Pharmacy Pricing Without the Confusion

Chances are high that you’ve been here before: you go to the doctor for an ailment, an affliction that’s easily combated by rest and the proper prescription.

You get the prescription information and drive to the nearest pharmacy to pick it up. They hand you the bottle of pills — and the accompanying price tag.

This is the part where many Americans end up walking away from the pharmacy counter without the medicine they need because of prohibitive costs.

Multiple publications this year have shared the stories of diabetic patients who have rationed their insulin due to its cost, resulting in difficulty functioning or even death.

This is just one common example of the life-threatening effects of pharmaceutical drug pricing, effects that your employees are subject to under traditional health benefit models.

Unfortunately, the skyrocketing prices of pharmaceutical drugs is an ongoing trend. A quick look at the 20 most expensive retail drugs of 2018 makes it clear why some patients are choosing to simply go without. The demand for most drugs is not likely to disappear, meaning that Big Pharma can continue setting their own prices and profiting off patients.

The result is that expenditures on drugs has nearly doubled since the 1980s. Most of the time, consumers are not even aware of their options, being left to navigate confusing and expensive drug pricing on their own.

This is a problem that could be prevented at multiple levels, and the Health Rosetta offers the groundwork for the process. First of all, ensuring that primary care physicians have a full grasp on patients’ entire health picture in order to only prescribe medication as needed automatically cuts back on costs at all levels.

Second, transparent pricing would offer clarity in advance on what medications are affordable. When Captiva partners with your business, they educate you on pricing options, allowing you to assist employees in shopping around for the best pricing on necessary prescriptions.

This removes the confusion and guess work, allowing for informed decisions and lowest possible prices. Even giants like CVS have started to understand how much this could improve the process, recently announcing that they will be rolling out their own prescription benefit plan to improve pricing simplicity and transparency.

Finally, it’s important to understand that improving pricing transparency would save money not just for consumers of prescription drugs, but for their employers providing benefits as well. With employees educated and able to choose the lowest cost options for treatment, benefit providers would be paying out less to keep their employees covered. Cutting back on the confusion in the process would ultimately streamline the process at every level.

To find out more about how we can partner with you in overcoming pharmaceutical confusion, contact Captiva Benefit Solutions.

Pharmacy Pricing Without the Confusion is courtesy of: Captiva Benefit Solutions

Here’s What Healthcare Consumers Are Looking For

The end of the year tends to serve as an opportunity for reflecting on both the year that was and what’s to come.

When it comes to the rapidly shifting realm of healthcare and health benefits, that annual conversation is particularly vital, with the year’s end serving as a chance for health industry professionals to take stock of consumers’ needs and adjust their strategy.

According to a survey published by patient-to-provider matching service Kyruus, one of those major needs boils down to convenience.

That drive for convenience is particularly prevalent in millennials, a generation with full schedules and limited budgets. Millennials were likely to search for health care providers based on who could get them an appointment fast — moving past anyone who couldn’t. However, convenience-based decisions held true across all generations surveyed. Unsurprisingly, most of those decisions are being made by searching online.

These findings are backed up by research done by online brand builder Reputation. They found that consumers hunting for healthcare lean heavily on positive online reviews and ratings to narrow down their search, skimming through assessments left both on Google and on individual provider websites.

There are a few crucial takeaways from these findings. First, we know that healthcare providers without openings when patients need it are missing out on business (and patients are potentially missing out on care). Second, we can conclude that where reliable and credible reviews of providers and practices are not quickly available, consumers are left in the dark.

The model that Captiva Benefit Solutions helps businesses implement, as consistent with the values of the Health Rosetta, can solve both of these problems.

With our focus on value-based primary care, patients are matched with primary care physicians who can much more quickly find the right fit for any specialized needs. Honing in on quality care instead of leaving a massive quantity of providers to sort through, hoping you win the schedule availability lottery, ultimately means more preventative measures are possible (which saves everyone involved time and money in the long run).

By providing concierge style customer service, Captiva’s model also removes the guesswork out of sifting through online reviews. With clearly defined options and networks of only vetted and approved options, the process becomes as hassle-free as possible. Having access to more information also allows patients to make decisions that make the most financial sense; with proper education about their options, they’re less likely to get pressured into unnecessary tests or procedures that quickly add up.

