Health plans

aequum Unveils 2022 Outlook for Employer-Sponsored Health Plans: Cost-Containment Strategies and Opportunities to Minimize Risk and Maximize Value

CLEVELAND–(BUSINESS WIRE)–
aequum LLC, acting on behalf of 325 self-insured health plans and their participants nationwide, predicts the regulatory and economic trends that will impact medical billing and shape employer-sponsored health plans in 2022.

“Over the past year, the focus has been on rising health care costs and federal legislation that supports employer-sponsored health plans access to affordable medical services with additional layers of protection and fairness,” says Christine Cooper, CEO, aequum. “For 2022, there are now opportunities for self-insured companies to implement strategies to capitalize on cost containment initiatives to fully optimize the value of their health plans.”

aequum highlights four key trends for 2022:

1. No more out-of-network balance billing surprises

At January 1st, certain provisions of the No Surprises Act (NSA) have taken full effect to protect health plan participants from excessive medical bills received from out-of-network providers – including urgent care services and at in-network facilities . However, balance billing is expected to continue to some extent from services rendered by out-of-network providers given certain situations. What a surprise it will be.

2. The rise of health savings accounts as a savings strategy

Many workers are “financially fragile” and have not set aside savings specifically for out-of-pocket medical expenses. Only a minority of “unforeseen” medical expenses are bills received from out-of-network providers. Most bills are regular shared costs – deductibles, co-payments, coinsurance. The least burdensome option to prepare for out-of-pocket expenses in 2022 is using a Health Savings Accounts (HSA) strategy. Although most employers do not offer HSA-compatible coverage, 80% of employers who offer an HSA contribute to the HSA. However, since only a minority of employers offer HSA-compatible coverage, those adding this option in 2022 can still gain a competitive advantage for both employer and plan members.

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3. Growing adoption of self-funded health plans

Kaiser Family Foundation Annual Employer Health Benefits Survey reports that 64% of we workers are enrolled in health plans that are self-funded. This growing adoption is often in response to significant increases in insurance premiums. Employers who have chosen self-funded coverage plans are attracted by the opportunities to mitigate risk and manage costs versus the ever-increasing premiums and other requirements that are typically part of traditional fully insured plans.

4. The most valuable provision of a self-funded health plan

Reference-Based Pricing (RBP) is one of the fastest growing solutions in managing healthcare benefit costs. RBP restores transparency in healthcare pricing by using Medicare reimbursement rates and other provider cost data to provide an objective cost baseline. This offers disciplined pricing – fair and rational reimbursement for providers. RBP may be subject to the NSA’s independent dispute resolution process where plans directly contract with facilities and vendors. Self-funded schemes need to be aware of this risk.

About aequum LLC

Founded in 2020, aequum LLC serves third-party administrators, medical expense management companies, stop-loss carriers, employer-sponsored health plans, and brokers nationwide to protect plan participants, improve employee satisfaction with their health care plans and generate plan and participant cost savings. aequum LLC helps patients defend their medical balance bills and provides savings to employer-sponsored health plans by providing administrative and other services to its partners. Additionally, its sister organization, Koehler Fitzgerald LLC, provides legal defense to plan participants. For more information, visit aequumhealth.com.

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Brittany Tedesco
[email protected]

201.641.1911×14

Source: aequum LLC