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20 Years After the HSA's Debut, Don't Let More Missed Opportunities Escape

"Only 53% of employers offer health coverage, ... and of those that do, just 24% offer HSA-capable coverage.... HSA contributions have remained stagnant, with a mere half of eligibles seeding their HSA, which is unchanged since 2017. Average annual individual contributions actually declined to $1,880 in 2021.... As many as 88% of accounts remained in capital preservation (money market) funds in 2021."

Independent Dispute Resolution Data Shows Need for Transparent Pricing Assistance

"While enforcement of the evolving legislative and regulatory landscape remains a concern, what is clear from the latest IDR Reports is the emergence of a vast underestimation in the number of cases being brought to arbitration.... 10 parties initiated as many as 78% of the cases, with SCP Health, Team Health and Radiology Partners accounting for as much as 58% of initiated disputes for the first six months of 2023.... [P]roviders won 77% of IDR cases, while 82% of awards to the winning party was the offer closes to the qualifying payment amount."

How Employers Who Sponsor Health Plans Can Avoid No Surprises Act 'Challenges'

"If you decided on a compliance-only approach, you are spending more in at least two ways: [1] Certain expenses that would have been processed using separate out-of-network cost sharing are now treated under in-network rules, and [2] You are paying for added administrative expenses ... The best response to the NSA is the same as it was for Health Reform -- deploy both strategic and compliance-oriented responses."

Workers Remain Financially Fragile: Healthcare Options to Improve Financial Resilience

"[T]he new transparency mandates to disclose prices for 'shoppable services' are too complex to be effective for most participants. The best opportunity to facilitate consumerism is to make available an innovative Advanced Explanation of Benefits (A-EOB) ... Because [DOL] guidance on the A-EOB has yet to be issued, any organization that strategically implements their own version of a 'best practices' A-EOB could capture a competitive financial advantage -- reducing both employer spend and employee out-of-pocket costs -- by putting the economic purchasing power and decision-making in the participant's hands."

District Court Ruling Provides a Win for Patients and Payers and a Huge Loss for Air Ambulance Companies

"The median price of air ambulance transport by private equity or publicly-traded parent companies was $32,051 in 2016 (and has only increased). Those rates were 60% higher than the average amount for rides provided by hospitals, nonprofits, and independent companies. As a result of this ruling, an air ambulance bill will be significantly less as hospital-based air ambulance fees will continue be included (and single case agreements will continue to be excluded) in the calculation of the QPA." [Association of Air Medical Services v. HHS, No. 21-3031 (D.D.C. Aug. 4, 2023)]

Survey Reveals Provider Frustrations Over No Surprises Act, Alleges Payers Ignore Independent Dispute Resolution Rulings

"According to physician respondents, many payers, including insurance companies, are ignoring arbitrated rulings on the reimbursement amounts or failing to pay them in full. Physicians also cite expediting delays with this process and frustrations when attempting to collect on awards with little to no effect from enforcement, leaving them questioning if the NSA is functioning as intended in the fair and amicable interests of all involved."

Price Transparency Has Limited Value If Not 'Done Right'

"A quality health plan should provide easy, direct access and understanding of pricing and advanced explanation of benefit information so participants can make informed and cost-effective decisions. Cost-management strategies include effectively designed acquisition cost-based pharmacy pricing, HSA-capable coverage, reference-based pricing and adequate participant protections against balance billing."

Specialty Rx Costs and Alternative Funding Programs

"For self-insured plans, bearing the financial burden of paying high cost for prescription drugs, specialty medications and associated stop-loss premium rates can be a challenge. In response, self-funded plans are increasingly using alternative funding strategies through Pharmacy Benefit Managers (PBMs) so as to maintain medication benefits while achieving a meaningful cost savings to participants."

HHS Issues First Annual Report Evaluating the Impact of the No Surprises Act

"The varying state methods for addressing surprise bills complicate the evaluation of the NSA's impacts.... The impact of state surprise billing laws on in-network and [out of network (OON)] prices is not clear.... The overall prevalence of OON professional claims decreased from 6% to 4.7% from 2012 to 2020. The share of OON payments also declined from 9.2% in 2012 to 6.8% in 2020.... OON claims were most common among people aged 18-24 and least common among people aged 55-64."

Healthcare Inflation Unusually Trails General Inflation, Squeezing Financially Fragile Employees from Both Sides

"To counter inflationary trends, experts recommend plan sponsors help participants build savings rather than purchase more costly insurance as part of a 'health and wealth' strategy that optimizes both savings and financial preparedness.... [S]trategies include effectively designed acquisition cost-based pharmacy pricing, HSA-capable coverage, reference-based pricing, adequate participant protections against balance billing, and participant advocacy and litigation support."