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New Hospital Safety Scores Released for Memphis Hospitals

The latest Hospital Safety Scores for Memphis-area hospitals are out! 

Results of interest include:  

  • The Regional One Health Center continued on it's improvement path with its grade moving up to a C.
  • The Methodist hospitals realized downgrades in their scores. Methodist University moved down to a B. Methodist Germantown, North and South moved down to a C. 
  • Congratulations to Saint Francis-Memphis for achieving Straight A's in all of the releases of the Hospital Safety Score since 2012.

The rest of the scores remained the same as in Spring 2015. 

Saint Francis - Memphis   A   Methodist - University    B   Baptist - Collierville            C
Saint Francis - Bartlett      A     Baptist- DeSoto                 C
     Baptist - Memphis             C
     Methodist - Germantown  C
     Methodist - North              C
     Methodist - South             C
     Regional One Health        C

Check out the full scores for these hospitals, as well as 2,520 other hospitals across the country, at You can also see the past scores for these hospitals by selecting "Show Past Grades".

Posted by Cristie Travis at Thursday, October 29, 2015 | 0 comments

C-Sections Too Common in Memphis

Methodist-Olive Branch and Saint Francis-Bartlett are the only Memphis-area hospitals to fully meet the Leapfrog Group's C-section standard of no more than 23.9% of births. Other reported rates for Memphis-area hospitals ranged from 27.0% at the Regional Medical Center to 37.5% at Methodist-Germantown.

 HospitalC-Section Rate 
Methodist-Olive Branch
Saint Francis-Bartlett
Regional Medical Center
Saint Francis-Memphis

Baptist Memorial Hospital for Women and Baptist-DeSoto did not report C-section rates due to a mid-year change in data collection systems which resulted in 12-months of data not being available.

Tennessee ranked 24th in the nation with an average C-section rate of 28.3%.

Using C-section data reported by 1,122 hospitals through the voluntary 2015 Leapfrog Hospital Survey, Leapfrog found that, nationally, over 60% of reporting hospitals had excessive rates of C-sections. 

These results mean that far too many women in Memphis, Tennessee, and the U.S. are undergoing a major abdominal surgery without medical necessity.

Cesarean sections carry serious risks of infection or blood clots, and many women experience longer recoveries and difficulty with future pregnancies. C-sections can also cause problems for babies, like breathing difficulties that need treatment in a newborn intensive care unit (NICU). In the long-term, research shows that C-sections can cause chronic pelvic pain in some women, and babies born by C-section are at increased risk of developing chronic childhood diseases like asthma and diabetes.

“This is really about how well we, as doctors, nurses, midwives, and hospitals, support labor,” said Elliott Main, M.D., chair of Leapfrog’s Maternity Care Expert Panel and medical director of Stanford’s California Maternal Quality Care Collaborative. “Hospital staff that support labor appropriately and are sensitive to families’ birth plans are shown to have lower C-section rates overall. If we want to improve this rate across the board, then hospitals must hold themselves to this standard to ensure safe short- and long-term outcomes for both mom and baby.”

Click here to:

  • Read more about the methodology used to determine C-section rates
  • Provide your employees with information to help them avoid C-sections except when medically needed
  • Learn more about how providers and policy makers can help reduce unnecessary C-sections
Posted by Cristie Travis at Monday, October 12, 2015 | 0 comments

New York Times Editorial Calls for Reduced Cost of Hep C Drugs

This New York Times (NYT) editorial lays out the tension in the current debate over the very expensive (@$84,000/treatment un-discounted) Hepatitis C drugs: broad coverage that will significantly increase health plan costs or restricted coverage to keep costs under control but that will not benefit as many patients.

In the end, the NYT points out that manufacturers generally pay what the market will bear so calls for public and private insurers to push for lower pricing, which can support providing these drugs to more people.

MBGH is kicking off a specialty pharmacy management initiative for members which addresses this very issue. The initiative provides hands-on training, data analysis and, most importantly, technical assistance and consulting, that employers need to actually achieve cost savings in specialty spend while still making these drugs accessible to their employees and families. Contact Cristie Travis at for more information.

Read the editorial

Posted by Cristie Travis at Thursday, September 3, 2015 | 0 comments

First: Doctor Visits on Demand; Now: Medications Delivered to Your Doorstep

Health care innovators in New York City prove, once again, that where there is a need, entrepreneurs will step in to fill it.

This time Pager, a doctor-on-demand company, is teaming up with Zipdrug to have prescriptions delivered to a patient's home or office, often within one hour.

Customers can track the Zipdrug delivery status on their cell phones and pay the cost of the drug plus a $10 delivery fee.

Pager sends Board-certified physicians to homes and offices within 2 hours of a patient's request for urgent care needs. Currently they offer services in New York City and San Francisco. Read more about Pager.

Read the full article

Posted by Cristie Travis at Thursday, September 3, 2015 | 0 comments

More Potential Twists on the Cadillac Tax

Ricardo Alonso-Zaldivar's September 1, 2015 AP post details the Treasury Department's current thinking about the Cadillac Tax: 

"— The Treasury Department says it is considering an exemption for flexible spending account contributions for dental and vision care, which are two popular uses.The health care law already limited FSA contributions and without such accommodations, the Cadillac tax could lead to their demise.

"A benefit that you are offering your employees so they can save money on taxes is going to wind up costing you money," said economist Paul Fronstin of nonprofit Employee Benefit Research Institute.

— Treasury is also trying to figure what do about a different kind of workplace arrangement called a "health savings account."

A growing number of workers have high-deductible health insurance that comes with tax-sheltered health savings accounts, or HSAs, that they and their employer can contribute to. But if an employee has his or her contribution deducted from their paycheck, it could potentially trigger the tax.

Officials say they're considering options."

The article also provides perspectives on the potential demise of Flexible Spending Accounts (FSAs). See related blog post here.

Read the full article here.

Posted by Cristie Travis at Thursday, September 3, 2015 | 0 comments

Uninsured Rate Decreases to 9.2% in First Quarter 2015

According to a Dan Mangan September 1, 2015 blog post for CNBC:

"In the first three months of 2015, the CDC said, the rate of people without health insurance stood at 9.2 percent. That's down from 11.5 percent in the same period in 2014, and represents a 20 percent reduction in the uninsured rate over the past year.In absolute numbers, 29 million people lacked health insurance in early 2015, compared with 36 million people in 2014. That number reached a high 48.6 million in 2010, the year the ACA was signed into law by President Barack Obama."

"The CDC's report is the latest survey that strongly suggests the ACA is behind a marked decrease in the uninsured rate in the U.S., as well as declines in the number of people who have difficulty accessing and paying for care."

Read more about how this decrease occurred

Posted by Cristie Travis at Thursday, September 3, 2015 | 0 comments

Fewer People Skipping Medical Care for Cost Reasons

According to the September 1, 2015 Amy Goldstein article in the Washington Post:

"During the first three months of the year, just 1 in 20 Americans said they did not get medical care they needed because they could not afford it, according to the U.S. Centers for Disease Control and Prevention.The findings, from the federal National Health Interview Survey, show that 4.4 percent of people interviewed from January through March said they had skipped medical care in the previous year because of its cost -- the lowest percentage in 16 years. The percent skipping care for cost reasons had reached nearly 7 percent in 2009 and 2010 and has been shrinking since then.

The survey, conducted with people of all ages, does not explain the reason why fewer people are avoiding treatment because of its cost, but the improvement coincides with two big changes: Health insurance has become more common under the Affordable Care Act as government exchanges began nearly two years ago to sell private insurance policies for people who cannot get coverage through a job and as Medicaid for low-income people expanded in some states. At the same time, the economy has been recovering from the Great Recession of 2008-09, so more people are working.The new CDC estimates provide the latest evidence of a significant lessening of  the ranks of Americans who are uninsured: 29 million Americans said they lacked health insurance coverage, 7 million fewer than in 2014."

Read the full article here.

Posted by Cristie Travis at Thursday, September 3, 2015 | 0 comments

Isn't It Time That The Impact on Patients Be the Major Concern?

When exactly did we cross the threshold where we became more concerned about the financial impact on hospitals and doctors than on the health, and sometimes, actual lives of patients?

Why do commentaries, such as this one, which call out the shame of not righting this wrong in New York state, still include an argument that expanding laws allowing malpractice claims are likely to only result in a minimal increase in actual claims?

To give the author's credit, they make many of the right points:

  • Hospitals and doctors are doing a poor job of policing themselves, so malpractice laws that support patients are needed
  • Hospitals should do a better job of focusing on patient safety
  • Patients should not be limited to what they can collect 
  • Don't make it more difficult for patients to even get their case heard
  • Hold top hospital administrators accountable for negligence in their facilities
  • And, their final statement, " But as long as hospitals and doctors block legislation and fight regulation, patients will remain in peril."

I just feel that they should have left the financial discussion out because, by putting it in, they unintentionally support the flawed argument of the hospital and physician lobby that blocked "Laven's Law" from passing in New York. This is a moral issue, not a financial one.

Cristie Upshaw Travis, CEO, Memphis Business Group on Health

Posted by Cristie Travis at Monday, August 31, 2015 | 0 comments

Narrow Networks Can Result in "Surprise" Bills for Patients and Employers

We've all heard the stories, or even experienced it ourselves, about finding out after-the-fact that the anesthesiologist used during surgery was out-of-network and, therefore, the patient and employer owe a lot more for those services that expected. This happens even though the hospital is in-network.

