In Focus

News & Insight from Chelko Consulting
Is COVID-19 Worse than a Root Canal?

Is COVID-19 Worse than a Root Canal?

COVID-19 had a dramatic impact on work and life. Health care changed dramatically too, with huge drops in emergency room use and an immediate shift to telehealth. But how about dental care? Did it get lost in the “work from home” shuffle? The pandemic’s impact may have actually been bigger on dental than on medical care and prescription drugs. read more…

Beware of the Fine Print

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

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?

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

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

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

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

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…

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