Axion RMS, Author at Axion RMS

Small Group Revolution: Association Health Plans By: Devon Bellamy, Axion RMS The Donald Trump administration recently made a decision on healthcare that could effectively change how small groups offer medical insurance to their employees forever. On June 19th, 2018, the Trump administration ruled in favor of expanding access to Association Health Plans for healthy individuals. So what exactly is an Association Health Plan?   Association Health Plans (AHP) encourage healthy people to seek cheaper, less robust coverage options. These health plans will not cover certain catastrophic procedures or drugs, so a major medical supplement plan may be needed to complement AHPs. However, by excluding certain drugs or procedures, insurers are able to dramatically reduce premiums for individuals. Moreover, Trump’s ruling is making it easier for small-group AHPs to meet ERISA standards and relaxes business’ requirements for association plan eligibility.   Currently, healthcare trend averages somewhere between 8% – 12% each year, which is unsustainable for any employer, but especially those in the small group market. According to a study conducted by Avalere Health, they project “premiums would increase by as much as 4% between 2018 and 2022”, a much more affordable solution for employers and employees alike. If you would like to learn more about […]

The Unsustainable Cost Shift: Where to Turn By: Chad Burdo, Axion RMS Depending on which source is referenced, healthcare expenses have been increasing anywhere from 6-12% on average year over year.  We see employers getting hit with an unexpected 20% plus renewal that sets that company back for the upcoming year.  Surely, employers are unable to continue and absorb these costs.  Instead, these costs have been passed onto employees through higher deductibles (think prevalence of HDHPs), increased coinsurance rates and increased contribution rates for the employee.  The employers have limited the damage done to their bottom line… but at what cost?   Since 2012, employees’ real wages (wages adjusted for CPI) have only increased about 10%.  Contrast that with the medical spending increases of 6-12% a year, and the magnitude of the disparity is clear. It is harder than ever to retain current employees as they are paying more for lower quality benefits, and harder to offer cost effective, enticing benefits to attract top talent.  These cost increases are an unsustainable trend that goes beyond affecting the employer.  Companies must realize that at the core of medical spending increases is an employee who may be struggling to afford proper healthcare.  […]

Affordability Percentages Will Increase for 2019

Affordability Percentages Will Increase for 2019 On May 21, 2018, the IRS issued Revenue Procedure 2018-34 to index the contribution percentages in 2019 for purposes of determining affordability of an employer’s plan under the ACA. This ACA Compliance Bulletin describes the adjusted percentages. Affordability Percentages Will Incresase for 2019

Dependent Eligibility Audits By: Abigail Cutler, Axion RMS On average, there are two dependents for every subscriber on a medical plan. When self-funded employers allow employee’s dependents on their medical plans, they accept the risk that comes with the dependent’s claims. For fully insured groups, carriers will often investigate the legitimacy of a dependent when that dependent files a major claim – and if it happens that the dependent is ineligible for the plan, the carrier will refuse to provide coverage. For this reason, it is extremely important for every employer to verify that all dependents on the plans are able be covered under the plan according to the certificate.   Unbeknownst to the employer, most medical plans have 4-8% of dependents on a plan are ineligible for coverage. When you consider that the average employer cost per dependent is $3,500 and associated ERISA noncompliance fines, employers realize large savings when they reduce the number of ineligible members on their plans. A Dependent Eligibility Audit is able to help identify and reduce those people in order to maintain order. The audit acts as an internal cost control measure that helps maintain employer fiduciary responsibility, compliance, and reduced risk of stop-loss […]

Telemedicine: A Growing Trend Helping Employers Cut Cost By: Curt Beckman, Axion RMS When it’s two in the morning and your child is sick, it’s natural to think of a trip to the emergency room as the only way to receive immediate care. But a $300 copay for the ER doesn’t have to be your only option – with the utilization of telemedicine, it can become your last resort. One of Axion’s strategies to help employers mitigate healthcare costs is introducing telemedicine services to their benefits offerings. Several of our clients provide telemedicine to reduce cost and increase the overall wellness of their employees – and the results are in. This solution is a cutting edge, innovative approach that is yielding positive results for employers and employees. Telemedicine implementation in 2017 showed savings that ranged from $300 per year for a single employee or more than $1000 per year for a family of four. Not only is telemedicine reducing cost, but its convenience, ease of use, and 24/7 accessibility is creating a healthier and happier work environment. Axion Risk Management Strategies can assess if this solution would integrate smoothly into your benefits program. We make the process of implementation efficient […]