This situation is becoming even more frequent due to the expanded number of narrow-networks put in place with the advent of the Marketplace (aka public health insurance exchange) and in the growing number of employers offering narrow networks as a cost-reduction strategy.

And anesthesiology isn't the only specialty where this can happen. Emergency room physicians, pathologists, radiologists, specialists, and hospitalists are just examples of other, hospital-contracted physicians, that may not be in-network.

Although many insurance companies and self-insured employers have taken steps to protect the patient from the balance billing, the higher out-of-network costs (then picked up by the insurance company or employer) still accrue and add to the increasing high cost of care and therefore premiums.

For employers: What do you do to protect yourself, as well as your employees and their families, from this type of balance billing? How do you hold your health plan or hospitals accountable for having contracted physicians in the networks they accept?

Read more.

Posted by Cristie Travis at Monday, August 31, 2015 | 0 comments

New, Very Expensive Treatments for Cholesterol Approved

NOTE: MBGH's new, specialty pharmacy management program for members is exactly what employers need to make the tough decisions around how to manage the costs of the new, very expensive treatments for high cholesterol, while still getting this treatment to those that need it. Contact Cristie at to learn more.

Two drugs in a new class of cholesterol-lowering treatments have now been approved by the FDA --  Praluent, made by Sanofi Regeneron and approved last month, which costs $14,600 a year, and Repatha, made by Amgen and approved last Thursday, at $14,100 a year. Typically, patients that can't tolerate statins, the most prescribed drug class for the treatment of high cholesterol at a cost of only pennies per day, are candidates for the new drugs. Like statins, the new drugs are taken for the rest of a patient's life, resulting in well over 6 figure cost of treatment.

Read this article in the New York Times to get an understanding for the dilemma patients, physicians, insurance companies, and self-insured employers are facing regarding use of these new drugs.

Posted by Cristie Travis at Monday, August 31, 2015 | 0 comments

Flexible Spending Accounts May Disappear

Richard Stover, an actuary with Buck Consultants, predicts that Flexible Spending Accounts (FSA) will be the first to go if the Cadillac Tax moves forward as planned.

FSAs allow employees to save their own money, pre-tax, to pay for various health-related expenses including co-pays and deductible, eye glasses, and more. According to Stover, eliminating FSAs may be the most obvious way the Cadillac Tax impacts the middle class.

The Cadillac Tax, which taxes the amount of benefits over $10,200 for individuals and $27,500 for families beginning in 2018, is expected to apply to traditional health insurance, supplemental health insurance plans, flexible spending accounts and, potentially, worksite clinics. 

In his August 31, 2015 article in Politico. author Brian Failer points out that "The Cadillac tax will cap for the first time the open-ended tax break employers receive for providing their workers with health benefits. Economists love the tax because they say that break is a big reason for rising health care costs. Overly generous insurance coverage shields beneficiaries from having to worry about the cost of their care, they say, which encourages them to use more services, which drives up prices.But the tax is quickly becoming one of Obamacare’s least popular components, and businesses and unions alike are demanding lawmakers scrap it before it takes effect."

Repeal of the Cadillac Tax is being pushed for from many fronts, but is not expected to happen during the Obama administration. Both Clinton and Sanders have signaled willingness to reconsider it if elected.

In the meantime, employers are already taking steps to avoid the tax and it is doubtful that they will reinstate many of these changes if the tax is repealed.

Read more here.

Posted by Cristie Travis at Monday, August 31, 2015 | 0 comments

Memphis Restaurants Receive Eat REAL Tennessee Recognition

Through a partnership between the Tennessee Department of Health and the United States Healthful Food Council (USHFC), Eat REAL™ Tennessee has announced the first REAL Certified establishments in Memphis.

Responsible Epicurean and Agricultural Leadership (REAL) is a growing national program that helps combat diet-related disease by recognizing foodservice operators committed to holistic nutrition and environmental stewardship. 

MBGH encourages all employers to share this list of restaurants with your employees and their families so they can eat healthy outside of work too! Click here to see the list and learn more about the restaurants and share the link with your colleagues.

Memphis’s inaugural class of REAL Certified foodservice establishments can be found throughout the city and include: 

Andrew Michael Italian Kitchen     
Cafe Eclectic
City Market 
The Farmer
Fuel Cafe
Hog & Hominy
Lettuce Eat Salad Co.
Taziki’s Mediterranean Cafe     
Trolley Stop Market
Two Vegan Sistas

“Memphis is a city rich in local food culture and community, and these eating establishments are helping shift the environment towards a more healthful and sustainable model,” said Eat REAL Tennessee Project Manager Nikkole Turner.   

Eat REAL Tennessee is a statewide initiative supported through a grant from the Tennessee Health Department as part of an innovative approach to preventing diabetes and obesity across the state. The program also serves as a community outreach platform, engaging and educating the public on nutrition and healthy dietary choices.   

Utilizing the points-based REAL Index, independent registered dietitians conduct an assessment of menu offerings and overall nutrition and sustainability practices. Establishments are credited with points across a range of criteria such as the use of vegetables, fruits, whole grains, healthy preparation methods, moderate portion sizes, unsweetened beverages, healthy children’s options and sustainable sourcing. Those that satisfy the necessary requirements are awarded and recognized as REAL Certified.    

The USHFC has partnered with the Memphis Business Group on Health (MBGH) and certified its annual awards luncheon this year at Rhodes College. “We were able to offer our awardees a healthy and locally sourced meal in support of our mission and that of the USHFC’s,” said Cristie Travis, Chief Executive Officer of the MBGH.    

All REAL Certified establishments are featured on and promoted through the USHFC’s local partners to help identify “better for you” dining options. The USHFC is partnering with FITKids, a program of the University of Memphis, to help Memphians find healthy family friendly dining establishments through its website and mobile app.   “Shelby County Government is very excited to be working with Eat REAL Tennessee to provide healthier options to our employees and encourage better nutritional choices,” said Shelby County Deputy Administrator Brenda Greene.   

The newly certified Memphis establishments mark an expansion of REAL Certified, which launched with a restaurant campaign in Washington, DC, two years ago and has since grown to include restaurants, workplace dining facilities and public venues in 28 states.    

ABOUT THE UNITED STATES HEALTHFUL FOOD COUNCIL (USHFC) Established in 2011, the USHFC is a 501(c)(3) registered nonprofit, dedicated to fighting diet-related disease by realigning the food industry’s incentives with consumers’ health interests. The USHFC works towards its mission through the REAL Certified holistic nutrition and sustainability certification program. REAL Certified foodservice operators must satisfy prerequisites and earn sufficient points in the areas of Responsible (nutrition), Epicurean (preparation), Agricultural (sourcing) and Leadership (going above and beyond). More information can be found at and 

Posted by Cristie Travis at Monday, June 22, 2015 | 0 comments

Telemedicine Expansion Gets Boost from Walgreens, United, Anthem

According to Modern Healthcare, Walgreens plans to reach about half the country with computer based telemedicine programs (also adapted for tablet, smart phones) by December 31, 2015. This announcement falls on the heals of plans announced by Anthem and United to expand their telemedicine services to more than 40 million by next year.

The American Telemedicine Association estimates that 450,000 Americans had telemedicine visits last year for primary care and although that number is only a small portion of the total 15 million people that access telemedicine, it has doubled in the past two years.

Read the Modern Healthcare article here.

The potential impact on health care costs is clear when you realize that the average cost of a telemedicine visit is $39 compared to a physician visit at $120 and ER visit of $499.

Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

Health Care Cost Increases Picking Up Speed

Drew Altman, in his June 11, 2015 WSJ blog post, believes the "lowest of the lows of the health cost slowdown are now in the rear view mirror" and as the economy has recovered, people are using more health care services. In addition, more people covered through health reform are likely impacting the increase as well. Read the blog post here.

Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

Out-of-Network Charges Can Break the Bank

A recent report from America's Health Insurance Plans (AHIP) shows that across the US, some physicians are charging patients fees that are 10 times, and in some cases as much as 100 times, the amount Medicare pays when patients go outside their health plan's network. In Tennessee, for the selected procedures, out-of-network charges range from 7 times what Medicare pays to 33 times what Medicare pays.

Hospitals have adopted a similar strategy. A study reported in the June edition of Health Affairs found that the 50 hospitals with highest prices charged, on average, 10 times the Medicare allowed amount. A CMS study released June 1 found a similar pattern with hospitals charging, on average, $54,000 for a major joint replacement compared to Medicare's average payment of less than $15,000. Read the NY Times article here.

There is increasing pressure on health care providers from both the public and private sectors to re-examine these policies and to get charges more in line with Medicare payments.

Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

CVS Almost Doubles in Memphis Through Purchase of Target Pharmacies

CVS's purchase of Target pharmacies will almost double the number of CVS locations in the Memphis-metro area, making CVS a more attractive network model for Memphis-area employers and their employees.


Read more about the acquisition in the NY Times

Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

Potential Insurance Company Mergers Could Limit Employer Choices

Source: Morning Consult

6/21/15 Update: Cigna Rejects Anthem's $47 billion offer. Read why and more about other possible mergers in the latest NY Times article.