Captiva’s approach disrupts the status quo and easily answers the health care consumer priority of convenience. If you’re ready to bring that kind of healthcare to your business’s employees, please get in touch with us.

Here’s What Healthcare Consumers Are Looking For is available on: https://captivabenefitsolutions.com

Returning Power to the Patient

The number of hurdles to acquiring health insurance and healthcare continues to increase.

A clear barrier is financial, with a very high percentage of the uninsured workplace citing cost as the reason they’re foregoing insurance. However, the cost of care itself continues to be problematic even for employees who do have health benefits.

Many times, patients are faced with deciding between getting desperately needed care and getting bills paid. Sometimes, they have to decide which health problem is actually severe enough to warrant care, leaving other needs untended.

The problems with access don’t end there. Transportation is another lesser discussed issue, causing particular problems for those in rural areas or those living with chronic illnesses. Simply understanding the options for getting to healthcare facilities is lacking for many patients.

Another common barrier is language. Especially for Hispanic populations, not being able to understand or be understood in a healthcare setting poses significant challenges to both becoming insured and receiving medical services. Sometimes this can even lead to mistakes on vital paperwork and prescriptions.

A lot of other healthcare hurdles boil down to lack of education. Without understanding what problem solving solutions are available to them, how are prospective patients supposedly to choose accurately?

Navigating the contemporary healthcare field can be like trying to walk through a wholly unknown minefield, unsure what missteps might cost dearly in the form of financial, legal or health headaches. 

This is one of the many problem areas that the Health Rosetta is committed to helping companies solve for their employees. Most of the time, employees are being left to navigate dense swaths of confusing and even conflicting data to make any kind of decision about their healthcare.

This is costly not just in terms of the care that isn’t being received; it also means that sometimes the care that is being recommended and administered is ineffective and non-evidence based.

For a lot of patients, the information (confusing or not) simply isn’t available at all. The silo model of healthcare, in which each type of care and care provider exists entirely independently with very little data sharing. This makes it very difficult for anyone to accurately compile and compare information from different sectors to make the most informed opinion. Keeping the data segmented also makes it harder for the most effective and cost sensitive solution to be found.

As we at Captiva follow the Health Rosetta’s model, we’re committed to information transparency at every level: for care providers, for companies and for the employees they benefit. We make sure that information is always available for employees when they need it so that they can make an informed decision.

A crucial part of Captiva’s ongoing model for your business as you continue to provide benefits to your employees is providing education. This ensures that employees can continue to overcome barriers to care that might arise in the continually shifting healthcare landscape.

Returning Power to the Patient was first published on: https://captivabenefitsolutions.com

Concerns as the Aetna and CVS Merger Closes

2018 has been a year full of game-changing shifts and innovations in the health insurance landscape. One of those milestone changes we’ve referenced before is the recently approved merger between pharmacy major player CVS and health insurance network Aetna.

One of the initial hurdles it had to overcome was a potential block from the Department of Justice. The block was requested by New York Assemblyman Kevin Cahill, who voiced concerns that the move would reduce competition, forcing up drug prices.

According to Cahill, "The sheer magnitude of this vertical restructuring is likely the biggest in healthcare and perhaps in the history of commerce in our nation."

That was a concern shared by some legislators in California as well. Their concerns led to clearing the deal with a condition: a promise that premiums wouldn’t increase as a way to cover merger costs.

At this point, it’s still unclear exactly what the long-term impacts on premiums in future years might be. But CVS got everyone on board, and on Nov. 28, the merger was officially approved. 

The healthcare world is bracing for how this is likely to change the playing field. As we said earlier, the most obvious problem is the one that has given legislators pause: the risk of narrowing market options, reducing competition and subsequently driving up prices.

There is a very real possibility that any potential savings that occur from consolidating will just go to further line insurance companies’ pockets rather than actually reaching the consumer.

Another potential impact that critics have pointed out is the possibility that this will allow providers in Aetna’s network to limit consumer’s options while raising the prices.

This concern is well-grounded given that two monolithic institutes combining gives them a lot of power to decide what kinds of care and prescriptions are covered (and which are not).

Beyond just the limitations that this could pose to consumers, the merger puts other healthcare providers in a hard place as well. The DOJ recently also approved a similar merger between Cigna and Express Scripts.

