Achieving Savings Exceeding $5 Million Through a Self-Funded Health Plan

In a time of increasing healthcare costs, Nebraska Furniture Mart (NFM) managed to save $5 million in health plan costs in 2022 by partnering with Centivo, a health plan provider for self-funded employers. NFM moved away from the traditional care model for its 5,000 employees and focused on curating a network of healthcare providers that demonstrated the best health outcomes at the best prices.

The key to lowering health plan costs was a shift in utilization, emphasizing preventive care and screenings while reducing unnecessary expenses like emergency room visits. Centivo's ability to identify the best providers for NFM's employee population played a crucial role. The success of this approach highlights the importance of employers taking control of their healthcare plans and demanding a different model to address rising costs.


Top Concerns for Self-Insured Employers in 2024

The Business Group on Health has reported that self-insured insurance employers are expected to face challenges in addressing the mental health needs of their workforce and developing strategies for on-site clinics amid a shift to larger volumes of remote work. The report indicates a significant increase in mental health concerns, with 77% of employers reporting such issues, compared to 44% the previous year.

Ellen Kelsay, CEO of the Business Group on Health, attributes this increase to various factors, including the pandemic, economic uncertainty, and political shifts. Employers are focusing on providing more support options due to a shortage of psychiatrists and psychologists, while also reassessing the need for on-site clinics.

The survey, covering 152 large employers with over 19 million lives, highlights the challenges related to virtual care. While virtual services saw increased use during the COVID-19 pandemic, employers are now tempering their expectations about the transformative impact of virtual health in the care delivery system. Concerns include the lack of positive impacts on outcomes, quality, cost, experience, and integration. Employers are also worried about market saturation and too many choices for employees. Despite a decrease in expectations, 64% of employers still believe virtual health will have a significant impact in 2023.

Employers are reevaluating vendor relationships, particularly with pharmacy benefit managers (PBMs). They seek transparency in drug pricing and want additional data on compensation and pricing from PBMs. The report indicates that 92% of employers are concerned about the cost of drugs in the pipeline, and 91% worry about the overall pharmacy cost trend.

Cancer care emerges as a top concern for employers, with 50% rating it as the number one driver of healthcare costs. Late-stage cancer diagnoses are anticipated due to delayed screenings during the pandemic, leading employers to focus on advanced screening measures and maintaining coverage for prevention and screening services. Additionally, employers are monitoring advancements in cancer care and considering a cancer-focused center of excellence approach.

The survey underscores the evolving priorities and challenges faced by self-insured employers in healthcare, encompassing mental health, virtual care, vendor relationships, and cancer care concerns.

Source: Fierce Healthcare

Walgreens Pays Humana $360 Million for Overpriced Drugs

Walgreens has settled a long-standing compensation dispute with Humana by agreeing to pay $360 million, approximately half of the initial amount ordered last year. The dispute arose when Humana alleged that Walgreens overcharged for medications for over a decade by unlawfully inflating prices, particularly through its pharmacy savings club.

Walgreens recorded standard retail prices for drugs dispensed under the program when submitting reimbursement claims to Humana, leading to the arbitration process initiated by Humana in 2019. While Walgreens denied wrongdoing, an arbiter ordered a $642 million award last March, which Walgreens challenged in federal court.

The recent settlement follows a dismissal of Walgreens' federal lawsuit by U.S. District Judge Ana Reyes. Despite the settlement, Walgreens faces other lawsuits, including claims of inflating prescription drug claims. The settlement is seen as a positive development for Walgreens amid financial challenges and previous expensive settlements.


Eli Lily Now Offering Obesity Drug Direct to Consumers

Eli Lilly has launched a new online service called LillyDirect, offering telehealth prescriptions and direct home delivery of its weight-loss drug Zepbound. The service aims to address challenges patients face in accessing medications, providing a convenient pathway to obtain prescriptions and receive home delivery.

LillyDirect also offers delivery of certain Lilly insulin products and a migraine drug, with the possibility of adding more products in the future. The move responds to the increasing demand for weight-loss drugs, particularly GLP-1s like Zepbound, which saw a rise in U.S. prescriptions.

LillyDirect partnered with telehealth provider Form Health to facilitate online consultations for Zepbound prescriptions. The service includes access to telehealth providers and search tools to find healthcare professionals for in-person care if preferred. Patients may receive discounts through Lilly's savings card programs, and costs vary based on insurance coverage, with Zepbound potentially priced between $25 and $550 per month. Lilly plans to update the platform with new products, partners, and services in the future, marking a disruptive shift in the drug market's traditional go-to-market strategy.


BCBS Minnesota Sued by the DOL

The U.S. Department of Labor has filed a lawsuit against Blue Cross and Blue Shield of Minnesota (BCBSM), alleging that the payer incorrectly imposed a state provider tax on self-funded health plan customers and violated fiduciary duties under the Employee Retirement Income Security Act of 1974 (ERISA).

The lawsuit claims that BCBSM passed the cost of the tax to self-funded employer health plans without proper authorization, collecting at least $66.8 million from such plans between 2016 and 2020. BCBSM, serving as a third-party administrator for 370 self-funded plans in Minnesota, is accused of violating ERISA's fiduciary standards and prohibited transaction rules. BCBSM denies the claims, stating they are without merit.

Source: Becker’s Payer

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