Are these possible mergers good or bad? Well, the answer is "depends". They would certainly limit employer choices as well as people purchasing individual insurance or insurance through the exchanges. On the other hand, larger insurance companies may be able to negotiate more favorable financial arrangements with the health care provider industry that is continuing to consolidate.

Read more about possible mergers:

Wall Street Journal (subscription required)

LA Times

Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

MBGH & Methodist: Innovation Has Been the Key

Thinking back over the MBGH-Methodist Healthcare relationship, the first word that comes to mind is “innovation”. In many ways, Methodist has been a “Mikey” for MBGH. You remember “Mikey”, that little boy at the breakfast table in commercials that is willing to try anything for breakfast. Some highlights from the list of “Mikey-like” innovations with MBGH include:

  • The first worker’s compensation PPO network for self-insured employers in the region.
  • The first CAHPS survey in the nation which captured employer’s experience with the MBGH/Methodist worker’s compensation PPO network.
  • The first health system to implement internal quality improvement processes in reaction to MBGH’s 1998 Hospital Report Card on cardiac care.
  • The first roll-out of The Leapfrog Hospital Rewards program in the nation. Cigna ended up implementing a bonus pool for Methodist based on their performance on key Leapfrog safety and quality measures for their entire book of business which gained national recognition and became a model of other pay-for-performance programs nationally.
  • The first, and still only, health system in Memphis to post their detailed results from the Leapfrog Hospital Survey and Hospital Safety Score on their website. 

MBGH and Methodist have also collaborated on the University Medical Center Alliance (Memphis’ own version of the Institute for Healthcare Improvement), launching of the Healthy Memphis Common Table, and implementing the CDC’s Diabetes Prevention Program for their employees. About seven years ago, Methodist provided input into how to help them and other employers create a culture of health at the worksite, which is now a key component of MBGH’s CEO Culture of Health initiative.

Over the past six years, MBGH has recognized the important role Methodist hospitals play in providing safe, high quality, cost efficient care in the greater-Memphis area, including:

  • Best odds of survival for abdominal aortic aneurysm repair, pancreatic resection, esophageal resection, and heart angioplasty
  • Cost of care for heart angioplasty
  • Reducing the number of babies delivered before they reach full-term
  • Improvements in ventilator-associated pneumonia
  • Receiving “Straight A’s” on the Hospital Safety Score (Methodist University Hospital and Methodist LeBonheur Germantown Hospital)
  • High risk deliveries
  • Creating and sustaining a culture of health that supports the health of their employees.

As is always the case, these innovations and recognitions don’t just happen. It takes the commitment of a strong leadership team to see the need and then act upon it. Cristie Upshaw Travis, MBGH CEO, remembers what happened after MBGH released the first hospital report card in 1998, “I will never forget the afternoon I picked up the phone and Maurice Elliot, CEO and President of Methodist, was on the line wanting to talk about the report card MBGH had just issued on cardiac care in Memphis. I expected the usual “your data are wrong” and high level marketing points, but instead we spent two-hours going through every data point. The bottom line was that Methodist had been comparing their performance to other Memphis-area hospitals, not to national best practices and was surprised at the results. All of the Memphis health systems had similar if not bigger opportunities for improvement, but Methodist was the one that wanted the details so they could jump on improvement.”

From the early days of working with Maurice to our work with Gary Shorb, Donna Abney, Bill Breen, Ed Rafalski, Mitch Graves, Donna Winfrey, Jane Van Deren and others there has been a common commitment to innovation focused on improving quality and affordability of care for patients first and employer purchasers second.

MBGH thanks Methodist LeBonheur Healthcare for being a special sponsor for our 30th Anniversary and we look forward to working together as we start our next 30 years.
Posted by Cristie Travis at Monday, May 18, 2015 | 1 comments

Opioid Abuse Costing Employers Billions

According to a recent study released by Healthentic and an article in Employee Benefit News, lost work and productivity due to opioid abuse account for $10 billion. 13% of the opioid users accounted for 92% of the employer costs. 

What should you do?

Insist on conservative prescribing approaches from your health plans and participating physicians

Use HIPAA-compliant tools to identify abusing employees 

Increase and ensure confidential access to treatment

Click here to read the EBN article and access the report here.

Posted by Cristie Travis at Friday, May 15, 2015 | 0 comments

Check Out Latest Memphis Hospital Safety Scores

The latest Hospital Safety Scores for Memphis-area hospitals are out! Results of interest include:

  • The Regional Medical Center improved its score moving to a D.
  • Methodist North and Methodist South moved back to the Bs they have had in previous results. 
  • For the first time, Baptist Collierville had enough volume to receive it's own score, which was a C.

The rest of the scores remained the same as in Fall 2014: 

Methodist University: A
Methodist Germantown: A
 Saint Francis Memphis: A
 Saint Francis Bartlett: A
 Baptist Memphis: C
 Baptist DeSoto: C 

You can now check out all the past scores for Memphis area hospitals on the website. Select the hospital you are interested in and click "Show Past Grades".

These hospitals have received A's on all of the Hospital Safety Scores since the beginning in Spring 2012:

Methodist University

Methodist Germantown

Saint Francis Memphis

Click here to see the details on Memphis-area hospitals as well as more than 1,500 other hospitals across the country.

Posted by Cristie Travis at Thursday, May 14, 2015 | 0 comments

Radical Approach to Hospital Bills: Set Your Own Price

According to Kaiser Health News, May 13, 2105:

 "A small benefits consulting firm called ELAP Services is causing commotion by suggesting an alternative: Refuse to pay. When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients (generally medium-sized employers) to just say no."

"Instead, employers pay hospitals a much lower amount for their services — based on ELAP’s analysis of what is reasonable after analyzing the hospitals’ own financial filings."

Needless to say, this approach is disrupting the conventional approach to hospital payments.

In this approach, employers and their TPAs don't have contractual arrangements with hospitals and employees are free to go to any hospital. In other words, there are no pre-defined networks or PPO-type arrangements. According to Kaiser Health News, "Employers detail the reimbursement process in documents establishing how the plan covers workers. That gives it legal weight, ELAP has argued in court. ELAP agrees to handle all hospital bills for an employer and defend workers from collections in return for a percentage fee tied to total hospital charges."

Click here to read the article.

Posted by Cristie Travis at Thursday, May 14, 2015 | 0 comments

Hepatitis C Virus Surges in Appalachia, Including Tennessee

The CDC found that hepatitis C cases increased 364% from 2006 to 2012 for residents ages 12-29 in the Appalachian states of Tennessee, Kentucky, West Virginia, and Tennessee. Rural rates were more than double urban rates.

73% of those that responded to a survey regarding risk factors reported they had used intravenous drugs, primarily heroin and prescription opioids. 

Add this to the fact that Memphis ranks second in the country for hepatitis C cases per 100,000 population and it is clear Memphis and Tennessee are hot spots for hepatitis c virus and the new drugs that can now cure this disease.

MBGH is working with employers and specialty pharmacy management experts to develop a series of workshops to focus employers on these issues and develop strategies to manage the cost of specialty pharmacy while, at the same time, offering these and other high quality drugs to their employees and dependents. 

Look for the announcement of our workshops soon!

Posted by Cristie Travis at Tuesday, May 12, 2015 | 0 comments

Clarifications Issued On Key Health Reform Coverage Requirements

Click here to print out a copy of the clarifications issued by HHS and DOL regarding key health reform coverage requirements, including:

Coverage of FDA-approved contraceptives

BRCA genetic testing

Sex-specific recommended preventive services

Well-woman preventive care for dependents

Colonoscopy anesthesia services

You can also click here to go directly to the DOL site.

Posted by Cristie Travis at Tuesday, May 12, 2015 | 0 comments

CDC Focuses on a Healthy Workforce

2015 MBGH Annual Conference Topic: Effective Worksite Wellness Programs

MBGH CEO Culture of Health Initiative

The latest issue of Business Pulse: Healthy Workforce is now available and explores how the CDC can help employers maximize their worker health and safety while improving their profitability and productivity.  The piece links to many tools that employers may find of value including business-focused CDC resources, the Total Worker Health program and this interactive infographic. 

Check out the Essentials Elements of Effective Worksite Programs under the Resources tab and note that MBGH's CEO Culture of Health initiative completely aligns with these elements. Interested in learning more about this evidence-based program? Contact Cristie Travis at

The CDC Foundation is a non-profit organization that connects the Centers for Disease Control and Prevention (CDC) with private-sector organizations and individuals to build public health programs that make our world healthier and safer. The Foundation produces Business Pulse, a quarterly online series which offers useful CDC health resources to businesses, executives, employers and employees.

Posted by Cristie Travis at Tuesday, April 14, 2015 | 0 comments

How Does Your Health Plan Treat the New Biosimilars?

2015 MBGH Specialty Pharmacy Management Workshop Topic (held April 1)

From the National Business Coalition on Health:

"Earlier this month, Novartis’ Zarxio was the first biosimilar product approved in the United States, ushering in a new era for the drug industry, consumers and third parties who manage medical and drug benefits. The introduction of cheaper alternatives to relatively complex biologic drugs has created confusion over the U.S. Food and Drug Administration’s approval process and specialty-related product availability to be used or marketed."

