Health Management

New Specialty Medications Expected To Cost Billions

specialty medication

Drug costs are expected to rise in the next few years primarily due to the high costs associated with specialty medications. While less than 1% of a typical employer group population utilizes specialty medications, they can account for up to 25% of a group’s overall drug spend, and sometimes more. Historically, specialty medications were produced to treat rare diseases or specific health problems that impacted relatively few individuals. This trend has been reversed in the most recent years, with many of these high cost medications being developed to cover more common problems. The drug Solvaldi recently received a great deal of attention in the media due to it’s very high cost in treating Hepatitis C even causing some health policy experts to cite the need for cost controls. More concerning is a warning CVS released last week regarding the pending approval of two new specialty medications that fight cholesterol.  These cholesterol medications called PCSKG inhibitors have been developed to treat patients who are intolerant to normal statin protocol. They come with a big price tag as these drugs are expected to cost $7,000-$12,000 per year. Herein lies the problem, a patient could be on these medications for a lifetime, unlike […]

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Top Tips To Gain Executive Support For Health Management

health management

According to the Wellness Council of America (WELCOA), gaining executive support for your work site health management initiatives is a crucial first step to a successful program. Leadership support is a significant driver in getting employees to pay attention to and engage in the program. An executive champion serves to communicate the program to the masses, and sets a positive example of the desired healthy behaviors. However, this is often easier said than done. If you are struggling to get your C-Suite on board with your plans for a health management program, try following these key steps: 1. Establish Common Ground. How does the program tie in with your overall business strategy? How can you relate it to the company’s mission and vision statements? The CDC breaks down the reasoning for having a health management program into three key arguments: the Health Care Cost Argument, the Productivity Argument and the Great Please to Work Argument. Consider, for example, that you are part of a small company, thus your medical insurance is community rated. The Health Care Cost Argument may not be as important, but your field may be highly competitive, and being considered a “Best Place to Work” could be […]

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Is Legally Required Telemedicine In Our Future?


Wouldn’t it be nice to just “phone in” your swimmers ear symptoms and get a prescription for the drops? How can a physician possibly diagnose accurately with only a phone call? According to the American Telemedicine Association, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.” On one hand, there are a growing number of telemedicine practices expanding their businesses. While on the other hand, there is still a considerable difference of opinion in the medical community around the ethics and effectiveness of telemedicine. Against this back drop, the state of New York now requires that telemedicine benefits be covered the same as other physician visits siting access and improvement of care and significant cost savings for the state Medicaid program.  Ultimately, this type of state requirement is a significant expansion of the expansion of telemedicine. A recent Deloitte business report estimates that this year there will be 100 million telemedicine visits globally, with a potential cost savings of over $5 billion compared […]

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What The Triangle’s Healthiest Employers Have In Common

tbj healthiest employers

In December, the Triangle Business Journal awarded the title of Healthiest Employer to 35 companies across the Triangle at their annual luncheon. Hill, Chesson & Woody would like to congratulate all of the winners on their hard work, including eight of our clients who were awarded this honor. The organizations varied across industries, from manufacturing to municipalities and technology firms to law firms. The employers also covered a wide range of sizes, from less than 30 to over 4,000 employees locally. These companies didn’t seem to have much in common besides being the healthiest in the region. As I sat listening to synopses of their programs, though, two themes were apparent across the organizations. First, there was a clear focus on developing and maintaining a culture of health in the work environment. This was realized through a variety of facets, but the most successful companies included the health of their employees in their company values and their overall business strategy. Once a healthy culture became a priority for the company, these employers looked at what other characteristics needed to fall into place to make this a reality. This is not a one person job – they developed wellness committees that […]

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FSA Balances – Time to Spend Down or Roll Over


Flexible Spending Accounts allow employees to set aside a portion of their income on a pre-tax basis to use for qualified expenses.  For 2015, the maximum amount that can be put in an FSA is $2,550.  Participation in an FSA and/or the amount elected, has historically been low due to the use-it-or-lose-it rule.  If the money was not spent by the end of the plan year (or during the next 2.5 months for employers that elected a grace period), the balance was forfeited. Beginning late last year, employers have the ability to offer a $500 rollover on their FSA.  Due to this change, participation in an FSA is expected to increase at employers that adopt the rollover feature.  If an employee makes a $500 FSA election, they can roll over the entire amount if they don’t spend any of the money.  For employees who make a higher election, as long as they have $500 or less at the end of the year, they can roll over the remaining balance.  The employee can still make full election for the next year, regardless of the rollover amount.  Employees need to be reminded that if an employer elects to have the $500 rollover feature, […]

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Controlling Pharmacy Costs – What Is It Worth?

