How can employers encourage increased utilization of employee assistance programs (EAPs)?

We know that more and more employees are dealing with increased stress both inside and outside the workplace these days, and that employee assistance programs (EAPs) can be a helpful, effective way to help them address their concerns and work toward healthy solutions. So, I think the big question here is...

Dec 05, 2018

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Why is medical necessity a factor when reviewing health claims?

As employers work to get more control of the health plan dollars they’re spending, closer claim review has become a key strategy. Medical necessity factors into this as it’s one area where excess spending is occurring on a regular basis. Unfortunately, in today’s society, there’s a trend toward overutilization in care:...

Jul 12, 2018

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How can educating employees to be smart consumers of care impact a health plan?

In the case of a self-funded health plan, TPAs can work with employers to put the very best cost containment tools in place – but without employee education, those efforts may not be overly effective. Consider a member who was just told she needs hip replacement surgery. Maybe your health plan...

May 23, 2018

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How is the concept of “everywhere care” affecting consumers?

This is a concept that was explored at our Cypress University conference last spring and explained as an innovation opportunity for care management by presenter Narus Health. Basically, “everywhere care” refers to the shift from limited options for receiving care (think of the long-time hospital-based focus here) to a host...

Nov 29, 2017

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Why are so many companies opening on-site medical clinics at the workplace?

For a while there, the concept of having an outside company come in and provide employees with biometric screenings seemed pretty cutting-edge. But look how far we’ve come. Many organizations are now moving to a model that goes well beyond these on-site health assessments and offers things like primary care...

Sep 07, 2017

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1 min read

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Is low health literacy a problem, and what is being done to address it?

Before digging into this question, I think it would help to explain the concept. Health literacy is the ability to understand basic health information, make informed decisions based on it and navigate the health system. Without a doubt, it is something people are struggling with. When looking in to some stats,...

Aug 09, 2017

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In reviewing two separate health claims for the same MRI procedure, how can the charges be so drastically different?

We see cases of this all the time. The same procedure is performed at two different locations (sometimes within just a few miles of each other), but the health claim charges are outrageously different. It’s the result of the tremendous lack of transparency in health care. Unfortunately, this pricing variation can...

Mar 15, 2017

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Can choosing care at one facility over another really make that much of a difference savings-wise for health plans?

It can and it does. In the self-funded world, I hear people make reference to general examples quite often, but sitting in on a presentation at Cypress University delivered by one of our partner firms, Akeso Care Management, was an eye-opener. We saw a series of actual cases and the...

Oct 19, 2016

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How can we, as consumers, be more proactive about avoiding hospital readmissions?

The high rate of hospital readmissions has long been a topic of debate, especially those that are considered avoidable and happen within the first few weeks after discharge. From an employer’s point of view, these re-hospitalizations can be a source of frustration as they often lead to more extensive medical issues...

Mar 17, 2016

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What is this concept of defensive medicine all about?

Do you remember the old episodes of ER when it seemed someone was always getting slapped with a malpractice suit? These claims are a pretty big deal in the real-world, too, and providers want to steer clear of them as much as possible. But are they going too far? A 2014...

Dec 03, 2015

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2 min read

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