"For plan sponsors, this situation is not ideal and continues to cause confusion around timing as well as terms important to benefit coverage sought by members as patients for these new biologic/specialty products from manufacturers. In addition, pricing has not been determined but is unlikely to rein in rising specialty drug cost trends or improve current year spending on medical or pharmacy benefits in the U.S."

Cheryl Larson, vice president of our sister coalition, the Midwest Business Group on Health, and Randy Vogenberg, principal for The Institute for Integrated Healthcare, highlight questions employers should be asking related to biosimilars in their April 14, 2015 article in Employee Benefit News.  

1. Have a conversation with your pharmacy benefit management organization and/or health plan regarding their coverage approach or policy related to biosimilars. If you have questions about how biosimilars are different, ask them. 

2. Review your vendor contract and coverage of specialty drugs to determine the impact on current or future plan costs to your organization. 

3. Review your own plans’ drug use patterns and if this type of approval would make a cost savings difference to your members. 

4. Determine if this will make any difference on annual cost trend for the plan versus just the unit cost of a particular drug for an individual medical condition like cancer-related anemia. 5. Continue to advocate for full cost transparency on all specialty drug products by your vendors. 

 The full article published in Employee Benefit News can be found here

Posted by Cristie Travis at Tuesday, April 14, 2015 | 0 comments

Cadillac Tax To Become 2016 Election Issue

MBGH Members Only Peer Roundtable Discussions: Strategies Being Implemented re: Cadillac Tax

The next time your CFO asks you to explain the Cadillac Tax just tell them it is a way to "equalize the way wages and health insurance are taxed. "

According to the April 13, 2015 article in Employee Benefit News, Jonathan Gruber, an MIT economist, explains "Health insurance is compensation and wages are compensation. They should be taxed the same. And they're not". Gruber believes that since health insurance benefits aren't taxed, the system encourages excessive consumption.

The Cadillac Tax, which goes into effect in 2018, is a 40% excise tax on health coverage that costs more than $10,200 for an individual or $27,500 for a family. It is estimated that about 1/3 of all employers will be subject to the tax if they don't make changes by 2018.

Michael Cannon, director of health policy studies at the Cato Institute, believes that because so many employers will be impacted, there will be political pressure to repeal it. However, such a move may result in all of the ACA being re-opened for reconsideration and repeal of other reforms.

Democrats are likely to be pressured more than Republicans since Republicans say "we hate taxes, we hate the ACA, we want to get rid of this tax". Additionally, union plans and unions will be heavily impacted by the tax and will pressure for its repeal as well, putting more stress on the Democrats.

Read the complete article here.

Posted by Cristie Travis at Monday, April 13, 2015 | 0 comments

Private Exchange Enrollment Doubles in 2015

2015 MBGH Annual Conference Topic: Private Healthcare Exchanges!

According to an April 13,2 015 article in Employee Benefit News, Accenture data shows that enrollment in private exchanges doubled from 3 million in 2014 to 6 million in 2015.

Accenture projects that by 2018, the first year of the Cadillac Tax, 40 million will be enrolled in private exchanges.

Although most of the growth in 2015 was in the mid-market segment, Accenture believes that more large employers, who have been waiting to see what happens in the private exchange market, will fuel future growth. 2018 will be a pivotal year and with 1/3 of employers being impacted by the Cadillac Tax, Accenture predicts that larger employers will have exhausted traditional cost cutting strategies and moving to the exchanges will be the remaining strategy to get them below the tax level.

Read the entire article here.

Posted by Cristie Travis at Monday, April 13, 2015 | 0 comments

MBGH & Baptist Redefined Providing Health Benefits in Memphis

Thirty years ago, a small, but mighty, group of employers came together to commiserate about the high cost of health care in Memphis. They commissioned a special study that showed not only were their costs high, but there didn’t seem to be a rationale for how rates were set and there were vast differences, some as high as 80%, between what hospitals charged for the same service. 

Deciding that unless they became more active purchasers nothing would change, these employers, joined now by others, formed the Memphis Business Group on Health and decided to pool their lives and invited health systems to bid on their business. No doubt this decision caused quite a stir among health care providers and it was certainly disruptive.

But, what would the response of the health systems be? Would any system actually propose, or would they all sit it out and hope this new activism would just fade away?

Baptist Memorial Health Care stepped up to the plate and said they were ready to forge a relationship with MBGH. None of the other systems responded to the request for a proposal in 1987, but did throw their hats in the ring in 1989 and every bidding year afterwards.  Employers working directly with a health system literally redefined what it meant to offer health benefits in Memphis. This was a first for both MBGH and Baptist and actually was an early “first” nationally, as business coalitions were being formed around the country to reduce the cost and improve quality and accessibility to health care services.

The group purchase arrangement was not only innovative and disruptive at the time, but also for how it evolved over the next 12 years. Just a few of the most significant innovations were:
  • Agreeing contractually to report quarterly on the quality of care provided by Baptist compared with national benchmarks 
  • Moving away from a discount off fee-for-service to per diem and case rates for inpatient care and ambulatory surgical procedures
  • Providing access to MBGH’s group pricing to smaller businesses through MBGH’s fully-insured Business Group Health Insurance Alliance
As you can see MBGH and Baptist partnered on implementing what is now referred to as “value-based purchasing” at least 10 years before it became a national trend.

Over the past six years, MBGH has recognized the important role Baptist hospitals play in providing high quality, cost efficient care in the greater-Memphis area, including:
  • Best odds of survival for heart bypass, aortic vale replacement, pancreatic resection, and esophageal resection
  • Reducing the number of babies delivered before they reach full-term
  • Improvements in catheter-associated urinary tract infections
  • Creating and sustaining a culture of health that supports the health of their employees.
But, as Cristie Upshaw Travis, MBGH CEO says, it is not only about what MBGH and Baptist accomplished together; it is also about the people of Baptist.

“Being the daughter of a physician that practiced at Baptist for over 40 years I have always felt at home there. An especially poignant example of how this personal relationship played out was Steve Reynolds’s invitation for me to be the keynote speaker at the annual meeting of the Baptist medical staff when my Daddy would be recognized. That thoughtfulness has been there in our working relationship as well. From the early days working with Steve Reynolds, Bob Gordon and Mike Clement to our work with Jason Little, David Elliott, Beverly Jordan, Dana Dye, Anita Vaughn, Nancy Averwater and others there has always been a common commitment to putting employees and patients first and, I am glad to say, we have had some fun along the way.”

“Baptist is proud to be a long-term partner with the Memphis Business Group on Health,“ said Jason Little, president and CEO of Baptist Memorial Health Care. “Being MBGH’s first partner, we have always taken best clinical practices and quality excellence very seriously. We look forward to our continued joint work to help improve the health of those in the communities we serve.”

MBGH thanks Baptist Memorial Health Care Corporation for being a special sponsor for our 30th Anniversary. It just wouldn’t be the same if our first partner in this journey were not there to help us blow out the candles on August 20! Thank you Baptist.
Posted by Cristie Travis at Sunday, April 12, 2015 | 0 comments

How To Develop a Culture of Health For Successful Worksite Wellness Programs

"There is considerable debate about whether worksite wellness programs are effective in improving health and in reducing health benefit costs. Supporters argue that if employees are healthier they are less likely to develop chronic diseases that are linked to lifestyle choices. Skeptics counter that many worksite wellness approaches actually increase costs and don’t deliver on the promise of reducing health benefit cost trends. Both of these viewpoints can be correct, especially if the issue is effective execution of worksite wellness programs.   

If worksite wellness programs are implemented merely as cost control measures laid on top of, or even integrated into, health benefits and are not a reflection of a core value of the organization, then they are likely to be less effective. When these same programs are wrapped within a culture of health they become a part of the fabric of the organization and engage employees more effectively."

Click here to read the rest of the article from HR Professionals Magazine that answers these questions:

  • What is a culture of health?
  • What would your organization look like if you had a culture of health?
  • How do employers create a culture of health?
  • Are others creating cultures of health?

The article, by Cristie Upshaw Travis, MBGH CEO, Dr. Kathy Tuberville of the Fogelman College of Business and Economics at the University of Memphis, and Renee Frazier, Common Table Health Alliance CEO, ends with a call to action for more employers to build cultures of health to strengthen the effectiveness of their worksite wellness programs.

Posted by Cristie Travis at Monday, April 6, 2015 | 0 comments

The Y Leads by Example in the CEO Culture of Health Initiative

The YMCA of Memphis & the Mid-South is one of our newest CEO Culture of Health participants, having just joined in 2015. Believe it or not, they have already met the requirements for the Small Starts @ Work program and are officially a Healthier Tennessee Workplace!

Now you may be saying to yourself, “Well, it was easy for them, they are in the business of helping people get and stay healthy.” Cleo Griffin, Corporate Relationship Director for The Y, will quickly tell you that it is not easy, even for them. "The most responsible action was for us to offer our employees free Y membership so they can also take advantage of the programming we offer to help lead a healthier life. Thereafter, we had to be intentional about the behaviors that influence a culture of promoting the health of our team members”.  

Some of the other steps the Y has taken include: 

Offering free biometric screening through their health insurance benefits; 

Providing the Diabetes Prevention Program as a covered benefit under their staff health insurance plan;  

Giving a healthy tip at the beginning of team meetings; 

 Adopting water as the exclusive beverage offered to staff; 

 Changing their vending machine options; and 

Giving employees a health-related item when they exercise at least 12 times a month.   

