Tim Carter, CEBS

Taking the Hassle Out of #Healthcare - Greater #Sacramento area health insurance company offering the best health insurance benefits for your company. It’s Simple by Design. -----See how we advocate for you with health insurers and providers. www.simplysummit.com #simplysummit #employeebenefits

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The #InflationReductionAct includes major changes to Part D intended to control prescription costs, cap maximum retiree out-of-pocket costs and simplify coverage for Medicare enrollees. #ViaBenefits https://ow.ly/k6rw50SihtU

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This year is shaping up to be an interesting one for California and the nation, with significant network negotiations underway among the largest payers and hospital facilities post-COVID. The backdrop of inflation and labor shortages adds complexity to the discussions - which most of us are seeing on a daily basis. There is no universal solution for each client for the benefits plan. However, exploring the various levers in a self-funded can lead to enhanced data transparency, innovative cost containment strategies, and the reduction of unnecessary margins, fraud and waste. #CaliforniaHealthcare #HealthInsurance #CostContainment #DataTransparency #Negotiations #HealthcareSpending #stoploss #selffunding #Captive #RBP #Benefits

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United HealthGroup reported their earnings yesterday and their earnings call was chock full of interesting tidbits Tim Noel , the CEO of Medicare for UHG was on the call again, what he said probably left a lot of distributors wondering what he means “we continue to believe that there's opportunities to improve the distribution environment in Medicare Advantage and have been in a dialog with CMS for several years on how to do that. Some of the elements of the final notice that were published recently are directly in line with some of our recommendations and some of them are relatively consistent, but not totally as we had conceived them”  “it's a little bit early to comment on how this might rebalance some of the channel mix, as still some questions on how some of the key elements of that will be rolled out.” Pretty aggressive wording about how much influence they have with CMS The Change Healthcare hack was the first thing mentioned after a couple of quarters where Medicare Advantage led things off on the earnings calls Andrew Witty, the CEO was strident in his defense of Medicare Advantage as a better deal for seniors financially as well as with care outcomes. Interesting to see how strong he was here considering UHG’s market leadership in Medsupp as well Their commercial business had its largest quarterly gain in years, likely driven by some recent marker exits by Humana and Aetna, although UHG said it was mostly from their innovative products. Individual exchange business was also mentioned as a growth driver MLR on Medicare Advantage went down from the 85% in Q4 to 84.3% and that is inflated by 40 basis points due to suspension or care management plus an additional $800 Million due to claims reserves related to the cyberattack AJ Rice from UBS asked about the $800 Million and they basically said the actual claims costs will be more than 0 but less than $800 million, so MLR is down at least a full point and maybe more in reality Jared Strock also posted some great analysis diving into the numbers, check it out!

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Cardiovascular disease (CVD) has risen to the second-highest paid claims position. 😳 (-Insurance Business Sun Life US) Since 2020, the average cost of CVD claims has surged by 33%, surpassing the overall increase in medical claims costs. 📈 This is not just a financial issue, this is a health issue. How do we help our people learn to make healthy life style choices? ☀ ❣ Hello Heart's latest publication in the Journal of the American Heart Association looks at over 100,000 Hello Heart users, and shows significant reductions in Blood Pressure, Cholesterol and Weight. https://lnkd.in/eCC3k4dN

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One of the cornerstone principles of a high-functioning private healthcare system is empowering the Consumer rather than the "rule-makers" who operate it. Doctors, hospitals, PBMs and insurers need to be accountable to the Consumer, who is the ultimate authority over their own physical and mental health. Article IV of the Healthcare Bill of Rights sets forth this right #NABIP #NABIPHealthcareBillofRights #HealthAutonomy #InformedDecisions

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Wonder why your prescription costs are so high? The role of PBM's in driving up your prescription prices! read more in our latest newsletter #affordablehealthinsurance, #PBM , #BlueShieldofCA, #PharmacyBenefitManagerrole, #dhighdrugcost , read more in our newsletter https://conta.cc/3Qvbmw4

