Matt Byrne, Author at Spiralight Group Benefits | Results-Driven. Proven-Process.™

All posts by Matt Byrne

Reference-Based Pricing: A Baseline Standard in Health Care

If you are an employer enrolled in a PPO, did you know that you are likely paying at least three times what the largest payer in the country is paying for health-care services?

That’s because the so-called “negotiated” rates PPOs have set with health-care providers (primarily hospitals and health systems) are not truly negotiated at all–rather PPOs are offered a “discount” off of artificially inflated prices in the “price-master” (under terms that are kept secret). The result: “Preferred Provider Organizations” (PPOs) originally created to bring costs down by offering exclusivity to network providers in exchange for lower rates, today are nothing more than mini-monopolies.

The result: Employers in PPOs are left paying 300 percent more for a medical treatment than would be paid by the country’s single largest payer of health care: Medicare.

Reference-Based Pricing:

Setting a Baseline Standard in Health Care Pricing for Self-Funded Employers

Today, Reference-Based Pricing (RBP) is helping employers with self-funded plans gain better control of health-care costs. Rather than accepting at face-value an arbitrary cost figure for a given medical treatment (which at “full retail,” is often five to seven times what Medicare pays), RBP plans use the Medicare rate as benchmark for what they will pay for that treatment.

It does not necessarily mean that an RPB plan  will only pay what Medicare pays; rather these RBP models enable employers to negotiate payment levels that range from 120 to 160 percent of what Medicare will pay–which results in huge employer savings over what they would normally pay through a PPO.

It’s a SHELL GAME…and Has Been for a Long Time

For far too long, there has been NO TRANSPARENCY in the actual cost of health care service. And until employers (and the consumers they employ) begin to take responsibility, ask questions and behave as though it is their money being spent (because it is), this trend will continue.

The changes in healthcare and insurance are turning this tide, and self-funded plans are helping to make this happen. Employers who wish to gain a fairer advantage and better control over their health care costs (which often amount to the second- or third-highest expense category the business faces) should connect with a trained, qualified advisor who has experience in Reference-Based Pricing Plans.

Spiralight Group is specializes in alternative funding solutions, including Reference-Based Pricing Plans. Recent product innovations are disrupting the status quo and rewarding forward thinking employers. What have you got to lose? We look forward to speaking with you.

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Health Reimbursement Accounts (HRAs): Are They Set for a Come Back?

One of the key steps President Trump took when he signed his executive order in October, 2017, was to expand employers’ ability to give their workers money to buy non-group health coverage on the individual market.Read More…

Why the Sudden Attention on Association Health Plans?

After multiple failed attempts by Congress to repeal and replace ACA, this month President Trump issued an executive order to bring back patient choice (and hopefully begin to lower costs).

The focus of the President’s order is on the needs of those often regarded as most negatively impacted by ACA: small business owners, their employees, and millions of individuals who earn too much to get subsidies but can’t afford the skyrocketing premiums.

Since the implementation of ACA the number of small business employees with health coverage has fallen from 50 percent to thirty percent. And premiums continue to climb.

For many small businesses, there has been a “work-around” available (that we at Spiralight have been offering for years). These are Association Health Plans (AHPs – and also occasionally referred to as “chamber plans” when made available through a chamber of commerce).

The president’s order in October aims to expand these Association Health Plans, which permit small businesses and other groups (like professional associations) to join together, offering two major advantages:

  1. They gave them buying power to a level similar to larger nationwide employers, and

  2. Alleviated many of the burdens brought on by ACA.

And until this month, ACA had placed severe restrictions on the availability of these plans. But this new executive order removes them. This is good news for small employers.

Here’s even more good news: Spiralight can provide immediate access.

Because of the complexity and sophistication of some of these plans, not all brokers and advisors are certified to enroll employers in these plans.

At Spiralight, our brokers will perform a Situational, Strategic and Technical assessment to understand where you’ve been, where you are now and what is the best solution to deliver you to where you want to be. To learn more or schedule your complimentary assessment, send us an email or call us at (614) 300-1316.

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AHCA v. 2.0…Explained

Employers…feel free to review this self-guided presentation outlining “AHCA 2.0” —the new House Bill H.R. 1628, the American Health Care Act (AHCA) reconciliation bill to repeal and replace portions of the ACA!

As you know, this bill must pass the Senate before it becomes law but here is everything you need to know as it stands right now. Remember, CHANGES are inevitable, and we’ll provide updates as they become available.

If you would like, I am happy to present on the topic if you have any groups or associations you think would benefit from the content. Feel free to drop me an email at mbyrne@spiralightgroup.com.

Note: if viewing this page on a mobile device, tap HERE to open the presentation on Prezi.com

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AHCA v1.0: What You Need to Know

Well the first version of the GOP answer to ACA has been revealed…let the roller coaster ride begin! Several weeks ago, as we were anticipating the release of the new proposed plan and speculating over what might change, it dawned upon us that, what mattered more was what would likely remain the same.

As we anticipated, despite criticisms from conservative groups that this “version 1.0” of what has been named the American Health Care Act is nothing more than “Obamacare-LITE,” we have seen a greater emphasis on various forms of self-insurance (HSAs, HRAs, etc.).

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ACA 2017: Everyone is Asking the Wrong Question.

All across the country, individuals and businesses are asking themselves the same question regarding ACA in 2017: What will change under our new administration?

My answer is this: You’re asking the wrong question. Rather than focusing on what is most likely to change, instead focus your attention, and strategy, on what is most likely to stay the same.

The first thing that will not change is change itself. Even had the election outcome in November been different, changes still would occur.Read More…