The year 2015 is slowly fading in the rear view mirror. The fresh new year of 2016 is ahead. I think we can call 2015 The Year of the Drug. That may be a suitable name for 2016 as well. However, drugs weren’t the only topic of conversation.
Biologics and specialty medications
Every 2015 conference I attended spent time addressing the threat of high-cost specialty medications or biologic drugs. Every insurance carrier trotted out their latest cost-saving features, programs and formularies to address the threat (including ASSOCIUM). However, we also saw high-cost drugs begin to show up in claims reports. The industry was not crying wolf, as it were.
For 2016, most of the talk will have turned to action, most likely. As drug costs increase the carriers are all implementing their programs in a bid to mitigate the impact on group plans. While these initiatives will succeed in deflecting and offsetting some of the impact of five and six figure dollar-cost drugs, they will likely be done through greater scrutiny on individual claims, more involvement and less discretion by individual plan members.
Green Shield Canada did a study of trends in the health services typically offered in benefit plans. The study revealed how usage of services such as massage, chiropractors and physiotherapy shifts dramatically through ages and life stages of claimants. The single most surprising finding was the 500% growth in teenaged girls’ usage of massage therapy.
We are already seeing employers reducing maximums and access to paramedicals as those claims begin to become a larger part of their overall benefit spend. In the future, we are expecting to see many more limitations imposed on plans in a bid to reduce costs.
All the plan carriers have seen an increase in fraudulent claims over the past few years. While some of these claims are blatant attempts to defraud, others are as a result of practitioners going too far as they attempt to get the most from their clients’ benefits plans. Going forward, we will be seeing more communications and employee education initiatives designed to prevent these kinds of claims from being incurred in the first place.
We, at ASSOCIUM, have been constantly working to broaden our offering of products and services to our clients. For 2015, the big news here was that we have aligned with MDM Insurance Inc., a company that specializes in claims adjudication and payment and has developed one of the most flexible and up-to-date systems in the industry.
Throughout 2016, we will be working closely with MDM to create opportunities that will improve the value of benefits plans for our clients, while reducing costs and finding alternative approaches to structuring benefits offerings. Over the next year, new products will be made available to small and to large employers. We will be more flexible in the types of solutions available to our clients. As a Third Party Administrator (TPA), the flexibility goes beyond our own products to include offerings from sources across the spectrum. Watch for more information.
2015 was a year during which significant cost challenges began to impact benefits plans everywhere. In 2016 solutions to those challenges will need to be found and implemented, if we are to maintain stability in the employee benefits market. ASSOCIUM is poised to do just that.
ASSOCIUM Benefits is a very unique employee group benefits provider, focused on supporting benefits advisors and their employer clients. We provide Brokers and Plan Sponsors with a range of solutions from traditional group benefits to more customized, cost and tax effective employee compensation. Let’s connect to find out how we can help.