak, the recent Deep Dive Roundtable meeting sent a clear signal regarding the importance of staying vigilant when it comes to plan management.

Our seventh such annual gathering featured leading employers enjoying robust conversations around benefit strategies and spend for the roughly 50-company cohort, allowing attendees to explore how their plans stacked up against others in the market. read more…

Reality Check: PBMs Make Commissions for Selling Drugs

Reality Check: PBMs Make Commissions for Selling Drugs

Most PBMs would describe their mission as “managing” the cost of drugs and making them more affordable for customers (benefit plans and their members). They like to position themselves as loyal negotiators working on behalf of plans in dealing with drug manufacturers.

This role has led to two key pricing components: discounts and rebates. Both are touted by the industry as important ingredients in the effort to lower drug benefits costs. But are they really? read more…

Can AI Solve the Problem of Rising Healthcare Costs?

Can AI Solve the Problem of Rising Healthcare Costs?

It seems like artificial intelligence (AI) has been hyped by every news outlet on the planet recently. We may look back at 2023 as the year AI received as much press as when the internet forced its way into the public consciousness as a transformational global communications and information network. read more…

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