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As healthcare insurance costs continue to escalate, an increasing number of companies are contemplating the shift to self-funding their employee health insurance plans. Self-funding presents an attractive opportunity for businesses to mitigate healthcare expenses. By opting for self-funding, employers gain access to valuable data that aids in assessing plan performance and pinpointing areas for potential cost savings. While the idea of navigating the complexities of a self-funded plan can be daunting, advancements over the years have made the process of risk management and goal prioritization more manageable. -Katie Mercurio

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As Bob Dylan famously sang, "The Times They Are A-Changin'." Indeed, we're facing some possible changes to Medicare Advantage that could impact us all. It’s important to stay informed and prepared as we navigate these shifts. By understanding what's on the horizon, we can continue to provide the best service and advice to our clients. But amidst all these changes, there’s one thing that remains steadfast and reliable: Hospital Indemnity! It’s the perfect complement to any Medicare plan, offering additional peace of mind and financial protection. Hospital Indemnity is a true constant in an ever-evolving landscape, and it continues to be a "win-win" for both agents and clients. Now is the time to leverage the stability of Hospital Indemnity to make a real difference. By educating our clients on its benefits, we not only enhance their coverage but also reinforce our role as trusted advisors. This product bridges the gap between Medicare Advantage and Supplement plans, ensuring comprehensive protection for our clients. Let’s embrace the opportunity to make a positive impact. Get out there, share your knowledge, and start selling! Every conversation you have is a chance to make someone’s life a little easier and a lot more secure. Together, we can navigate these changes and come out stronger on the other side. Remember, success is not just about numbers; it’s about the lives we touch and the peace of mind we provide. So, let's all be winners! Stay positive, stay motivated, and let’s make a difference in the lives of our clients. #Medicare #Motivation #StayPositive #ClientCare

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According to our National Survey of Employer-Sponsored Health Plans, 42% of large employers cover weight-loss medications, with the majority imposing prior authorization requirements. However, addressing obesity require more than covering GLP-1s for weight loss. We highlight how employers should think about addressing obesity through their benefits plans. #benefits #health #healthcare

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This week we talk to Brad Johnson, and he shares insights from the Rand Hospital Study, which compares hospital payments from private insurers vs. Medicare. The study reveals a widening gap, with private plans paying an average of 2.5 times more than Medicare. This differential varies by state, with Iowa having one of the lowest at 1.84 times Medicare rates, while Georgia has the highest at 3.45 times. As hospital contracts come up for renegotiation post-COVID, medical inflation (currently around 8-8.5%) is expected to rise further. This raises concerns about the sustainability of the current system and the impact on employer health plans. Join the conversation: How do you think this growing payment gap can be addressed? #HealthcareEconomics #MedicareVsPrivateInsurance #HospitalPayments #EmployerHealthPlans Brad Johnson Chris Boling - PPACA

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This week we talk to Brad Johnson, and he shares insights from the Rand Hospital Study, which compares hospital payments from private insurers vs. Medicare. The study reveals a widening gap, with private plans paying an average of 2.5 times more than Medicare. This differential varies by state, with Iowa having one of the lowest at 1.84 times Medicare rates, while Georgia has the highest at 3.45 times. As hospital contracts come up for renegotiation post-COVID, medical inflation (currently around 8-8.5%) is expected to rise further. This raises concerns about the sustainability of the current system and the impact on employer health plans. Join the conversation: How do you think this growing payment gap can be addressed? #HealthcareEconomics #MedicareVsPrivateInsurance #HospitalPayments #EmployerHealthPlans

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The PCORI fee, included in almost all health insurance plans, whether self-funded or fully insured, may seem like just another administrative burden and tax. However, it actually serves a vital function in financing research that leads to improved health outcomes. The article from BenefitMall below provides essential details for understanding the #PCORI fees before the approaching July 31st deadline: #selffunded #healthinsurance