Cost Reduction is now #1 Issue, MRIs for All?, and more | Issue 79
John Hansbrough, CEBS
Make benefits your Competitive Advantage | Healthcare Supply Chain Strategist | Mental Health & Suicide Prevention | Advocate & Speaker
Changing Benefits Priorities for Employers: Cost Reduction is Now #1
According to a recent national benefits survey, employers are now making Cost Reduction as their top priority. This is a significant development as Attracting & Retaining Talent held the top spot every other year since 2019, which reflects ongoing cost pressure from rising health care & health insurance costs.
So far this year, I'm seeing 10%+ increases in the small group market and similar increases in the large group market for fully insured renewals.
One issue with this, however, is that most employers would rather not take big swings at changing their benefits programs. Just 9% of respondents to the survey consider their companies "Trailblazers" when it comes to changing employee benefits plans, while 31% call themselves "Fast Followers" and a majority, 53%, want to see other companies implement a tactic effectively first before they try it.
When a majority of the market wants to wait and see the impact of any innovation before they themselves will try it, change can be hard to spread through the industry.
Every employer is looking to balance cost savings with member service and employee needs. The problem is that constant cost growth is unsustainable and employers and employees are reaching a breaking point.
Here are a list of some strategies employers can consider, starting with low impact & low disruption, to high impact and high (potential) disruption:
With Q4 renewal season starting soon, company leadership should rethink their willingness to consider cost reduction strategies. The analogy we liken to the health insurance industry is a frog being boiled alive; 10% increases year after year doubles premiums in 7 years!
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Check out this 50+ page open-access handbook for founders building health & science companies. Here's a great tool for any founders out there!
What if we we just do full body MRIs on everyone?
Neko Health is a healthcare company in Sweden that is sharing tons of data about their practice, and what's notable about them is how they perform MRIs on everyone. Their data visualization is pretty neat too!
In 2024, they saw 4,362 people in their Stockholm clinic, 2,885 of which were 1st time scans and 1,477 follow up scans.
While 81.3% or 3,547 members were found to be in good health and needed no follow up, they did find that:
Of those significant diagnoses, examples included skin cancer, sever cardiovascular disease, metabolic conditions, blood diseases, autoimmune diseases, kidney disorders, and more.
Why is this fascinating?
We think approaching healthcare with a prevention & maintenance strategy rather than caring for people only once they are sick enough to present to the healthcare system is a way to improve health and reduce costs.
With the way healthcare costs are distributed across a population with 60-80% allocated to just 2-5% of a population, there are serious benefits to catching conditions early and treating them before they progress further.
Strategic employers today are investing in primary health care and preventative screenings to identify disorders and conditions in the early stages. Let's talk if you want to brainstorm ways to do so for your organization.
⚖️ Labor & Employment Updates
Supreme Court Decides Kennedy v. Braidwood Management, Inc.
“The Court rejected Braidwood's arguments thatTask Force members are not inferior officers.... The Court interpreted the term 'independent' to mean avoiding undue influence from external affiliations, not complete insulation from the Secretary of HHS. Finally, the Court found that the Secretary's inability to compel specific recommendations does not disqualify Task Force members as inferior officers.”
Full Article from Faegre Drinker Biddle & Reath
Federal Court Strikes Down HIPAA Reproductive Health Privacy Rule – What it Means for Health Plan Compliance
“The ruling essentially eliminates the enhanced federal privacy protection for reproductive health care information. Certain regulated entities are still required to comply with applicable state privacy and consumer laws regarding the disclosure of reproductive health care information.”
Full Article from Stinson
Final Regulations Address ACA Exchange Integrity; Revise 2026 Annual Limitation on Cost-Sharing
"The maximum annual limitation on cost-sharing for 2026 has been revised to $10,600 for self-only coverage and $21,200 for other than self-only coverage, superseding the previously announced 2026 limit of $10,150 and $20,300. Beginning with the 2026 plan year, insurers subject to the essential health benefits (EHB) requirement (i.e., non-grandfathered individual and small group market plans) may not cover 'specified sex-trait modification procedures' as an EHB.” Full Article
Full Article from Thomson Reuters / EBIA
Sixth Circuit Holds TPAs Do Not Get a Free Pass from ERISA’s Fiduciary Duties
“Employers overseeing the day-to-day management of their plans should also be able to use the ruling to seek disclosure of information about the pricing and payment of claims, which in the past TPAs have been unwilling to share. In their role as an ERISA fiduciaries, TPAs will be obligated to disclose this information when requested by a plan administrator looking to properly administer its plan.”
Full Article from Polsinelli
Cybersecurity and Your Employee Benefit Plan: What Every Plan Sponsor Should Know
"As a plan sponsor, taking steps to secure your plan data isn't optional, it's part of your legal duty to act in your participants' best interests.[1] Review your vendor contracts for cybersecurity language. [2] Request and review audit reports from your service providers. [3] Implement basic security practices for your internal team. [4] Educate your participants about protecting their accounts. [5] Document your efforts as part of fiduciary oversight.”
Full Article Schechter Benefits Law Group,
Pharmacy Benefit Manager Hit with $95 Million False Claims Act Judgment
“This ruling is particularly significant as it sheds light on the all-too-opaque process of drug pricing. When PBMs are accused of having violated the False Claims Act by overbilling Medicare -- when Caremark is supposed to be reporting the actual prices remitted in reimbursement to pharmacies for Medicare Part D drugs -- it follows that the reimbursement paid to pharmacies is significantly less than what it otherwise should be.”
Full Article from Duane Morris
That's it for this week's Competitive Advantages! Be sure to follow and reach out to me with any questions.
📧 Email me at jhansbrough@acrisure.com