pharm cost

As I contemplate employer concerns for 2015, I came across an article from Forbes about the 5 trends employees will see as options for plan design adjustments. One of the key elements employees will see is a more concerted effort to control pharmacy costs as we continue to see new specialty medications hit the market. The most recent and most expensive being Sovaldi, the Hepatitis C treatment that cures over  90% of its users. However, this medication costs around $84,000 for a 6 month treatment. This is causing a lot of angst for employers, insurance carriers and even the federal government, where nearly 30% of the users are receiving treatment through Medicaid as referenced in this article. The major question being asked about this medication is: is it worth it? At $1,000 a pill and nearly 4 million Americans that could seek treatment for Hepatitis C, Sovaldi comes with a steep price tag. This will, inevitably, place a great burden on health plans. To answer this question, I would look two recent articles, one from VeriskHealth and a second from Forbes. Both discuss the benefit of such a high priced medication and how it outweighs the cost. While Sovaldi and […]

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How Do E-Cigarettes Fit Into Your Workplace And Wellness Policies?


More employers are beginning to review the use of e-cigarettes in their workplace.  Currently, no states have completely banned e-cigarettes.  However, several states are prohibiting the sale of these items to minors and have included them in their indoor smoking bans.  Now employers have some tough decision to make.  Should these devices be banned or could they be seen as a tobacco cessation device – helping employees to kick their tobacco habit? As with everything, there are two sides to this issue. Some will argue these devices eliminate the harmful carcinogens found in most tobacco related products, and therefore are not a health hazard.  Others claim that e-cigarettes are designed to still deliver the nicotine punch, which is addictive in any form.  It is also just as confusing when it comes to how e-cigarettes will fit into a wellness program.  There is no mention of e-cigarettes in the regulations of the Affordable Care Act, but the terms “not smoking” and “smoking cessation” are seen in reference to an employer’s wellness programs and possible incentives to qualify for a program reward.  The FDA currently does not regulate or recognize this as a smoking cessation device.  Most employers are not recognizing this […]

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Healthcare Cost Transparency – There’s An App For That

mobile healthcare cost

There is a lot of talk about transparency in the cost of healthcare. Providing cost, quality, and other information before treatment lowers costs, improves outcomes and goes hand in hand with encouraging employees to be better consumers of healthcare. However this poses a two-fold challenge: 1) having a tool available for employees to be able to make informed decisions, and 2) getting them to use it. Providing this information in a convenient, practical manner is key. Well, there’s an app for that. UnitedHealthcare has released an app, Health4Me, which can be used by both UHC members and non-members. This app compares expenses and outcomes for many services and procedures. It allows consumers to find healthcare providers, urgent care centers, and emergency facilities, as well as average costs for over 520 medical services. Additionally, the app provides education regarding managing healthcare costs and improving health. The app, which has been available to UHC members since 2012, can now be used by anyone with a smart phone. Of course turning employees into better healthcare consumers requires more than transparency of cost and quality, but it is a necessary part of a strategy to engage employees in making informed decisions. Adding plan design features […]

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What Lies Ahead For Worksite Wellness Programs?

workplace workout

Earlier this week, Blue Cross and Blue Shield of North Carolina (BCBSNC) announced that they will no longer award premium credit to employers with fewer than 100 eligible employees based upon participation in their Healthy Outcomes Group Wellness Program.  We anticipate this to be a trend among all carriers for similar sized groups. While this news may come as a surprise to many, when you think about the change to community rating  that is scheduled to launch in 2016, it begins to make more sense . In this upcoming change, all fully insured groups with under 100 employees will no longer be impacted by claims experience or health factors. This begs the question as to whether employers in this size market segment will continue to see value in spending time and resources on worksite wellness and medical management initiatives. Certainly employers who move to a self-funded model could continue to see an impact in their claims.  However, for those employers who continue on the fully insured platform, it will be interesting to see if they value wellness programs for reasons other than a direct impact on medical claims/rates.  These other reasons might include: desire to be a destination employer, increased […]

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Are Gated Health Plans The Way Of The Future?


As employers continue to identify new ways to control their health plan costs, many employers are considering gated health plans as an option. A “gated” health plan, offers a different spin on the traditional wellness incentive that employers and employees have become used to.  Instead of offering employees lower payroll deductions through the completion of a health assessment or completion of a biometric screening, employers are now considering the option of offering richer benefits as well. In a recent survey, more than 1,000 employers were asked to disclose current plan designs and changes they expect in the next three to five years. It’s a way for employers to control costs and reward employees for their healthy lifestyles. 52 percent of employers said their current health plan focuses on traditional trend mitigation approaches, such as employee cost shifting. Interestingly enough, it dropped to 21 percent when asked if this would be their preferred approach in three-to-five years. Employers are beginning to lean more towards plans that require employee action. In the upcoming years, over 60 percent of employers plan to introduce a gated plan, where employees must complete a task to obtain access to richer design options, compared to only 20 […]

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