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Attacking Out-of-Network Again

One of the hallmarks of in-network-only plans is that the provider prices have been pre-negotiated as a precondition for the doctor or hospital to join the network – and the insurer and employer to benefit from the lower costs – in exchange for the volume the provider receives through the insurance network. Preferred Provider Organization (PPO)-style plans, similar to the earlier indemnity-style plans, provide coverage (albeit at greater cost to the member) for non-negotiated, out-of-network providers. Employees get more choice at greater cost, and doctors receive some reimbursement from the plan and the remainder …

https://www.epicbrokers.com/insights/attacking-out-of-network-again/

COVID-19 Makes 2021 Medical Cost Predictions Far More Challenging

Self-insured employers typically establish “premium equivalent rates” in the third quarter of the prior year. These are an estimation of claims based upon the most recent claim data available. While these rates are used to set healthcare cost budgets, the costs that hit an organization’s income statement are based upon actual claim costs paid during the year. Several of the large public brokers predicted significant COVID-19-related costs. The EPIC financial team did not. We believed that the deferral of care would offset any pandemic claim spikes and we were right. As 2020 winds down, it is …

https://www.epicbrokers.com/insights/covid-19-makes-2021-medical-cost-predictions-far-more-challenging/

Pharmacy Update Aug 2020

FDA Rejections The Food and Drug Administration (FDA) recently rejected Gilead’s filing for approval of filgotinib for rheumatoid arthritis. With the FDA asking to see data from an ongoing clinical trial, Gilead is unlikely to be able to refile until mid-2021, pushing it further behind its competitors for the Janus Kinase (JAK) inhibitor market. These drugs suppress the immune system to prevent damage to the joints. The FDA rejected BioMarin’s Roctavian for hemophilia A. This expensive gene therapy was expected to revolutionize the treatment of this disease. However, the manufacturer will be required to complete an ongoing …

https://www.epicbrokers.com/insights/pharmacy-update-aug-2020/

There’s a Lot of Money Going to Healthcare Innovation – Will It Work?

Viewpoints from Craig Hasday Lucrative profit potential, along with political and economic pressure to reduce healthcare costs, has spawned consolidation and vertical integration of traditional insurers and pharmacy benefit managers. But costs continue to escalate, and these traditional markets will no doubt be challenged for solutions. Mergers, consolidation and innovation have combined with political agendas with multiple opinions even within the Democratic and Republican parties. Healthcare is a fragmented and inefficient industry in the United States and nearly 20% of U.S. Gross Domestic Product represents a significant opportunity for the nation’s largest companies to do it better. Walmart …

https://www.epicbrokers.com/insights/theres-a-lot-of-money-going-to-healthcare-innovation-will-it-work/

Communication Basics in a Not-So-Basic World

… excellent tools to help support your message as long as they are relevant and provide an important visual reference for your audience. Callout boxes are another effective way to visually draw attention to key points or information. Remember – plan ahead and start with the end in mind; identify what your audience needs to know, key points they need to remember, and why they should care. These things will help you prepare, design and deliver your message concisely and effectively. The EPIC Communications & Engagement team works closely with our clients to help make meaningful, engaging employee communications. Check out our recent

https://www.epicbrokers.com/insights/communication-basics-in-a-not-so-basic-world/

Brace Yourself for More from the Opioid Addiction Crisis

Just as the first cases of coronavirus (COVID-19) made their way into New York City in March, I wrote about efforts made by dental insurers and medical carriers to address the opioid epidemic in our country. The COVID-19 pandemic started tearing its way through the world soon after. Flash forward to summer, when the Centers for Disease Control and Prevention (CDC) reported nearly 71,000 American drug overdose deaths in 2019 according to preliminary data – a new record that predates the COVID-19 crisis and was primarily driven by fentanyl, other synthetic opioids, cocaine and methamphetamine. For more …

https://www.epicbrokers.com/insights/brace-yourself-for-more-from-the-opioid-addiction-crisis/

Don’t Let COVID-19 Stop Your Preventive Dental Care

COVID-19 has significantly impacted dental care in America. A 2018 study by Guardian shows that even before this pandemic, one in four Americans with employer-provided dental insurance hadn’t had a dental cleaning in the prior 12 months and almost 50 million had not visited a dentist in the prior 24 months. During the current crisis, dental care has screeched to a halt. In the best of times, a dental visit is avoided by many. In the worst of times, Americans don’t seem to feel it’s worth the risk of exposure to the virus. Viewpoints from …

https://www.epicbrokers.com/insights/dont-let-covid-19-stop-your-preventive-dental-care/

EPIC Adds Nancy Webster

Addition further strengthens EPIC’s Employee Benefits Operation in the Southwest Region EPIC Insurance Brokers and Consultants, a retail property and casualty insurance brokerage and employee benefits consultant, announced today that Nancy Webster has joined the firm as Senior Principal. Webster will report to KJ Wagner, President of the Southwest Region. In her new position, Webster is responsible for new business development, and the design, placement, and management of employee benefits insurance programs and solutions for mid-market and large clients. Webster joins EPIC from Arthur J. Gallagher & Co., where she spent 18 years of her career and became Area …

https://www.epicbrokers.com/insights/epic-adds-nancy-webster/