A theme that runs through the Y’s approach to both employee health and wellness, and in their work to promote and support the health of Memphians, is removing barriers that stand in the way of people living healthier lives. Cost is often a significant barrier and by offering free Y memberships to their employees this barrier is removed.   The Y also works with businesses across the region to make this same benefit available to their employees by offering packages to employers who help subsidize the cost of Y membership for their employees. But even if the employer doesn’t subsidize membership, employee membership rates are based on their annual household income, making the Y financially accessible to lower wage earners. 

Other barriers the Y works to remove include:   

Convenience: There are 9 locations throughout the Mid-South; 

Child Care: The Y offers free child watch while employees workout; and  

Time: Ys are open early in the morning until late at night.    

But the Y is not just about working out and exercising. Other programs businesses may be interested in include the Diabetes Prevention Program, the Corporate Games, and for a small fee they can come to your worksite to present health topics for your employees.   For more information on the Y and ways in which they can support your employee health and wellness programs, click here.

Posted by Cristie Travis at Friday, April 3, 2015 | 0 comments

CVS Urges Cost Controls For New Cholesterol Medications

Citing the concern that eventually 15 million patients at an annual cost of $150 billion of a new class of cholesterol medications, CVS Health warned that the cost of these new medications could overwhelm the U.S. health care system "if rigid cost control mechanisms are not put in place".

According to Reuters, CVS negotiates drug pricing for 65 million through contracts with employers and health plans.

The concerns around cholesterol medications are closely following criticism regarding the new Hepatitis C drugs, which may cost up to approximately $94,500 for a course of treatment. But unlike Hep C drugs which are effective with one course of treatment, the new cholesterol medications are essentially taken for life and significant annual financial implications for patients undergoing treatment and employers and plans covering the cost of that treatment.

Express Scripts also voiced concerns although their cost estimates are somewhat lower than CVS estimates.

Learn more about specialty pharmaceutical management on a February 26 webinar and in-person at a 1/2 day workshop in Franklin, TN on April 1. Email Cristie at for more information and registration details.

Read the Reuters article.

Posted by Cristie Travis at Wednesday, February 18, 2015 | 0 comments

Scope of Wellness Programs Growing

MBGH's CEO Culture of Health is growing rapidly with 6 new participants so far in 2015. We are now at 60 participating organizations with over 66,000 employees. Contact Cristie at for more information on the complimentary benefits available to you from MBGH. And, here are the survey results from the International Foundation for Employee Benefit Plans (IFEBP) 2015 Worksite Wellness Trends survey. As you will see, having a culture of health at the worksite pays off!

Benefits Expanding To Support Social, Community and Mental Health 

Brookfield, Wisconsin – Celebrating a birthday, rolling up the sleeves for a community volunteer project and taking that extra day of vacation are probably not the first activities that come to mind concerning workplace wellness. However, less traditional benefits are quickly taking the stage as top wellness initiatives, according to the International Foundation of Employee Benefits Plans' recent surveyWorkplace Wellness Trends.

More traditional wellness initiatives like health risk assessments and flu shots remain popular among workplaces, but the International Foundation noticed a growing emphasis on more non-traditional initiatives like mental health coverage, vacation time and tuition reimbursement.

According to the survey, top non-traditional wellness initiatives include:

Vacation time/time off use is encouraged (66 percent)

Mental health coverage (63 percent)

Tuition reimbursement (63 percent)

Community charity drives (57 percent)

On-site events/celebrations (50 percent).

Some of the more unusual offerings emerging are discounted or free wearable tracking devices, themed dress-up days, game leagues, financial education and workplace design changes like collaborative work spaces, standing/treadmill desks and walking loops.

Top traditional wellness initiatives include:

Flu shot program (71 percent)

Smoking-cessation program (54 percent)

Health risk assessments (51 percent)

Health screenings (50 percent)

Wellness competitions/fitness challenges (42 percent).

Organizations are offering wellness initiatives for different reasons—59 percent offer wellness primarily to invest in/increase worker health and engagement, while 41 percent primarily aim to control/reduce health-related costs. 

As organizations embrace both traditional and nontraditional wellness initiatives, it is clear that their efforts are creating results."Employers are taking a greater interest in the social and mental well-being of their employees," said Julie Stich, CEBS, Director of Research. "Both traditional and nontraditional wellness benefits are creating the return on investment employers are looking for in their workplace wellness programs."

Of the responding organizations with wellness initiatives, about one in four (26 percent) is analyzing the return on investment of their wellness program. Proof of wellness results is in uniquely high demand – just four percent of organizations that calculate wellness ROI also analyze the ROI of other initiatives/benefits.

Among organizations analyzing and aware of their wellness ROI, 93 percent are achieving positive ROI –the average ROI per $1 spent is $3. Among organizations tracking more specific wellness efforts, 54% said wellness efforts have improved engagement, 45% said wellness efforts reduced absenteeism, and 38% said wellness efforts have positively affected their organization's overall bottom line.

 "Positive changes exist with the expansion of workplace wellness initiatives but what's even more exciting is the future emphasis of wellness-related offerings," said Michael Wilson, CEO of the International Foundation.  "Many organizations are moving beyond just physical health and are looking at the whole picture of employee well-being."

Click here for an infographic of major results.

About Workplace Wellness Trends Survey

Survey responses were received from 479 individuals from the U.S. and Canada, including benefits and human resources professionals, financial managers, and other professionals. Responding organizations represented a variety of sizes, regions and industries or jurisdictions. For complete results and more information visit

Posted by Cristie Travis at Wednesday, February 18, 2015 | 0 comments

Get Intensive Training on Techniques and Skills to Manage Cost and Quality of Your Health Benefits

All Greater Memphis-area and West Tennessee HR and Benefit professionals are invited to attend the College for Value-Based Purchasing at Nissan North America in Franklin, TN on March 31-April 1, 2015.

Tuition costs are waived for MBGH dues-paying members and conference sponsors at the Supporter level and above (committed before March 13). For others the tuition for the College is $500. Attendees are responsible for all travel and overnight accommodations and meals not provided by the College.

The College for Value-Based Purchasing provides a practical, intensive program that focuses on benefit purchasing techniques and skills that emphasize improving value, quality-cost ratio and effectiveness of health care services purchased on behalf of employees.

The College is held from 8:00 am - 5:00 pm on March 31 (includes breakfast and lunch) and from 8:00 am - 12:00 pm on April 1 (includes breakfast). For the Franklin,TN session, College registration also includes an optional half-day session from 12:00-5:00 (including lunch) on specialty drug management on April 1 at no additional cost. 

The College has been approved for 10.5 (General) HR recertification credit hours. 

Click here for more College details including faculty, courses and schedule. Click here for information on the specialty pharmacy management session. Click here to register.

Posted by Cristie Travis at Wednesday, February 18, 2015 | 0 comments

What the Anthem Breach Means to Employer Health Plan Sponsors

Thank you to the National Business Coalition on Health for sharing this Advisory with MBGH

Advisory Information from the law firm Davis Wright Tremaine LLP 02.09.15 By Adam H. Greene, Sarah L. Bhagwandin, Sean B. Hoar, Christin S. McMeley, Dipa N. Sudra, Rebecca L. Williams, and Anna C. Watterson 

NOTE: Even if you do not contract with Anthem, this is a great case study on your obligations and considerations if a breach ever occurs for you!

On Feb. 4, 2015, Anthem announced a data breach involving the personal information of more than 80 million individuals resulting from what it characterized as a sophisticated, targeted cyber-attack. 

Group health plans may be affected because Anthem: (1) provides insured health benefits; (2) administers health benefits for a self-insured plan; or (3) administers out of area/network claims. 

Employers, as plan sponsors on behalf of their group health plans, need to identify how the Anthem breach may affect them, if at all, and get their arms around what they need to do in response. The following is practical guidance on what employers need to know and do now and in the coming weeks to comply with their legal obligations. 

Does HIPAA apply? 

One question is whether the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) applies. HIPAA applies if the compromised information is “protected health information”—a broad category of individually identifiable health information that arguably includes demographic information when it is indicative of whether an individual is participating in a health plan.

Anthem has not used the term “protected health information” in its statements, but has indicated that “names, birthdays, medical IDs/social security numbers, street addresses, email addresses and employment information, including income data” were compromised, all of which may fall within the definition of the term. Anthem also has stated that “there is no evidence that credit card or medical information, such as claims, test results or diagnostic codes were targeted or compromised.”

Seemingly based on this statement, some at first reported that there has been no violation of HIPAA. These reports may be based on some confusion surrounding what information is protected by HIPAA and the definition of the term “medical information” under certain state laws, such as the California Confidentiality of Medical Information Act. A court in California recently ruled that “medical information” does not include “personal identifying information that is not coupled with that individual’s medical history, mental or physical condition, or treatment.” Anthem’s emphasis that no medical information was compromised may have been in reference to the California definition or something similar, and may become a key issue in the success or failure of any class action litigation under state law. 

We understand that class action lawsuits already have been filed, so it is not surprising that Anthem may be laying the groundwork for possible defenses. It is likely that the Anthem compromised information qualifies as “protected health information,” or “PHI” under HIPAA, which is a broader term than “medical information.” If this is the case, then Anthem, and in many cases employers, will clearly have breach notification obligations under HIPAA. 

What does this mean for employers under HIPAA? 