Corporate Wellness Programs By: Jake Doman, Axion RMS The new necessity in employee benefits is workplace wellness. Eighty-three percent of our employer partners believe wellness programs are absolutely necessary to attract and retain employees. Amidst an economy with record highs of employment, every perk an employer can offer solidifies the relationship with top talent – queue corporate wellness programs. Companies in various industries are recognizing the importance and relevance of wellness and are rushing to implement these programs. Beyond employee satisfaction, what is the corporate benefit of wellness? Most importantly, how will it affect an employer’s bottom line?   Axion applies risk management techniques, such as wellness program implementation to alleviate some of the healthcare costs. One of the primary objectives of a wellness program is financial success within a company. With chronic conditions, the goal is to mitigate risk by diet and exercise versus reliance on prescriptions. What does ROI look like for a successful wellness program? We see an average of $3 to $6 for every $1 invested over a 5-year (or longer) period. Savings can be seen in medical costs, worker’s compensation claims, absenteeism, presenteeism, and short-term disability claims. A reason for low ROI on wellness correlates with […]

Final Notice of Benefit and Payment Parameters for 2019

Final Notice of Benefit and Payment Parameters for 2019 On April 9, 2018, HHS issued its final Notice of Benefit and Payment Parameters for 2019, which describes benefit and payment parameters under the ACA for the 2019 benefit year. This ACA Compliance Bulletin provides an overview of key changes included in the final rule for 2019. Final Notice of Benefit and Payment Parameters for 2019 4.18

Direct Primary Care – A New Alternative to Primary Care Physicians By: Devon Bellamy, Axion RMS With the cost of healthcare rising about 8.5% each year, employers must embrace creative solutions – or face extinction. By introducing risk management solutions, it helps employers not only protect their bottom line, but also anticipate the consequences of cost shifting to employees. Direct Primary Care (DPC) is a new, innovative solution that helps empower employees at an affordable price for employers.   DPC doctors charge a monthly “subscription fee” and typically don’t accept insurance. These are highly trained primary care physicians and health coaches who often see patients without copays, coinsurance or even prescription drug costs (varies by policy contract). By not being constrained to health insurance carrier’s whims, DPC doctors are able to deliver more customized care while cutting out many of the tedious, insurance “middle-man” costs. If a treatment falls outside of the DPC doctor’s scope of services, doctors are able to write a referral to a specialist and oversee care.   Employers have seen the greatest returns on investment by pairing DPC networks with reference based pricing/high deductible health plans to cover the most remedial doctor visits to the most […]

Pharmacy Carve Out Programs By: Abigail Cutler, Axion RMS Pharmaceutical related costs make up a third of all health care costs. Naturally, many employers are now looking for creative solutions to help curb these costs and gain transparency to identify savings. Axion has developed partnerships with companies that can provide a solution for this: Pharmacy Carve Out Programs. A pharmacy carve out program is a risk management strategy where a health care sponsor selects a Pharmacy Benefit Manager to administer and manage its prescription benefit. By using PBMs as a separate claims administrator from the employer’s health insurer, it removes the health plan as an intermediary for pharmacy benefits. Also, stand-alone PBMs can provide a more customized plan design strategy than the embedded pharmacy plans offered by their health insurer. Furthermore, the standard language in the PBM contract allows for increased transparency by allowing access to pharmacy data, and potential for pharmacy claim audits. Employers can select from several different PBM vendors to find the best choice based on their pharmacy claims history. Studies show that a pharmacy care out plan can reduce pharmacy trend by as much as 50%. By actively managing pharmaceutical costs and gaining access to critical […]

Surgery Costs Continue Driving Employer Healthcare Spend By: Chad Burdo, Axion RMS Surgery costs represent the single largest component of United States health care spending at approximately $700 billion, or 31% of the total annual health care spend.  Much of this cost is passed on to self-funded employers who continue to see their health care spend, especially spend related to surgery, skyrocket.   Beginning in 2018, Axion is able to introduce a solution that has been proven to reduce surgery costs 30-50% on average, while guaranteeing employees are able to be admitted to a Center of Excellence (top 25 percentile provider) in the United States.   This solution is an innovative approach that yields positive results for employers, employees and providers. By implementing this strategy, employers are able reduce overall healthcare and surgery spend, employees receive quality outcomes from Centers of Excellence with more affordable, pre-negotiated surgery packages, and providers have surgery procedures paid in full before the surgery and receive higher patient volume.   By partnering with Axion Risk Management Strategies, we will be able to assess how this solution will fit into your comprehensive benefits program. We help make implementation seamless and transparent for minimal disruption and maximum […]