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Full Potential of Value-Based Insurance Designs for Employers Is Yet to Be Realized

"Pitney Bowes' V-BID strategy returned $1.33 in savings for every dollar the program spent in the three years that followed.... V-BID strategies mainly rely on upfront investments into patient health to create long term savings.... V-BID is more complex than some other benefit designs, making it potentially more difficult for consumers to understand; clear communications and ongoing education are critical."

American Journal of Managed Care

Value-Based Care Gains Favor as a Provider Reimbursement System

"Value-based care pays health providers based on how much they improve a patient's quality of health management. Quality of care is based on metrics including reducing hospital re-admissions; improving preventative care; and using health technology. Value-based models reward providers financially when they deliver better and more cost-effective services and often penalize them financially when they fail."

Employee Benefits Report

Drugmakers Hike U.S. Prices on Over 200 Drugs

"Drugmakers ... are planning to hike U.S. list prices on more than 200 drugs in the United States on [January 1] ... Nearly all of the price increases will be below 10%, and around half of them are in the range of 4 to 6% ... The median price increase is around 5%[.]"


High Drug Prices Sparked Outrage But Little Action

"After hiking the price of an old drug for parasitic infections to $750 a pill from $13.50, [Martin Shkreli, the former CEO of Turing Pharmaceuticals,] became the poster boy for pharmaceutical greed that helped define the past decade. During that time, new drugs emerged with higher price tags than ever, and many old drugs got sudden price hikes. Meanwhile, nearly 1 in 4 Americans has trouble affording prescription drugs[.]"

National Public Radio [NPR]

Tenth Circuit Upholds HHS Risk Adjustment Methodology

"The Tenth Circuit [concluded] that HHS' use of the statewide average premium was not arbitrary or capricious, that the risk adjustment program must be budget neutral, and that HHS should have been given more deference. The ruling reinstates HHS' risk adjustment methodology and means HHS need not take additional action to justify its methodology for 2014 through 2016." [New Mexico Health Connections v. HHS, No. 18-2186 (10th Cir. Dec. 31, 2019)]

Katie Keith, in Health Affairs

2019 OCR Enforcement Shows Getting Defensibly HIPAA Compliant Necessary in 2020

"[V]iolations of HIPAA can have implications well beyond HIPAA.... Health plans and their fiduciaries also may face [DOL] and other fiduciary claims ... The [DOL] followed up on previous warnings that health plan fiduciaries duties include a fiduciary duty to protect health plan data by adding HIPAA compliance to certain health plan audits. Insurers, third [party] administrators and others also can face duties and liabilities under state insurance and data privacy laws from regulator or private litigant actions."

Solutions Law Press


How Four Pages Could Transform Health Care

"[E]mployers purchase health plans with pre-tax dollars, while individuals buy their policies with post-tax dollars -- substantially increasing the cost. The Personalized Care Act, S. 3112, [would let] patients themselves buy medical coverage with pre-tax Health Savings Accounts (HSAs). The ramifications of this tax parity between employer and employee plans would be profound."


Benefits in General

Brain Scientists Tap Into the Secrets of Living Well Longer: Extending 'Healthspan'

" 'Healthspan,' a coinage now gaining traction, refers to the years that a person can expect to live in generally good health -- free of chronic illnesses and cognitive decline that can emerge near life's end. Although there's only so much a person can do to delay the onset of disease, there's plenty that scientists are learning to improve your chances of a better healthspan."

Kaiser Health News

Selected Discussions
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Dependent Status of Custodial Stepchild for Purposes of Employer-Provided Life Insurance

"We have an employee who approached us with the following request and situation. She is the stepmother of a child. She and the father are no longer married. She has a court order awarding joint legal custody to the mother, father, and herself (stepmother). Primary physical custody has been awarded to her (stepmother). The employee (stepmother) wants to add the child as a dependent beneficiary to her employer-provided life insurance policy. Our policy language requires that the non-biological parent be a legal guardian or that the step-mother be married to the natural parent. The court order is a custody order and not an appointment of legal guardianship. Any thoughts?"

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Most Popular Items in the Previous Issue, Inc.
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(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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