In Focus
News & Insight from Chelko Consulting
Beware of the Fine Print
There’s a troubling trend among large administrators to prevent plan sponsors from effectively auditing their claims adjudication. Unfortunately, audits are one of only a few ways employers can hold TPAs and PBMs accountable for applying reasonable claim controls. After all, if they win new business by having broad networks, lower discounts, and lower fees, the easiest way to prop up that facade is to automatically pay almost every claim submitted by providers. read more…
Mental Health First Aid
The pandemic has disrupted work, family, and social routines, causing a rise in anxiety, depression, substance abuse, and other behavioral health issues like never before. That’s why we were so pleased to recently sponsor a Mental Health First Aid course for a group of our clients and roundtable members. read more…
Can Stop Loss Keep Living Up to its Name?
Anyone who’s followed our firm lately has probably heard us talk about the $1 million+ drugs already here and those coming to market over the next few years. While early in the game, we’ve already had a few clients incur enormous claims for these budget-busting medications.
It’s likely many of you reading this are familiar with some of the well-known drugs out there, but according to our latest survey, 73% of employers do not have a plan in place to avoid surprises related to high cost therapies like the ones we’re discussing. And while some of you may have a stop loss policy in place as a safety net to protect against such catastrophic claims, unfortunately, that may not be a foolproof strategy. read more…
COVID-19 Vaccine Considerations for Employers
Since the onset of the COVID-19 pandemic, companies across the globe have been working to develop a COVID-19 vaccine. As the pandemic continues on and vaccine clinical trials progress, there may be a possibility of a COVID-19 vaccine being approved for use in the foreseeable future.
The prospect of a vaccine is exciting to most, but also presents challenges for employers. Employers may be considering whether vaccination will be encouraged or mandated.
Employers must navigate the inherent legal risks and logistics of mandating or encouraging employees to receive the COVID-19 vaccine. To do so, employers should seek legal counsel to discuss which course of action is best for their organization. This article provides a general informational overview of considerations for employers. read more…
It’s Time to Speak Up
When I was working in a large health system’s patient safety department, we empowered patients to be their own advocate. If something didn’t seem right, feel right, or had not been explained clearly, we encouraged them to speak up.
This is something I’ve been thinking about quite a bit lately as mega high-priced cell and gene therapies make their way on the market with only scant acknowledgement from plan sponsors. As evidenced by our frequent posts, webinars, and pretty much sharing with anyone who will listen (sorry Amazon delivery guy), our firm has been closely ― some would say obsessively ― following these emerging therapies. read more…
Preparing for an Unprecedented Open Enrollment
Open enrollment following the COVID-19 pandemic will be unlike any other in recent memory. Many organizations are still trying to recover from extended closures and maintain safe working environments—open enrollment is the last thing on their minds. Yet, procrastinating on enrollment planning can actually cause more issues than it solves. This article explains what employers can expect this enrollment period and how to prepare. read more…
Brace for Impact
We’ve all likely seen at least one of the countless movies sharing this plot. You know the script: Large rock hurtles through space on a collision course with earth, leading to what will result in a mass extinction level event. That is, of course, unless divine intervention or the planet’s greatest minds hatch a plan to divert path of said rock.
Forgive our sense of the dramatic (and love of clever word play), but this scenario recently came to mind as we awaited what we thought was the imminent market introduction of gene therapy Roctavian. If you follow these sorts of things, you would know that Roctavian just received a rejection from the FDA. read more…
Meeting Demand for Rx Benefit Services: Chelko Adds Another Pharmacist
Responding to client needs within its rapidly expanding drug benefits management practice, the Chelko Consulting Group recently welcomed Lucia Vescera, PharmD, RPh.
Before joining Chelko, Vescera was instrumental in the opening and URAC accreditation of the Cleveland Clinic Specialty Pharmacy where her clinical focus was hepatology, infectious disease, and preventative cardiology. Her role also involved clinical consulting for solid organ transplant patients. read more…
Chelko Strengthens Experience and Actuarial Expertise by Adding Parsons
With the recent addition of benefits industry veteran Steve Parsons, the Chelko Consulting Group continues to expand its team of subject matter experts.
Throughout his career, Steve has focused on optimizing the value of clients’ employee benefits programs. His insights, creativity, and actuarial expertise have been key in building foundations for short- and long-term plan management success.
read more…
Be Prepared: New Wave of Costly Rx Claims on the Horizon
If recent events have taught us anything, it is to be prepared for the unexpected. While none of us could have fully predicted the dramatic impact of COVID-19 on our families, organizations, and the world economy, hindsight reveals safeguards we might have put in place to lessen the damage.
Ironically, this is a subject I had been wrestling with well before the coronavirus was receiving any attention from the international media. Those of you who follow our firm’s work know we have long been concerned about the growing economic threat posed by rising specialty drug costs to employer-funded health plans and their members. It actually dates back to 2005, when I first learned about a $125,000 oncology drug that didn’t save lives. On average, it only extended life by less than two months of sub-optimal living. read more…
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Westlake, Ohio 44145
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Email: info@chelkogroup.com
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Phone: 614.869.4140