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Monday, 08/02/21 Walt Podgurski 440-773-1108 E-Mail
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Self-Insured Employers Have Little Say in Hospital Price Negotiations
By Jill McKeon / REVCYCLE INTELLIGENCE / / Read Article

Most self-insured employers in the US lack the market power necessary to take part in hospital price negotiations, according to a study published in the American Journal of Managed Care (AJMC). Hospital prices paid by employers are quickly exceeding inflation and have risen considerably above payments from public payers. (Read Study.)

Between 2005 and 2019, the price differential paid by employers for hospital services compared to Medicare rates increased from 10 percent to over 100 percent. Most Americans under the age of 65 receive health insurance from their employers. A lack of power by employers to negotiate hospital prices could trickle down and negatively impact employee wages as employers look to cut costs.

Researchers used US Census Bureau County Business Partners (CBP) data to estimate year-by-year employer market power by metropolitan statistical area (MSA) between 2010 and 2016. They also used enrollment and commercial claims data from the Truven Health MarketScan to estimate hospitalization prices.

Results revealed that large, self-insured employers rarely had concentrated market power in most MSAs. The research also suggests that insurers may lack the incentive to negotiate lower hospital prices for their enrollees.

Former Iora Health execs raise $13M to guide seniors through Medicare enrollment
Christine Hall / Techcrunch / / Read Article

Employers typically offer three options for healthcare insurance. When it’s time to switch to Medicare, particularly Medicare Advantage, there are over 3,500 plans available nationwide, and an average of 30 plans someone can choose from in their particular area. Connie Health is leading seniors through the Medicare maze, helping whittle down those 3,000 plans into a handful of best choices based on care requirements.

The company’s three co-founders, Oded Eran, CEO, David Luna, chief revenue officer, and Michael Scopa, chief growth officer, saw this problem firsthand as executives at primary care company Iora Health, which is being acquired by OneMedical for $2.1 billion.

They started their company in 2019 to develop a Medicare concierge service to assist seniors in easily navigating through those 30 plans to find the right one for them.

New Research: Defining "Financial Wellness" - What It Means to Investors After COVID-19
PRNewswire / Yahoo Finance / / Read Article

Since the onset of the global pandemic, many aspects of one's financial life have changed as Americans report spending less on non-essential items (41%) and are focused on saving (41%). The survey shows 42% of Americans admit their definition of financial health also changed since the onset of the COVID-19 pandemic and 51% say having an emergency fund is the highest financial priority these days.

So what does the term "financial wellness" actually mean to the everyday investor? When asked to define the term in their own words, the results showed it's less about money or retiring at a certain age, but instead around the concept of financial freedom and having the ability to choose how they want to spend their money. Below are top insights on the concept of financial wellness and what it means in this post-pandemic world.

Key Findings on "Financial Wellness" and what it means to everyday investors:

There's no "one size fits all" state of financial wellbeing.
Financial wellbeing is rooted in "freedom and independence."
Financial wellbeing can also feel elusive.
Most need help on their journey to financial wellbeing.

Biden nominates lawyer to oversee retirement plans, worker benefits
Jessica Dinapoli / Reuters / / Read Article

U.S. President Joe Biden has nominated attorney Lisa Gomez to be the assistant secretary for the Employee Benefits Security Administration at the Department of Labor, overseeing private retirement plans, health plans and other worker benefits.

The Employee Benefits Security Administration (EBSA) covers $12.2 trillion in assets and has weighed in on controversial issues facing investors such as voting in shareholder meetings and retirement plan managers' using environmental, social and governance (ESG) factors to pick stocks.

Medical association CEO: New Montana law provides more affordable way to gain access to a physician
Bob Pepalis / (The Center Square) / Fairfield Sun Times / / Read Article

Montana Gov. Greg Gianforte signed a bill into law authorizing direct primary care agreements between patients and their doctors.

Direct primary care (DPC), sometimes referred to as direct patient care, is defined by the American Academy of Family Physicians as a practice where the physician contracts directly with patients for monthly or annual fees, replacing the traditional system of third party insurance coverage for primary care services.

