BY CYNTHIA MCGRATH | NOVEMBER 12, 2020Amidst the pain, anxiety, and budget hits caused by the coronavirus, one bright spot has been reduced healthcare spending. Medical claims dropped precipitously as provider groups closed or limited their practices to ensure capacity for COVID-19 patients. Most elective procedures were canceled or postponed. Patients also stayed away to avoid potential exposure. After a drastic reduction of costs in March, April, and May, claims costs returned to normal levels in June and July, as reported at the New England Employee Benefit Council’s October 15 Healthcare Cost Control Solutions Program.According to the State’s Division of Insurance, in Massachusetts:For August and September, payments came in 5%-20% higher than normal due to catch up demand as well as the increased costs associated with deferred care.For October and beyond, the agency projects 10% h...

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BY CYNTHIA MCGRATH | OCTOBER 7, 2020The Trends and Why They Could Get WorseThe pandemic has upended everyone’s life and the strains are showing in the escalating rates of anxiety and depression. In March, 32% of U.S. adults reported that their mental health had been negatively affected due to worry and stress over the coronavirus. This rate jumped to 53% in the Kaiser Family Foundation’s July Tracking Poll. Adults are also reporting specific negative impacts including:Difficulty sleeping – 36%Difficulty eating – 32%Increases in alcohol or substance use – 12%Worsening chronic conditions – 12%Social isolation, job losses, racial tensions, and balancing work and home responsibilities are taking a toll. People who have lost their jobs or work in healthcare have seen a dramatic increase in mental health disorders. Other at-risk populations include:Older adults age 65 and over who are espec...

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BY CYNTHIA MCGRATH | AUGUST 25, 2020Healthcare Cost Trends and ChallengesSince the COVID-19 pandemic hit the United States in force in March, there’s been a dramatic impact on medical claims:Medical claims have dropped precipitously as provider groups closed or limited their practices in order to ensure capacity for coronavirus patients and patients stayed away to avoid potential exposure. Most elective procedures were canceled or postponed. Provider practices have or are in the process of reopening, but traffic is not back to usual levels;Mental health care has skyrocketed as people face increased anxiety, stress, and social isolation. Much of this care transitioned to telehealth platforms, enabling patients to receive care in the comfort and safety of their home; andPrescription drug costs have largely been unaffected – spending continues to climb.These trends factor into the five r...

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BY CYNTHIA MCGRATH | MAY 20, 2020The COVID19 crisis is hitting the higher education industry particularly hard. Four-year colleges may face a loss of up to 20 percent in fall enrollment, according to a recent survey cited in Inside Higher Ed. Carlos Santiago, the Massachusetts commissioner of higher education, says in a recent Boston Business Journal article that no event has changed the nature of the higher education sector as much as the coronavirus pandemic. He projects that enrollment-driven and tuition-dependent colleges and universities will be especially vulnerable to closing or merging with other institutions.Human Resources departments are on the frontlines of trying to bring costs under control. Furloughs, layoffs, early retirement incentives, and benefit cuts are all strategies for reducing costs. Recognizing that collaboration between colleges and universities could help H...

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BY CYNTHIA MCGRATH | FEBRUARY 18, 2020Tackling rising costs and gaps in healthcare quality remains a challenge. One of the hottest trends over the last few years to address these needs – high-deductible plans and consumerism – is on the decline. A January 2020 report by Lively, a Health Savings Account (HSA) platform, found that the average American spends 96% of their HSA contribution on qualified expenses instead of saving money toward future expenses, a primary benefit of HSAs.“The concept of consumerism – having patients shop for care – hasn’t worked, and employers are moving away from these programs,” said Ellen Kelsay, Chief Strategy Officer, and Future President and CEO of the National Business Group on Health (NBGH), a coalition of large employers and industry partners, at a recent New England Employee Benefits Council event. Instead, employees are looking for employers, healt...

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Here are the tasks and deadlines for joining January 1; the timeline is similar for other times of the year:Submit letter of authorization, claims data, and working rate fee by August 31Determine your plan designs by August 31Review rates, make plan design adjustments, and determine choice of carrier by September 15General Counsel executes contractual agreements by October 1Fiscal Department provides financial and banking information by October 15Open Enrollment takes place late October – early NovemberEstimated premium and stop loss invoices due for January by December 15Adjusted final enrollment premium and stop loss invoices due for January by February 1

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BY CYNTHIA MCGRATH | DECEMBER 17, 2019We use a silo approach to healthcare. A podiatrist treats your foot or ankle; a cardiologist ­ your heart; and a dermatologist ­ your skin. Primary Care Physicians do their best at coordinating all of your care. However, your mental health is often overlooked no matter which kind of physician you’re visiting. “Treating the whole person is critical for quality of life,” said Teri Weber, Senior Vice President, Spring Consulting Group. “You can’t talk about someone’s health without including behavioral health.”Patients with complex medical conditions frequently suffer from other conditions, including behavioral health issues. The 2011 SYNTHESIS initiative by the Robert Wood Johnson Foundation found that:68% of adults with mental disorders have medical conditions; and29% of adults with medical conditions have mental disorders.Responding to this need, ...

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BY CYNTHIA MCGRATH | February 4, 2019How do we go about improving care for our employees while reducing costs? That’s the conundrum facing most employer healthcare purchasers. According to HCMS Group (dba Workpartners), edHEALTH’s data warehouse, 5% of our insureds represent over 50% of our claim costs. Our Board made the strategic decision to target these high-cost claimants. We believe it will be a triple win: an opportunity to reduce costs, improve care for our members, and benefit our participating schools.edHEALTH’s premium trends have consistently been lower than the industry. Over the last four years, we’ve averaged premium increases of 2.7% per year. That’s much better than national trends of 4.1% (Kaiser Family Foundation), and even better when employer cost shifting is factored in. We have made very few benefit changes since our inception in 2013. The first step in launching...

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TRACY HASSETT | February 27, 2017from the New England Board of Higher Education Tuition prices at colleges and universities are high. On that, pretty much everyone—from parents to students to college administrators—can agree. It’s also true that salaries and benefits are the single biggest chunk of every higher education institution’s (HEI) budget. And one of the largest and most difficult costs to contain is group employee health insurance. In fact, health insurance represents on average 4% to 5% of the total operating budgets at most private HEIs in New England. The situation is particularly difficult for smaller New England HEIs because they don’t have the power to bargain with commercial insurers enjoyed by, say, MIT or Harvard. They are forced to fend for themselves in negotiating for benefit packages, whose costs—including all benefits paid for by the employer and employee—have ...

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TRACY HASSETT | October 31, 2016When we started edHEALTH three ago, I never imagined I’d be an employee of edHEALTH, that we’d reach so many of our goals so quickly, that we’d have a website, or that I’d be writing my first blog!If you’re reading this blog, you’re either already a member of edHEALTH, you’re an edHEALTH partner, or you’re interested in learning more about edHEALTH.  No matter what your reason is, you’ve come to the right place. For those of you who don’t know me, my name is Tracy Hassett and I am the president of edHEALTH.  I have been in this role since September 1, 2015.  Prior to this role, I was vice president of Human Resources at Worcester Polytechnic Institute .  While at WPI, I was one of a number people from several institutions who spent more than three years looking at ways to address the ever-increasing rise of healthcare costs for our institutions, our fac...

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