aequum LLC, acting on behalf of 325 self-insured health plans and their participants nationwide, forecasts regulatory and economic trends that will impact medical billing and shape employer sponsored health plans in 2022.
“This past year saw needed focus on rising health care costs and federal legislation that support employer-sponsored health plan access to affordable medical services with added levels of protection and fairness,” says Christine Cooper, CEO, aequum. “For 2022, there now exist opportunities for self-insured companies to implement strategies to capitalize on cost containment initiatives in order to fully optimize the value of their health plans.”
aequum spotlights four key trends for 2022:
1. More Surprises from Out-of-Network Balance Billing
On January 1, certain provisions of the No Surprises Act (NSA) took full effect to protect health plan participants from excessive medical bills received from out-of-network providers – including services for emergency care and at in-network facilities. However, balance billing is expected to continue to an extent from services rendered by out-of-network providers given certain situations. What a surprise that will be.
2. Rise of Health Savings Accounts as a Savings Strategy
Many workers are “financially fragile” and have not set aside savings specifically earmarked for out-of-pocket medical expenses. Only a minority of “unexpected” medical expenses are bills received from out of-network providers. Most bills are regular cost sharing – deductibles, copayments, coinsurance. The least burdensome option to prepare for out-of-pocket costs in 2022 uses a Health Savings Accounts (HSA) strategy. While most employers do not offer HSA-capable coverage, 80% of employers who do offer a HSA, contribute to the HSA. However, because only a minority of employers offer HSA-capable coverage, those who do add this option in 2022 can still gain a competitive advantage for both the employer and participants.
3. Growing Adoption of Self-Funded Health Plans
The Kaiser Family Foundation Annual Employer Health Benefits Survey reports that 64% percent of U.S. workers are enrolled in health plans which are self-funded. This growing adoption is often in response to significant increases in insurance premiums. Employers who chose self-funded coverage plans are attracted to the risk mitigation and cost management opportunities when compared to ever increasing premiums and other requirements that are typically part of traditional, fully insured plans.
4. A Self-Funded Health Plan’s Most Valuable Provision
Reference-Based Pricing (RBP) is one of the fastest growing solutions in health benefits cost management. RBP brings transparency back into health care prices by using Medicare reimbursement rates and other provider cost data to provide an objective cost baseline. This offers disciplined pricing - fair and rational reimbursement for providers. RBP may be subject to the NSA Independent Dispute Resolution process where plans directly contract with facilities and providers. Self-funded plans should be aware of this risk.
About aequum LLC
Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans, and generate plan and participant cost savings. aequum LLC helps patients defend medical balance bills and brings savings to employer - sponsored health plans by providing administrative and other services to its partners. In addition, its sister organization, Koehler Fitzgerald LLC, provides legal advocacy to plan participants. For more information, visit aequumhealth.com.
View source version on businesswire.com: https://www.businesswire.com/news/home/20220125005034/en/
Contacts
Brittany Tedesco
btedesco@cpronline.com
201.641.1911 x14