If the breached data is protected health information, Anthem will be required to provide breach notification under HIPAA. Notice obligations under HIPAA vary, depending on whether the compromised information relates to: (1) an individual policy; (2) a fully-insured group health plan; or (3) a self-insured group health plan. 

With respect to individual policies and fully-insured group health plans, Anthem may be the health insurance issuer. In these cases, a breach of unsecured protected health information likely requires Anthem to notify affected individuals, the U.S. Department of Health and Human Services (“HHS”), and the media. In these instances, the employer does not appear to have breach notification obligations under HIPAA. 

For self-insured group health plans, Anthem could be the third party administrator (“TPA”) of the plan. Under HIPAA, as a third party administrator, Anthem likely would be the group health plan’s business associate that must report a breach of unsecured protected health information to the health plan. The plan itself has the obligation under HIPAA to notify affected individuals, HHS, and potentially the media. This responsibility ultimately falls on the employer, as the plan sponsor. The employer, however, may delegate its breach notification obligations to Anthem, as its business associate. 

In the present case, delegation likely makes the most sense. Otherwise, a large number of self-insured plans would need to go through the time and expense of breach notification, affected individuals may confusingly receive multiple notifications related to the same incident, and government regulators would need to wade through a large number of breach reports related to the same incident. A self-insured group health plan’s business associate agreement with Anthem may include and address delegation of breach notification responsibilities. If not, then formal documentation of any delegation may be required if the group health plan chooses to delegate breach notification to Anthem. Once an employer delegates the breach notification obligations to Anthem, it should obtain evidence on behalf of its self-insured health plan that HIPAA-required notifications have been made for the employer’s compliance records. 

While HIPAA requires breach notification without unreasonable delay and in no case later than 60 days, it may be reasonable for Anthem to delay notification for the moment while it investigates the breach and coordinates notifications. Employers may need to await instructions from Anthem regarding how breach notifications may be coordinated. 

How will state law apply? 

State laws may present similar issues. For example, 47 state breach notification laws, plus the District of Columbia and two U.S. territories, require the non-owner of data to notify the owner of the data if there is a breach of certain information, including social security numbers. 

When Anthem is acting as a TPA, it may be treated as the non-owner of the data and have an obligation to report to the owner of the information. Ultimately, under these state laws, the self-insured group health plan, as the owner of the data, may need to notify affected individuals and, possibly, regulators and credit reporting agencies. As with HIPAA, employers who maintain self-insured plans that use Anthem as their TPA may be well served by delegating state breach notification obligations to Anthem. 

So what should employers do now? 

If your organization has a self-insured group health plan and uses Anthem as a TPA, there are a few steps that you can take while Anthem continues its forensic investigation:  

(1) Notify employees of the current breach information that Anthem has provided (available at; 

(2) Educate employees to be on the alert for phishing scams or similar activities that may take advantage of the Anthem headlines to try to obtain personal information (Anthem has indicated that it will contact individuals by U.S. mail, so employees should be wary of any emails or other electronic communications claiming to relate to the Anthem breach); 

(3) Determine whether you (the employer) have breach notification obligations under HIPAA and state law (such as the plan sponsor of a self-insured plan with Anthem acting as the TPA); 

(4) If you have breach notification obligations, review whether the notification obligations have been contractually delegated to Anthem, such as in the business associate agreement; 

(5) If breach notification obligations have not already been contractually delegated to Anthem, consider whether to formally delegate those obligations to Anthem now; 

(6) Coordinate with your Anthem representative over the coming weeks to address who will provide any breach notifications that may be necessary and verify that the notification will be sufficient to meet your obligations under the law; 

(7) Create an internal security incident report to demonstrate that you are aware that a security incident affecting the group health plan has occurred, and document the actions that are being taken and the basis for any delay (e.g., that you are waiting on more information from Anthem); and 

(8) Once any required breach notifications have been made, ensure that you have some evidence (such as information from Anthem) demonstrating that the necessary breach notifications to affected individuals, HHS, the media, and potentially state regulators and credit reporting agencies have been made. 

For any questions, feel free to contact any of the authors of this advisory, any of the attorneys identified as “Related People” on the right, or the attorney with whom you normally work. Disclaimer: This advisory is a publication of Davis Wright Tremaine LLP. Our purpose in publishing this advisory is to inform our clients and friends of recent legal developments. It is not intended, nor should it be used, as a substitute for specific legal advice as legal counsel may only be given in response to inquiries regarding particular situations.

Posted by Cristie Travis at Wednesday, February 18, 2015 | 0 comments

Most Employers Are Unprepared for ACA's 2015 Requirements

A 2014 study by the ADP Research Institute finds that most employers, both mid-sized (50-999 employees) and large (1,000+ employees) are still unprepared for ACA's 2015 requirements.

For example, only the following are "prepared" for 2015 requirements:

 ACA Requirement  Mid-Sized   Large  
 Exchange Notification      33%     38%
 Annual Health Reporting      46%     51%
 Penalty Management      36%     40% 

The study also found that 49% of mid-sized employers and 62% of large employers are extending coverage beyond the mandated ACA full-time employees to attract/retain talent and avoid penalties.

Click here to see the infographic.

Click here to read more about major findings.

Posted by Cristie Travis at Monday, January 19, 2015 | 0 comments

No Impact on Employer Sponsored Insurance Coverage Rates Due to ACA

Data from the Health Reform Monitoring Survey for June 2013 through September 2014 was used to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. 

Results show that there is no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent (offer rate), 86 percent (take-up rate), and 71 percent (coverage rate), respectively, for all workers and around 63 percent (offer rate), 71 percent (take-up rate), and 45 percent (coverage rate), respectively, for low-income workers. 

To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong.

Read the complete Health Affairs article.

Posted by Cristie Travis at Monday, December 22, 2014 | 0 comments

Only 7% of Employers Use Objective Quality Information to Select Health Plans

A recent Associated Press-NORC Center for Public Affairs Research (AP-NORC) survey of employers found that 60% of employers think health plan quality ratings are important but employers employers lack familiarity with health quality information—particularly, objective data on the quality of health insurance plans.

Just 7 percent of employers that offer health insurance use objective quality information from sources tested in the survey; 89 percent do not use or are unfamiliar with any of the objective sources tested.

Interestingly, 55% indicated they are somewhat to extremely likely to pay more for a health plan with higher quality ratings than one with low ratings.

MBGH provides quality ratings from eValue8 on BlueCross BlueShield of Tennessee and Cigna to our members for use in their evaluation of plan performance and for potential selection.

86% of the employers indicated that cost to the organization is very or extremely important. Employers offering high-deductible health plans are more likely to say that the employee's premium is extremely important (44% vs. 25%).

Click here to see the entire report which also covers how employers are reacting to ACA, wellness program implementation, and other key employer perspectives.

Posted by Cristie Travis at Monday, December 22, 2014 | 0 comments

Wellness Programs Adopt Outside-the-box Solutions

According to Employee Benefit Adviser, employers are enhancing and refining their wellness strategies and programs "as they go". The latest trends include:

  • Using outcomes-based incentives with biometric thresholds
  • Bringing professionals, like dieticians, to the workplace vs. relying solely on digital or telephonic communications
  • Using social media to drive engagement
  • Integrating wellness with other benefit vendors, using one vendor for both

There is more emphasis on getting employees to take action, vs. just pushing information and more employers are now engaging the entire family, not just the employee.

Click here to read the full article.

Posted by Cristie Travis at Tuesday, December 16, 2014 | 0 comments

Menu and Vending Machine Calorie Labeling Regulations Announced

The U.S. Food and Drug Administration has finalized two rules requiring that calorie information be listed on menus and menu boards in chain restaurants and similar retail food establishments and vending machines. 

This is a significant act and will go a long way in helping your employees and their families make wiser choices when they eat out or use your company vending machine. We know that transparency changes behavior!

Menu labeling final rule: Applies to restaurants and similar retail food establishments if they are part of a chain of 20 or more locations, doing business under the same name, offering for sale substantially the same menu items and offering for sale restaurant-type foods. Restaurants have one year from the regulation publication date to comply.

Vending machine final rule: Requires operators who own or operate 20 or more vending machines to disclose calorie information for food sold from vending machines, subject to certain exemptions. Companies have 2 years from the regulation publication date to comply

What can you do? Consider implementing similar changes in your snack bar, cafeteria, or vending machines even if the regulations don't apply to you. There is a new norm now, and you can use the new regulations as the basis for wanting to offer your employees the same benefits of knowing calorie counts as when they eat out! If the regulations do apply to your worksite food and vending suppliers, be sure that they comply and THANK THEM for making this important health information available to your employees!

Americans eat and drink about one-third of their calories away from home. Making calorie information available will help consumers make informed choices for themselves and their families.

Click here for more information.

Posted by Cristie Travis at Wednesday, November 26, 2014 | 0 comments

CMS Announces ACA Transitional Reinsurance Fee for 2016

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including the transitional reinsurance program (TRP) fee.

Under Section 1341 of the Patient Protection and Affordable Care Act (PPACA), during the first three years that state health insurance exchanges are operational (2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance a three-year transitional reinsurance program. 

The contribution rate for 2015 is $44 per covered life; it was $63 per covered life for 2014.  The proposed regulations set the TRP fee at $27 per enrollee for the 2016 benefit year. 

