Despite encroaching competition from CVS, Amazon and even Alibaba, Walmart still holds the title as the world’s largest retailer, and with that distinction comes several mind-boggling statistics. One that caught my attention recently is astounding: approximately 140 million Americans visit a Walmart Store each week.
That’s a lot of people.
Stated another way, more than one out every three Americans step inside one of Walmart’s 4,000-odd stores on a weekly basis.
With market share like that, and a staggeringly extensive physical presence, it may seem unsurprising that the company has been gearing up to carve off an increasingly thicker slice of the $3.3 trillion that the U.S. spends on health care each year.
It was only a few years ago that Walmart announced its plans to be the “Number One Health Care Provider in the Industry.” At the time, the statement seemed a bit audacious, and even perplexing, to the average outsider, but both leaders in the health and retail industries now view the eventual fusion between their sectors as an all but foregone conclusion. The big question is not if such a convergence will take place, but how exactly it will all unfold.
Insurers will again be able to sell short-term health insurance good for up to 12 months under final rules released Wednesday by the Trump administration.
This action overturns an Obama administration directive that limited such plans to 90 days. It also adds a new twist: If they wish, insurers can make the short-term plans renewable for up to three years.
Short-term plans are less expensive because, unlike their ACA counterparts, which cannot bar people with preexisting health conditions, insurers selling these policies can be choosy — rejecting people with illnesses or limiting their coverage.
Short-term plans can also set annual and lifetime caps on benefits, and cover few prescription drugs.
Most exclude benefits for maternity care, preventive care, mental health services or substance abuse treatment.
The House of Representatives has passed two health care bills containing a broad array of policy changes.
According to the Employee Benefit Research Institute (EBRI), passage of the Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018 would raise the annual limits on contributions to health savings accounts (HSAs) to match the out-of-pocket deductibles of the high-deductible health plans that the accounts were implemented to support.
The new legislation would nearly double statutory limits on annual contributions to HSAs those with employee-only health coverage—from $3,450 to $6,550—and, those with family coverage could contribute even more—a new total of $13,300, ($6,400 more than the current $6,900 limit for HSA account holders with family coverage). Account holders older than 55 can contribute an additional $1,000 regardless of their health coverage level.
EBRI asked the question, “Would these limit increases prompt additional funding into HSAs?”
Canadian employee health benefits startup League has raised a massive $47.5 million ($62 million Canadian dollars) in a Series B funding round to transform health benefits market. The latest funding was led by Telus Ventures with participation from Wittington Ventures, Omers, Infinite Potential Group, RBC Ventures, Real Ventures, and BDC Ventures. In addition, the company also announced UK and EU expansion in 2019. The new funding will also help the company to further its mission to bring a consumer-centric benefits alternative for forward-thinking businesses.
“Employers experiencing the war for talent, skyrocketing healthcare costs, and the mental health epidemic are rapidly recognizing that a new approach to benefits will give them a competitive advantage,” said Mike Serbinis, League’s founder and CEO. “Health benefits represent a tremendous opportunity to improve the lives and health outcomes for employees, but they’re not currently driving the business value employers should expect from their investment. League gives them greater control over their spend while delivering an unparalleled employee experience that maximizes both health and productivity.”
Founded in November 2014 with the mission of empowering people with their health every day, League has helped businesses bring the same kind of convenience and personalization to benefits that the Netflix Generation have come to expect in a modern consumer experience, while helping employers to manage total costs. This has proven to be a differentiator for innovative League customers such as Uber, Shopify and Unilever, who are focused on making healthcare benefits a competitive advantage.
Zachery Tracer writes in Bloomberg, “Health maintenance organizations drove down costs but were painted as villains in that decade for limiting patient choice, rationing care and leaving consumers to grapple with high bills for out-of-network services. But some features of the plans are regaining currency. Companies reviving the model say that new technology and better customer service will help avoid the mistakes of the past.”
Bind, started in 2016, ditches deductibles in favor of fixed copays that consumers can look up on a mobile app or online before heading to the doctor. Another upstart, Centivo, founded in 2017, uses rewards and penalties to nudge workers to get most of their care and referrals for specialists from primary-care doctors.
In conjunction with a national Health of America report by the Blue Cross Blue Shield Association (BCBSA) about opioid use, Independence Blue Cross (Independence) is reporting the success it has achieved in addressing one of nation’s top health crises. The highlights of these results include:
Reducing opioid use and prescriptions: Since 2014, Independence has seen a 45 percent reduction in opioid users (45,000 fewer members), a 35 percent reduction in opioid prescriptions (100,000 total), and an 18 percent reduction in the morphine equivalent dose.
Changing physician prescribing habits: Independence shares the Centers for Disease Control opioid prescribing guidelines with our network providers. In addition, we gave detailed reports to more than 1,000 prescribing doctors about their patients (our members) who exceeded the recommended morphine equivalent dose. This outreach led to nearly 60 percent of those doctors changing or decreasing their prescribing habits over a six-month period.
Limiting initial opioid supplies: In July 2017, Independence became one of the first insurers in the country to restrict first-time, low-dose opioid prescriptions to a five-day supply limit, with an exemption for patients with cancer or terminal illnesses. This policy change resulted in a substantial reduction in opioid use and prescriptions: during the last six months of 2017, the number of members using opioids dropped 22 percent and the number of prescriptions dropped 26 percent compared to the same time period in 2016.
Enterprise software company Salesforce (NYSE:CRM) recently announced the upcoming launch of a new cloud service tailored to health insurance companies. Available this fall, the new software follows a strategy the company has used many times before in customizing platforms for other specific industries. This service could be a big deal, as it addresses several issues facing the health insurance industry and its customers.Health Cloud for Payers will help centralize the data a health insurance company has on its members. Having information on things like benefits and claims in one place will help an insurance company’s service department be more efficient. And features like the automation of case-management tasks and care requests will drive better results for patients and insurance-plan sponsors.
Joanne Sammer writing for SHRM states that as members of Generation Z, those born after 1995, graduate from college, employers will need to provide the support, freedom and flexibility these younger workers seek.
One example of how benefits programs are changing to accommodate the needs of younger workers is the Lifestyle Spending Account (LSA). Sammer explains that LSAs LSAs) allow employers to make taxable contributions on employees’ behalf. Employees can use these funds on products and services that the employer makes available, such as fitness classes, pet insurance or charitable giving.
You choose the yearly sum (let’s say, $1,500), and your employees choose what they want to put it towards (a gym membership and a new pair of running shoes, perhaps?). Then, you only pay for the amount they use. We repeat: You only pay for what they’ve used. This one small detail makes a huge difference at the end-of-year review. Not only does it help business owners eliminate those unpleasant year-end surprises, many end up owing less than anticipated.
Cort Olsen writes in EBA that an ad that appeared in January of this year by BlueCross BlueShield of North Carolina offered brokers a $50,000 sales bonus if they could convince their clients to enroll in their fully-insured health plan.
Olsen wrote, “While BlueCross BlueShield of North Carolina claims fully-insured is the best option for many large-group employers — it offers consistent cost and quality of coverage to bring greater peace of mind to both the employer and employee, according to their ad — many advisers say this is nothing more than a cash grab for the insurance carriers and the brokers who sign on. –
“This goes straight to the question of who does the broker work for, which is whoever signs the paycheck,” Griswold says, answering his own question. “The employer has no one — not the carrier, the broker, the third party administrator, the pharmacy benefit manager, the hospital or the doctor — sitting on their side of the table, with a shared incentive to lower healthcare cost.” – Nelson Griswold, president of Bottom Line Solutions in Nashville, Tenn.