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Healthcare Spending for Employer Plans Hits Record

"Healthcare spending has outpaced gross domestic product growth over the last five years, reaching an all-time high in 2017 ... People are essentially paying more for the same amount of care.... The share of U.S. physician practices owned by hospitals or systems increased from 27% to 48% from 2011 to 2016 ... That led to a 9% price increase in specialist outpatient procedures and a 5% hike in primary-care outpatient procedures[.]"

San Francisco Ups Employers' Health Care Spending Requirement for 2013

"Employers with workers in San Francisco will have to pay more next year to comply with the city's healthcare spending law. Beginning on Jan. 1, 2013, employers with 100 or more employees in San Francisco will be required to spend $2.33 per hour per covered employee on health care, up from $2.20 in 2012 ... Employers with between 20 and 99 employees will have to spend at least $1.55 per hour, up from $1.46. Employers with fewer than 20 employees are exempt from the requirement."

Employees Will Need to Be Educated About Benefits Eligibility

"Regardless of the particular measurement period employers select to determine which of its part-time, temporary and seasonal workers may be benefits-eligible under health care reform, they will need a robust time and attendance system to perform the calculations, benefits experts say. Communications also will be important in educating employees about their benefits eligibility[.]"

Intel Offers Employees Narrow Network of Health Insurance

"Dissatisfied with previous cost and quality efforts, computer chip giant Intel Corp. has entered an unusual direct contract with Presbyterian Healthcare Services for a narrow-network, accountable care-style arrangement ... The arrangement ... covers about 5,400 individuals ... Intel employees who selected Presbyterian's narrow network coverage will pay more for seeking care elsewhere. Presbyterian, which now operates a clinic at Intel's Rio Rancho plant, will receive a bonus if it meets quality goals and Intel's employee healthcare costs stay under a set target."

Cyberattack Exposes Data of 11 Million Premera Blue Cross Members

"Premera Blue Cross, a health plan in the Pacific Northwest, was hit with the second-biggest cyberattack in healthcare industry history, exposing the personal, financial and medical information of more than 11 million customers.... An investigation revealed that the initial attack occurred May 5, 2014. The breach affected Premera Blue Cross, Premera Blue Cross and Blue Shield of Alaska, and Premera affiliate brands Vivacity and Connexion Insurance Solutions."

Supreme Court Sides with Insurer, Against Vermont in Data-Sharing Case

"Steve Wojcik, vice president for public policy with the National Business Group on Health ... said it's a particularly important decision for employers that operate in multiple states that might otherwise have to comply with a conflicting patchwork of state laws and requirements.... But Alfred Gobeille, chair of the Green Mountain Care Board and the official petitioner in the case, said ... the decision won't necessarily stop states from continuing to seek the data from insurers for their databases.... Gobeille said the question now is whether Vermont and the other states with all-payer databases can work together to seek a remedy from the Secretary of Labor. He acknowledged that getting such a remedy might not be easy or fast, but the justices seem to be saying it's possible." [Gobeille v. Liberty Mutual Ins. Co., No. 14-181 (U.S. Mar. 1, 2016)]

Insurers See Opportunity in Exchange-Based ICHRAs

"Although only a small -- albeit growing -- share of businesses offer individual coverage health reimbursement arrangements, or ICHRAs, to their workers, insurers such as Oscar Health, Centene and Highmark are gambling they are the wave of the future as employers strive to contain healthcare spending."

United Loses in Court on Behavioral Health Coverage Guidelines

"A federal judge ruled Tuesday that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance abuse patients. The decision, if upheld on appeal, could have wide ramifications of what insurers must cover in the fast-growing behavioral healthcare sector." [Wit v. United Behavioral Health, Nos. 14-2346, 14-5337 (N.D. Cal. Mar. 5, 2019)]

Employers, Payers and Patients Are Looking Beyond Quality Measures in Provider Comparisons

"[A] comparison shopper, working on behalf of major employers, struggled to find prices she could trust as she scoured health insurers' websites this spring for the cost of procedures, laboratory tests and office visits. "It's not easy to get in a way that makes sense, in a way that is accurate," says ... a senior manager for ... a healthcare buyer coalition that includes Boeing Co., General Electric Co. and Target Corp. 'Nobody has the secret sauce,' ... But it's more than she could find a year ago, she says."

Cigna Extends Free Coronavirus Tests to Self-Funded Employer Plans

"Cigna Corp. said it has signed up all of its self-insured employer clients to eliminate cost-sharing for coronavirus tests. Cigna sent letters to these 'administrative services only' clients ... giving them 10 business days to opt out of the program ... Two Democratic members of Congress introduced legislation [HR 6173]... that aims to fill gaps left by ERISA by requiring self-insured employers -- along with private health insurers -- to cover the full cost of the coronavirus diagnostic test and prevent them from passing those costs on to beneficiaries in the form of higher premiums."