Health Insurance Industry Issues and Legislation

Researchers from Johns Hopkins University (JHU) and the Pacific Business Group on
Health (PBGH) have identified 49 medications employers can replace in their formularies
with significantly less expensive products. Together these medications accounted for
more than $6 billion in U.S. retail sales in 2019 according to data compiled by Bloomberg.
Only 5 drugs accounted for over $3.4 billion of that total. JHU and PBGH have published a
guidebook identifying the 49 drugs and the less expensive available alternatives

No one knows when, or even if, Congress will address surprise billing again anytime
soon. Until they do, H.H.C. Group will continue its proven three-pronged approach
to minimizing the impact of surprise bills on its self-insured clients and their
members nationwide. The approach starts with our attorney negotiators working
with providers to get them to sign agreements accepting the appropriate amount as
payment in full for the services they've provided, eliminating patient balance billing.
It also includes accessing national and regional network agreements, again reducing
plan costs and eliminating those balance bills. Finally, for large bills for which no
agreement can be reached, H.H.C. Group conducts line by line reviews of the bills to
identify errors and inappropriate charges, reducing plan and member charges

Surprise bills account for 10% of health plan spending, costing self-insured plans and
their members billions of dollars annually, according to a study by the University of
Southern California Schaeffer Center for Health Studies and Economics. Providers
charge their full list price for these out-of-network services, hitting both self-insured
plans and their enrollees hard in the pocket book. This Fall, Congress considered two
approaches to take the sting out of these surprise bills. One would eliminate the
ability of providers to charge out-of-network fees for surprise bill. The other would
require all services billed at out-of-network prices to be paid at 1.5 times the Medicare
reimbursement rate.

Premature deaths and lost productive potential due to poor health among working
age adults is costing the United States about 16% of real GDP annually and that
number is projected to only grow in the coming years. Based on a McKinsey Group
Institute (MGI) study, deploying existing proven approaches to improve health and
prevent and treat diseases, the US could reduce its disease burden by as much as onethird by 2040. MGI identified 4 imperatives whose adoption would enable us to take
advantage of this huge opportunity.

Medicare Reference Based Pricing • Claim Negotiation • Claim Repricing •
• Medical Bill Review (Audit), Claims Editing • DRG Validation • Specialty Drug Cost
Containment • Medical Peer Reviews/Independent Reviews, • Utilization Reviews •
Independent Medical Examinations (IME) • Pharmacy Consulting.

H.H.C. Groupis an URAC accredited Independent Review Organization for Internal and
External Reviews.

For additional information about H.H.C. Group and cost containment services, please visit www.hhcgroup.com or contact Dean Vaden at dvaden@hhcgroup.com or 727-253-0365.