“Depending on what their circumstances are, this is a great, more affordable way to gain access to a physician, versus having to buy an insurance policy that you may or may not use on a monthly basis,” Jean Branscum, CEO of the Montana Medical Association, told The Center Square.

At KindHealth, an Entrepreneurial Team Blends Health Insurance and AI Experience to Solve Coverage Crisis
PRNewswire / / Read Article

When Albert Pomales and Andrew Tomasik teamed up with co-founders Mark Adams and John Constantine to start KindHealth, a company that would untangle the health insurance issue, they brought to the table 18 years in technology development, 20 years in health insurance, and a deep conviction that getting and managing health coverage is needlessly complex.

Together with their team, they have developed a platform that leverages their expertise to build an AI-driven platform that makes it simple for people to assess their healthcare needs, find the best plan, and enroll and manage their coverage. They see it as essential in today's market.

KindHealth's AI can draw on a vast array of information, such as history of health care usage, ages of any children and tolerance for risk. "We can look at that data and generate smart insights that don't require humans and are instantly scalable," Pomales said.

And it's working. Austin-based KindHealth has a robust array of health, dental, vision, life and Medicare insurance offerings that includes more than 250 insurance companies and healthcare.gov policies. KindHealth has helped over 1M people shop, compare, and purchase health insurance plans, collectively saving $5M in health insurance plans.

AmeriLife To Acquire Saybrus Partners from Nassau Financial Group
PRNewswire / / Read Article

AmeriLife Group, LLC ("AmeriLife"), a national leader in developing, marketing, and distributing annuity, life, and health insurance solutions, has entered into an agreement to acquire Saybrus Partners, LLC ("Saybrus"), a life insurance and annuity distribution company, from Nassau Financial Group ("Nassau").

Based in Hartford, Conn., Saybrus Partners was formed in 2009 to bring its boutique model to institutions, delivering customized support, proactive consultation and transparent, centralized management for advisors and insurance agents. Saybrus has been a subsidiary of Nassau Financial Group since 2016 and has exclusively distributed Nassau's annuities and Medicare supplement insurance through independent marketing organizations (IMOs) and independent agents. Further, Nassau and AmeriLife have a longstanding relationship, with the latter as the leading distribution partner for Nassau annuities. Saybrus will continue to distribute Nassau's products after this transaction.

Hint Health Partners with athenahealth’s Marketplace Program to Support Direct Care Organizations and Membership-Based Practices
Collaboration will streamline patient information and health plan eligibility between Hint Health and athenahealth, benefitting direct care providers and their patients
BUSINESS WIRE / / Read Article

-Hint Health, the leading provider of membership management, billing, and direct contracting infrastructure for direct care and membership-based providers, today announced a partnership with athenahealth, Inc. through the company’s Marketplace program. As part of the athenahealth® Marketplace, this newly integrated application is now available to athenahealth’s growing network of healthcare providers to standardize and automate data exchanges and billing between Hint Health’s HintOS™ member management platform and athenahealth’s electronic health records (EHR) solution.

In partnering with athenahealth, the offering now enables streamlined enrollment, eligibility, billing, and payment workflows and eliminates the need for laborious double data entry across systems. The partnership will simultaneously reduce errors and create a single source of truth for membership and billing data across multiple teams.

Photo Of the Day

Monday, 07/26/21 - - Three Ways Insurance Brokers Can Use Technology To Help Small-Business Clients

Tuesday, 07/27/21 - - Insurance brokers Aon and Willis Towers Watson scrap their $30 billion merger

Wednesday, 07/28/21 - -
Walmart Is Rapidly Expanding Its Presence In Healthcare

Thursday, 07/29/21 - - 
America's largest retailer will cover 100% of college tuition for its workers

Friday, 07/30/21 - -
Employee Loyalty Reaches Lowest Level in More Than a Year, According to Energage Research

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Editorial Mission Statement: The goal of this publication is to provide readers a broad selection of what is being written about the insurance industry and related issues. Some articles may have a “tilt” towards a particular perspective one way or another. Inclusion in this newsletter is not an endorsement of any views or content; but report the various and differing views appearing in media.