Issue 27

Upcoming Forum All-Stakeholder Meeting on November 2nd

At our All-Stakeholder meeting on November 2nd attendees will hear presentations from Linda Wilgus, Chris Whaley, and Chris Deacon. The full agenda can be found here. This meeting is open to Forum members only.

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Employers Using Hospital Price Data to Lower Costs, Push Legislation

“Employers in Wisconsin, Indiana, Washington, Texas and other states are steering employees to low-cost, high-quality hospitals and outpatient facilities by reducing copays, narrowing their health plan networks and directly contracting with providers. They are using price transparency data—requiring hospitals and insurers to share their negotiated rates—to try to curb healthcare cost growth, which continues to constrain wages and benefits.” Read the full Modern Healthcare article here.

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Presentations

In October, Gloria Sachdev was invited to give presentations regarding market and policy ideas to advance transparency, affordability, and competition to the following organizations:

• October 3: Georgetown University in DC
• October 5: Hendricks County Chambers in Brownsburg, IN
• October 19: 32BJ Fund in NYC
• October 24: Lafayette Community Council
• October 27: Peterson Center Employer & Purchaser Roundtable in DC

Thank you for the opportunity to present!

2023 Employer Health Benefits Survey

The KFF’s 25th annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2023 survey included 2,133 interviews with non-federal public and private firms. Find the full report here.

Key Findings

Average Annual Worker & Employer Contributions to Premiums & Total Premiums for:

• Family Coverage reached $23,968!
• Single Coverage reached $8,435!

Eric Inman, MD

Co-Founder at WellBridge Surgical

What changes would you like to see in the healthcare space in the next 5 years?

We have a cost problem within the healthcare market that is unsustainable for individuals and self-funded businesses. I see two likely solutions. The government overhauls the system or the system becomes a free market. Both could curb costs. With the former, quality will decrease. With the latter, quality will rise to the top. Healthcare is the only industry that has lagged behind regarding free market principles. While the hospital systems, insurance companies, and some insurance broker/advisors have capitalized on it, we as consumers have paid for it. Someone needs to break the cycle.

Regarding outpatient surgical care, WellBridge Surgical has facilitated ACTIVE healthcare consumption by both individuals and employers. No longer should the system lead patients blindly to a surgeon they don’t know to have a procedure at a location they’ve never heard of that will then charge them an undisclosed amount. At WBS, we simplify the equation by offering concierge navigation and surgical service at a bundled, transparent, FAIR cost that ends up saving the buyer thousands of dollars. 

To have this all come to fruition, we have to collectively, as Hoosier healthcare consumers, educate ourselves to put us in the optimal position to make a difference. We need to understand that increased claims dollars lead to less dollars that can be invested into our state’s businesses. The time is over for complaining and throwing our hands up into the air. There are options to save your company money and reinvest in your employees. Because we have all been brainwashed by the broken system, it’s difficult to completely educate everyone. Therefore, we need to understand that placing member financial incentives into health plans is absolutely necessary to curb these costs. If companies are unwilling to implement these changes in your health plan, they now become part of the overall problem. If I had one wish for a change to occur in the healthcare space within the next 5 years, it would be self-funded Indiana companies coming to the realization that they can in fact control their own destiny in terms of surgical care.

What aspects of your career do you enjoy the most?

What really encourages me on a weekly basis is the difference WBS is making in the lives of our patients. Prior to WBS, I had unknowingly been in the system that took advantage of patients and overcharged for services.  By offering a totally different model, we can deliver better patient care while saving them their well-earned dollars. Companies are waiving patient cost and even giving taxable cash payments to plan members to incentivize responsible surgical care choices. When I take care of one of these patients, that puts a smile on my face. Creating a win for the patient (higher quality care and “free” surgery) and a win for the employer (saving the health plan dollars) is what I enjoy the most. 

What is your favorite fall activity?

My favorite fall activity is splitting wood from our yard and having a nice fire out on the porch. Close second is apple picking and carving pumpkins, both with my wife and 3 kids of course!

Employers:

• Hundreds of Referrals Received 6 Months in to Cleveland Clinic’s Employer Offering (Becker’s)
• Hospital Prices For Commercial Plans Are Twice Those For Medicare Advantage Plans When Negotiated By The Same Insurer (Health Affairs)
• Aegis Risk Medical Stop Loss Premium Survey (Aegis)
• Will Employers Put the Squeeze on Hospitals? (Becker’s)
• Changing the Game: Groundbreaking Drug Benefit Purchasing Standards for Large Employers (PBGH)
• Podcast: Julie Selesnick on the Impact of Recent Health Care Data Litigation (Catalyst for Payment Reform)

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Policy:

• Major Non-Profit Hospitals Take Advantage of Tax Breaks and Prioritize CEO Pay Over Helping Patients Afford Medical Care (Sanders)
• Congress Eyes Endgame for PBM Legislation (Modern Healthcare)
• Health Care Costs Target of State Policy Proposals (Indiana Capital Chronical)

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Hospitals

• Bed Counts of 14 Hospitals Fined for Price Transparency Violations (Becker’s)
• Federal Government Repaying Indiana Hospitals $222M for Improper Reimbursement Cuts (IBJ)
• Union Health to Acquire Terre Haute Regional Hospital (Tribune Star)
• Understanding Mergers Between Hospitals and Health Systems in Different Markets (KFF)
• Why Do Indiana Hospitals Charge More in Poorer Communities? (Indiana Capital Chronicle)

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Insurance

• Aetna to Cut Some Virtual Care Coverage (Modern Healthcare)
• Elevance Health Cuts Jobs as Company Confirms ‘Changes’ (Becker’s)
• Star Ratings Dim for Nearly 10% of Medicare Advantage Plans (Modern Healthcare)

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Providers & Physicians

• FTC Sues Large Private-Equity-Backed Anesthesia Provider (WSJ)
• 2023 Physician Compensation Report (Physicians Thrive)
• Provider Charges Relative to Medicare Rates, 2013-2021 (Brookings)
• Utilization, Steering, and Spending in Vertical Relationships Between Physicians and Health Systems (JAMA)

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Pharmacy

• Save Billions or Stick with Humira? Drug Brokers Steer Americans to the Costly Choice (LA Times)
• American Pharmacists Month: Recognizing the Vital Role and Professional Challenges (Pharmacy Times)
• FDA Approves First Tocilizumab Biosimilar (MedScape)
• Private Sector Profiteering Through The Expansion of a Federal Intended to Help the Poor (Pioneer Institute)

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Other Healthcare News

• Nearly Two-Thirds of Serious Mental Health Needs Unmet in Marion County, Report Says (IBJ)
• How a Cancer Screening Blood Test Could Backfire (Tradeoffs)
• Walgreens to Close 60 VillageMD Clinics as Part of Aggressive Cost-Cutting Strategy (Fierce Healthcare)
• California Raises Minimum Wage to $25 an Hour for Healthcare Workers (Becker’s)
• Reforming Abusive Billing Practices, One Step At A Time (Health Affairs)
• Health Care Consolidation: Background, Consequences, and Policy Levers (Alliance for Fair Health Pricing)
• Mark Isenberg: Indiana Takes Overdue Step Toward Retaining Physicians Health Equity and Economic Development (IBJ)