The regulations also include additional information on the exception for certain self-administered, self-insured group health plans, clarifications regarding certain counting methods, and guidance regarding the deadline for satisfying reporting requirements where the reporting date does not fall on a business day. Specifically:  

Self-administered, self-insured plan exception: For the 2015 and 2016 benefit years, a "covered entity" does not include qualifying self-administered, self-insured group health plans. In the preamble to the 2015 Notice of Benefit and Payment Parameters, HHS indicated that it considered a third party administrator to be an entity that is not under common ownership or control with the self-insured group health plan or its plan sponsor. The preamble to the proposed regulations states that principles similar to the controlled group rules of Code sections 414(b) and (c) would apply for purposes of determining whether a third-party administrator is under common ownership or control with a plan or its plan sponsor.

Snapshot Count and Snapshot Factor Counting Methods: The proposed regulations clarify the application of the snapshot count and snapshot factor counting methods to a health insurance plan or coverage that is established or terminated, or that changes funding mechanisms, in the middle of a quarter. The proposed regulations provide that, if the plan or coverage in question had enrollees on any day during a quarter and if the contributing entity uses either the snapshot count or snapshot factor method, it must choose a set of counting dates for the counting period such that the plan or coverage has enrollees on each of the dates, if possible. However, the enrollment count for a date during a quarter in which the plan or coverage was in existence for only part of the quarter can be reduced by a factor reflecting the amount of time during the quarter for which the plan or coverage was not in existence.

Reporting Deadlines: The proposed regulations would require a contributing entity to submit its annual enrollment count for the applicable benefit year to HHS no later than November 15 of benefit year 2014, 2015, or 2016, or, if such date is not a business day, the next business day. 

Posted by Cristie Travis at Wednesday, November 26, 2014 | 0 comments

In-Patient Hospitalization Requirements Finalized for Minimum Value Plans

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including in-patient hospitalization requirements for minimum value plans.

The proposed regulations formalize guidance provided in IRS Notice 2014-69 (released on November 4) addressing the glitch in the HHS minimum value (MV) calculator that generated a fair amount of media attention earlier this year. The calculator is intended to be used to determine whether an employer-sponsored plan provides 60 percent minimum value. According to HHS and Treasury, the online MV calculator was improperly qualifying certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services.


The proposed regulations would require that, in order to satisfy minimum value, an employer-sponsored plan must provide substantial coverage of both in-patient hospital services and physician services. The proposed regulations would apply to employer-sponsored plans, including plans that are in the middle of a plan year, immediately on the effective date of the final regulations. However, the proposed regulations provide that the final regulations will not apply before the end of the plan year for plans that, before November 4, 2014, entered into a binding written commitment to adopt, or began enrolling employees into, the plan, so long as that plan year begins no later than March 1, 2015.

Posted by Cristie Travis at Wednesday, November 26, 2014 | 0 comments

IRS Closes Loophole on Minimal Value Plans

The Internal Revenue Service, in a surprise move, said it will not qualify employer-sponsored health plans that fail to cover inpatient hospitalization as meeting the minimum value health plan standard under the Affordable Care Act. 

In a notice issued under the public radar on Election Day, the IRS says it, the Treasury Department and the Department of Health and Human Services believe that plans that fail to provide substantial coverage for inpatient hospitalization services or for physician services (or for both) do not provide minimum value intended by the ACA’s minimum value requirement. 

The departments will shortly propose regulations to this effect, with the intention of finalizing them in 2015, the notice adds.  

Posted by Cristie Travis at Friday, November 14, 2014 | 0 comments

Engaging Employees Year Round Ranks as #1 Communication Challenge for Employers

Most employers (56%) say improving employees’ understanding and perceived value of benefits is their main focus, yet companies still lack personalized benefits communication at a time when it’s commonly expected by employees.  

These are among the findings of a new survey of more than 330 employers conducted by the non-profit National Business Coalition on Health and Benz Communications. A collaborative effort, the 2014 Inside Benefits Communication Survey gathered key data from HR/benefits professionals about their benefits communication approaches, strategies and results.These findings are the second of two reports — the first report, released last month, detailed employers’ views on benefits through the lens of the Affordable Care Act (ACA) and other industry mandates and trends.

Key findings 

• Professionals spent the most time over the last year working to improve employees’ understanding and perceived value of benefits (56%). Time dedicated to lowering overall health plan costs was second (47%), followed by maintaining overall compliance (47%). 

• Communication is largely credited as a main driver in helping companies meet benefits goals as respondents were confident about achieving their goals in 2013, with more than 80% saying they reached all or some of their benefits goals last year. Communication played a major part in this success; 73% say benefits communication helped them meet their goals last year. 

• Keeping employees and families engaged in their benefits year-round was noted as the largest communications challenge (75%). Flawed approaches continue, however, as the majority (64%) say they only communicate with employees once a year at annual enrollment, and 46% measure success only by reduced calls to the HR/benefits department. 

• Forty-one percent of respondents rely on first-hand feedback via employee surveys/focus groups to gauge success, while others lean on numeric metrics like: Reduced benefit costs (40%) Improved wellness biometrics (26%) Reduced employee health risks (25%) Increased retirement plan participation/account balances (24%) 

• Employers are moving to embrace online and mobile channels to reach employees with benefits messages with 90% saying they put benefits information online. However, respondents are slower to leverage newer technologies and drop traditional IT protocols to reach a broader population: Just half (50%) place benefits information outside the firewall, accessible for spouses/partners and other family members; only 40% have their Internet sites optimized for viewing on mobile devices. 

• While just 15% of respondents are using social media in benefits communication, it is a bold minority—of that 15%, 50% use Facebook to communicate; 37% use blogs and 31% use Twitter. Most (57%) have been using social media for one to three years, indicating that employers using these channels have just begun to scratch the surface on their potential to drive communication success and benefits results. 

• Sixty percent of 2014 respondents say their annual budget for benefits communication is less than $25,000. Three-quarters of respondents say that amount has remained flat over the last year. Plus, one-half spend the majority of that budget on one-time costs—printing or mailing. 

“Given that health care benefits are critical to employer recruiting and retention efforts, it’s important that we better understand how organizations are addressing their benefits communications in light of industry changes due to health care reform and compliance issues,” said Brian Klepper, NBCH CEO. "This is really about what it takes to be much more effective.” 

The research gathered key data from 333 human resource/benefits professionals about their benefits communication approaches, strategies and results. Respondents spanned a wide cross-section of geographic regions, corporate industries and business coalition affiliations. Respondents are largely concentrated in the service and technology industries, located mainly in the Southeast and West regions of the United States. Most respondents’ have a population of 1,000–5,000 U.S.-based employees. 

Full survey details, including a sharable infographic illustrating the findings, can be found at 

“While we’re disappointed that there hasn’t been bigger movement forward among employers using what we know are communication best practices, we’re encouraged that the data show there is a clear contingent of leading-edge practitioners who are working to use communication to bring benefits value to the forefront for employees,” said Jennifer Benz, founder and CEO of Benz Communications. “As costs continue to rise and employees accept more of the financial responsibility for managing their health and benefits, it’s the employers who make investments in effective communication who will rise to the top in all the ways the matter—recruiting, retention, cost-management and employee satisfaction.”

Posted by Cristie Travis at Friday, November 14, 2014 | 0 comments

Survey Shows Two in Five US Workers Missed Work Due to Depression

Nearly a quarter (23 percent) of U.S. respondents indicated they have been diagnosed with depression in their lifetime and two in five (nearly 40 percent) of those patients reported taking time off of work – an average of 10 days a year – as a result of their diagnosis. 

These findings are just a few of the key outcomes stemming from The Impact of Depression at Work Audit (IDeA), evaluating the societal and economic burden of depression in the workplace. 

See complete news release here.

Employers Health, an Ohio-based employer coalition, announced results for the U.S. survey at the National Business Coalition on Health annual meeting in Washington, D.C. on November 12.

Posted by Cristie Travis at Friday, November 14, 2014 | 0 comments

EEOC Continues Legal Action Against Employer Wellness Programs

From the National Business Coalition on Health

The U.S. Equal Employment Opportunity Commission (EEOC) filed a new lawsuit against an employee wellness program on October 27, alleging violations of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). 

The lawsuit, filed in the U.S. District Court for the District of Minnesota, seeks a temporary restraining order and a preliminary injunction to prevent Honeywell International Inc. from imposing penalties on employees who decline participation in the company’s biometric screening program. 

The program assesses a $500 surcharge if employees forego biometric screening and an additional $1,000 tobacco surcharge for the employee as well as a $1,000 tobacco surcharge for the employee’s spouse/domestic partner if either foregoes the biometric screening and does not satisfy a reasonable alternative, such as participating in a tobacco cessation program. 

Additionally, only employees who participate in the biometric screening will receive a contribution to their Health Savings Account. 

The EEOC’s lawsuit contends that “The proposed medical testing is not voluntary, and therefore violates the [ADA]. The testing imposes penalties on employees whose spouses do not provide their medical information, and therefore violates [GINA].” 

In a public statement, Honeywell called the lawsuit “frivolous,” noting that the “incentives we provide are specifically sanctioned by two separate Federal statutes” (the Health Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (PPACA)) and “are in strict compliance with both HIPAA and [PPACA’s] guidelines … No Honeywell employee has ever been denied healthcare coverage or disciplined in any way as a result of their voluntary decision not to participate in our wellness programs.” 