In an era where power is consolidating to a few heavyweights, smaller companies might be forced to consider consolidating — or be crushed under the momentum of the giants.

Captiva exists to help your business bow out of those risks entirely. We’ve known for a long time that outrageous pharmaceutical costs and unchecked insurance providers should not be the status quo.

The Health Rosetta paradigm was developed to define a better way to provide benefits, and we’re here to apply that to your company. In the process, you’ll be freed from concern over the problems big business mergers could fuel.

The following post Concerns as the Aetna and CVS Merger Closes was first published to: Captiva Benefit

How the 2018 Midterm Results Impact Healthcare

In this final quarter of 2018, most of the attention of the news cycle has been fixed on the U.S. Midterm Election. Within that complex national conversation, as we’ve shared before, the biggest player was healthcare.

According to exit poll data, 41% of voters ranked healthcare policy as the top priority issue. In fact, it was the top priority by a significant percent, with immigration coming in second as a priority for only 23% of voters.

We can reasonably surmise from numbers like this that the questions of who gets healthcare and how have perhaps never been more crucial and pressing for the majority of Americans.

Here are a few key points to keep in mind about the midterms’ impact on healthcare and providing benefits to your employees.

 

Healthcare Changes Likely to be State-by-State, Not Nationwide

The biggest news from the midterms was that the Democratic party now holds the majority in Congress. 

Meanwhile, the Republican party strengthened its Senate majority. With a more bipartisan leadership in place in Washington, there’s a likelihood of gridlock over any major policy changes — which leaves any potential policy updates to occur on a state-by-state basis.

Although any chance of repealing the ACA or major national Medicaid changes seem to no longer be possible, state governments do have the ability to make significant decisions about whether to expand Medicaid or not in their individual states.

Adjustments on that front could be the biggest changes in policy to navigate over the next two years.

 

The Status Quo is Stabilizing

With the above mentioned slowing of policy change, the healthcare status quo is likely to be more stable than it has been in years.

The downside to that is, as we all already know, the status quo isn’t working. But the good news is that Captiva already has a plan in place to solve your benefit problems in this current climate. Policy won’t change much. Neither will our ability to bring your costs down.

 

Get Ready for Drug Pricing Conversations

Although overall the Democrats and Republicans have different priorities, there is a good chance there is one item they can agree on: pharmaceutical drugs are priced outrageously high. Any bipartisan progress to be made could well center on curbing this issue.

Bringing drugs to an affordable price is a mission that Captiva has been on already. We work towards transparency to uncover hidden pharmaceutical costs and do the hard work of shopping around for the most fair price.

If you’re ready to learn more about how Captiva can help your business’s benefits culture thrive regardless of the political climate, talk to us to find out how. 

 

The article How the 2018 Midterm Results Impact Healthcare was first published on: Captiva Benefit Solutions Blog

Healthcare a Top Issue in 2018 Midterm Elections

The 2018 Midterm Election is upon us, and once again, politicians are ramping up rhetoric about healthcare.

And rightly so. According to a report by the Wesleyan Media Project, healthcare is the top issue of concern to voters in the November General Election.

Similarly, new NPR/PBS/Marist Poll finds healthcare as the No. 2 issue (following the economy and jobs) concerning voters in 2018 — with 17 percent saying it was the most important thing driving their vote.

Over the last month or so, nearly half of political advertisements in federal elections predominantly mentioned healthcare, and about a third of gubernatorial airings included the topic. Both parties are mentioning healthcare, but it is featured more heavily by Democratic campaigns, appearing in 54.5 percent of that party’s ads.

It’s interesting to see how the parties have treated healthcare in the last few election cycles. Wesleyan Media Project found that after the Affordable Care Act passed in 2010, healthcare became a prominent issue in a third of all national pro-Republican ads. Democrats, by comparison, only used it 8.7 percent of the time in 2010.

Republicans talked less about it in 2012, 2014 and 2016, as mentions declined to 28.4 percent, 20.8 percent and 16 percent, respectively. Now, in 2018, the GOP saw healthcare mentions surge to 31.5 percent of their ads — almost as much as they did when the ACA passed in 2010.

So what are they saying?

Essentially, Democrats are campaigning to save the ACA, and warn that Republicans’ current and future plans to scrap the Act will hurt Americans. Republicans, by contrast, are campaigning that they’ll come up with a replacement plan to provide healthcare to Americans by strengthening the private sector.