This is the third lawsuit filed by the EEOC in recent months challenging employer-sponsored wellness programs. The EEOC is also pursuing a lawsuit challenging a wellness plan sponsored by a Flambeau, Inc. (a Wisconsin-based manufacturer with 1,600 employees) as well as a similar suit against Orion Energy Systems. 

Importantly, the EEOC lawsuit against Honeywell cites the Seff v.Broward County case, in which the Court of Appeals held that the employer’s wellness program fell within a safe harbor of the ADA, which states that the ADA does not restrict organizations from “establishing, sponsoring, observing or administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are not based on or not inconsistent with State law.” The EEOC lawsuit contends that “Seff’s analysis is inconsistent with the language, the legislative history and the purpose of the safe harbor provision.” 

The EEOC announced in its most recent semi-annual regulatory agenda that it intends to issue regulations later this year addressing wellness programs under the ADA and GINA. Specifically, EEOC states such regulations will address “whether, and to what extent, Title I of ADA allows employers to offer financial inducements and/or impose financial penalties as part of wellness programs offered through their health plans, and to address other aspects of wellness programs that may be subject to the ADA's nondiscrimination provisions.” Additionally, EEOC is drafting a proposed rule to amend GINA regulations “to resolve whether employers may offer inducements to employees' spouses or other family members who answer questions about their current medical conditions on a health risk assessment.”

Posted by Cristie Travis at Friday, October 31, 2014 | 0 comments

67% of Memphis-Area Hospitals Receive an "A" on National Hospital Safety Score

Memphis, Tennessee October 29, 2014 – Updated Hospital Safety Scores– the “A,” “B,” “C,” “D” or “F” grades assigned to more than 2,500 U.S. adult general hospitals (pediatric and specialty hospitals do not receive a score)– were released today by patient safety advocate The Leapfrog Group, an independent nonprofit organization representing employer purchasers of health care.

The Scores are based on preventable infections, injuries and errors, and grades were assigned to nine adult, general hospitals in the Memphis area with six receiving an “A,” the highest letter grade.   

Memphis Business Group on Health is pleased to recognize our local ‘A’ hospitals, including both of Saint Francis Healthcare’s hospitals and all four of Methodist Healthcare’s hospitals, for demonstrating they have made the well-being of their patients a top priority. We are excited that 67% of Memphis hospitals have now achieved an “A”, our largest number since the score was initially released in 2012, and more than twice the national average of 31%,” said Cristie Upshaw Travis, CEO. “Hospital errors are the third-leading cause of death in the United States, behind heart disease and cancer – a fact that serves to highlight the crucial need to put safety first in our hospitals. We hope these hospitals will continue to strive for a consistent level of safety excellence and that other area hospitals will follow that example.” 

The Hospital Safety Score is designed to give the public information they can use to protect themselves and their families whenever faced with a hospital stay. The Score is calculated by top patient safety experts, peer-reviewed, 100-percent transparent and free to the public. 

A full analysis of the data and methodology used in determining grades is available, as always, on the newly re-launched website, which now also includes consumer-friendly videos and tips for patients and their loved ones. Visit the site at   

“We want to turn patients into savvy health care shoppers by enabling them to take an active role in selecting a hospital. By evaluating hospitals based on important safety measures and grading them accordingly, we can help consumers make smarter choices for themselves and their families,” said Leah Binder, president and CEO of Leapfrog, which administers the Hospital Safety Score. “Those hospitals receiving an ‘A’ today should be proud of their record, as they are helping us to raise the standards of health care and transparency nationwide. The local community should take note of that.”    

“Memphis-area residents should use every resource available to protect themselves when planning for a hospital visit, including the Hospital Safety Score. For our part, we will continue to use the Hospital Safety Score as a tool to educate the public while working with hospitals, physicians, nurses and other clinicians to improve patient safety in our community,” said Travis.   

Calculated under the guidance of Leapfrog’s Blue Ribbon Panel of patient safety experts, the Hospital Safety Score uses 28 measures of publicly available hospital safety data to produce a single score that represents a hospital’s overall performance in patient safety. Leapfrog’s Score is the only tool available today that focuses exclusively on errors, injuries and infections.    

For more information on the Hospital Safety Score, or to find out the score of your local hospital, visit A Hospital Safety Score mobile app is also available for download.   

About Memphis Business Group on Health 

Memphis Business Group on Health (MBGH) is a non-profit coalition of member employers sharing solutions, providing connections, and offering tools to its members so they can manage the quality and cost of their health benefits. MBGH is the only organization in Memphis representing the employer’s voice – fighting to help employers manage the rising cost of health care, improve the quality of medical care for their workforce, and empower employees to choose healthier lifestyles. MBGH members provide health insurance benefits to more than 300,000 across the state of Tennessee.   

About The Leapfrog Group 

The Hospital Safety Score (  is an initiative of The Leapfrog Group (, a national nonprofit organization using the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans. The flagship Leapfrog Hospital Survey allows purchasers to structure their contracts and purchasing to reward the highest performing hospitals. The Leapfrog Group was founded in November 2000 with support from the Business Roundtable and national funders and is now independently operated with support from its purchaser and other members. 

Posted by Cristie Travis at Wednesday, October 29, 2014 | 0 comments

How One Employer Saved $3.5million in Health Benefit Costs

The results of a dependent audit saved Baptist Health, an 18-facility health care system based in KY, $3.5 million according to an article in

Check out how they conducted their audit and see if you have incorporated the same best practices!

Define "dependent" and then stick to it

Give fair warning (and get some voluntary terminations!)

Consider "amnesty" for past offenses

Posted by Cristie Travis at Tuesday, October 28, 2014 | 0 comments

Beginning to See the Change We Want

An insightful article by Mark Hepler, CFO of Munson Healthcare, an 8-hospital system based in Traverse City, MI, on, reveals that health care providers, well, at least his, are beginning to make the changes that we want to see and that have, to a large extent, been spurred by the Affordable Health Care Act (see recent blog post on whether the ACA is working).

What changes are happening in how health care is delivered?

Investing in becoming clinically integrated networks vs. investing in facilities and equipment

Aligning costs with revenue to live within new payment models no longer based on fee-for-service; becoming leaner and more efficient.

Focusing on a "team effort" with physicians; getting them to help realign costs and care

The pressures put on the system for value-based purchasing by major payors, including Medicare and self-insured employers, are the primary motivator for these changes. 

Memphis Business Group on Health will continue to apply this pressure through:

Our eValue8 health plan performance evaluation where we push plans to move away from fee-for-service to value-based payment models such as bundled payments and pay for performance.

Our work to recruit Memphis-area employers to participate in the State of Tennessee's new payment model for TennCare and State of Tennessee Employee Benefits Administration (we have a working meeting scheduled for December for MBGH purchaser employer members to learn more)

Our Leapfrog Annual Hospital Survey and Hospital Safety Score initiatives which, through public reporting, shine the light on the safety and quality of Memphis-area hospitals, both of which are essential elements of value

We are beginning to see the change we want, so let's keep up our pressure so we can see it in Memphis and in the cost and quality of care, and your benefit plans!

Posted by Cristie Travis at Tuesday, October 28, 2014 | 0 comments

Is the Affordable Health Care Act Working?

From Brian Klepper, CEO of National Business Coalition on Health:

The New York Times has published a major, multi-article piece, on different aspects of the Affordable Care Act's (ACA) performance. 

Here's the overview: "After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash." 

The article poses and then responds to seven big questions, based on data gathered from many sources. 

Has the percentage of uninsured people been reduced? 

Has insurance under the law been affordable? 

Did the Affordable Care Act improve health outcomes? 

Will the online exchanges work better this year than last? 

Has the health care industry been hurt or helped by the law? 

How has the expansion of Medicaid fared? 

Has the law contributed to a slowdown in health care spending? 

Because the law is so politically polarized and charged, this objective status update is a welcome contribution to the discussion. Group health care purchasers have so much riding on the law, so this is a particularly worthwhile read. 

Those of you attending the NBCH Annual Conference's first day will hear Bob Laszewski's take on the law's rollout. Mr. Laszewski is a former health insurance executive and a highly regarded independent analyst who has tracked each step of the law's formulation and execution.

Posted by Cristie Travis at Tuesday, October 28, 2014 | 0 comments

Specialty Drugs to Account for 50% of Pharmacy Spend by 2018

Wonder why specialty drugs are likely to account for 50% of pharmacy spend by 2018?

Here are three reasons:

Supply and demand. Only 3.6% of the commercial population use specialty drugs so the market for these drugs is very small. On the other hand, the development costs are very high, resulting in high costs per patient.

No generics. Specialty drugs are often too complex to be produced under generic requirements.

LImitations on price increases once on the market. Manufacturers set initial prices high because regulations limit price increases on the drugs are on the market.

What can you do? Here are three suggestions:

Doctors often prefer the drugs they both sell to patients and administer at their office. Check other options that may be available to see if they are less expensive.

Require pre-authorization of specialty drugs to be sure they are being used appropriately.

Consider home administration, or even physician office administration, vs. hospital administration of the drug.

Read more from PBS and the recent study published in Health Affairs.

Posted by Cristie Travis at Monday, October 27, 2014 | 0 comments

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