It’s a big deal, especially as Republicans gutted key provisions of the ACA while not replacing them. The federal mandate to purchase insurance has been all but removed, and experts predict millions more Americans will be uninsured.

Meanwhile, plenty of Americans -- especially middle class Americans caught in the coverage gap -- don’t see the ACA as it was as a viable answer. ACA or no ACA, prescription costs, doctor/hospital fees and insurance premiums continue to rise, with no end in sight. 

Regardless of how most voters feel about each party’s strategy for healthcare, the Motley Fool’s Sean Williams said it best: government is trying to “fix” the wrong problem:

Lawmakers continue to center around the idea that access to health insurance is the biggest problem, when the issue at hand is the underlying inflation of medical care, not access to health insurance. If the cost of underlying medical care stopped outpacing inflation and wage growth nearly every year, access to health insurance wouldn't be an issue for most folks, and we wouldn't even be having this debate. In other words, they're trying to fix the symptoms without getting to the root cause of the problem.

Those issues include the unchecked pricing power of the pharmaceutical industry — something Congress has only just started to pay attention to — ballooning administrative healthcare costs, rising provider costs and more. Williams summarized what we at Captiva say every day: “Congress is trying to close a gaping wound with a Band-Aid.”

It’s been bad enough that an increasing number of private enterprises like Amazon and Google are dedicating significant resources towards developing industry-disrupting solutions.

If there’s anything we’ve learned watching the political landscape over the last few decades as it relates to healthcare, it’s that there haven’t been any changes that have resulted in lower overall costs to Americans.

There’s really no reason to think that with an access-minded approach to healthcare still very much ingrained in Congress, that things will be any different this time around.

But change is possible — regardless of current and future political proceedings.

Captiva Benefit Solutions and the Health Rosetta community use pricing tools and accountability measures that will provide better healthcare for less money to your employees. Your company will have the tools and partnerships available to smartly negotiate better pricing structures, demand transparency and accountability in billing, and comparison shop for the best deals.

If this is a future you’ve been waiting for, wait no longer. Let us consult with your benefits manager to share just how Captiva can make a big difference right now.

Healthcare a Top Issue in 2018 Midterm Elections was originally seen on: Donnie Marcontell

Employers Fight to Absorb Higher Healthcare Premiums

As health insurance costs continue to rise, employers are struggling to stop the expenses from overburdening their employees.

A recent study by Aon found that throughout the course of 2018, healthcare premiums have overall risen by 3.5%. However, most employees only experienced a 2.2% rise, as employers have chosen to absorb some of the increase themselves.

This means that employers were paying 3.9% higher premiums in 2018. That's a big pill to swallow as companies are trying to make a profit and stay afloat.

This information has several important things to tell us.

First of all, it tells us what we already know: health costs, including premiums, are continuing to make up a disproportionately high percentage of expenditures.  The increase rate is three times the rate of general inflation.

And unfortunately, initial analyses suggest that 2019 might see an even higher price increase.

But Aon reports tell us about more than just bare facts about the statistical rise of premium costs. It also tells us that employers are taking an active role in trying to triage the situation so that their employees aren’t saddled with the extra costs.

A lot of that active negotiation of costs has involved experimenting with non-traditional methods of providing healthcare benefits. Even with premiums increasing, alternate options are increasing also.

This is where Captiva Benefit Solutions comes in. We believe there is a better way than just paying the increasingly rising premiums that insurance providers demand.

Utilizing elements of the Health Rosetta like transparent open networks and advisor relationships, we can help your business stay ahead of the premium increase curve.

The Aon data that proves that more employers are trying to negotiate better options for their employees is proof that Captiva is on the cutting edge of combating premium hikes.

Our model joins companies like Walmart, Boeing, Cisco and Intel in opting to enable the employer to negotiate directly with healthcare providers. That approach cuts back on overhead, provides more personalized care and removes unnecessary costs so that premium increases are removed from the equation entirely.

Getting out of the way of snowballing premium increases is just one of the ways in which Captiva can help your company provide more affordable, more streamlined, more effective benefit options to your employees. If you’re ready to take the next step towards better benefits, contact us to get started.

Employers Fight to Absorb Higher Healthcare Premiums is courtesy of: Captiva Benefit Solutions