Health Insurance Industry Issues and Legislation

Implementation of Inflation Reduction Act begins in January 2023. The Act includes several provisions for reducing prescription drug costs for Medicare recipients and the federal government. Unfortunately, this will most likely mean increased prescription drug prices for commercial insurers and their plan members. Smart benefits professionals are utilizing five strategies to help offset the impact of any potential increases.

Providers continue to reject payments for NSA covered claims by the tens of thousands. Faced with the time-consuming, drawn-out Independent Dispute Resolution process with its uncertain outcomes, payors are turning to HHC Group to negotiate settlements of their ambulance emergency room and other NSA claims. We're securing significant discounts for them, sometimes even below the QPA. They are winning twice, enjoying the big savings while avoiding those IDR headaches.

The bad news - More than 40% of U.S. adults with multiple chronic conditions avoided getting medical care in the last 3 years. The number of undiagnosed pre-pandemic treatable/curable cancers exploded and the health of people with multiple chronic conditions avoiding regular checkups got much worse. The good news – Powerful tools have emerged to help plan sponsors improve the health of their chronically ill plan members.

Administrators and insurers reported medical trend factors varied by product from 5.8% to 6.9%, down 1 to 2 percentage points as claims spiked due to residual demand from the pandemic. Unfortunately, due to inflation and provider contract renewals, health plans will be under pressure to increase provider reimbursement rates again this year and next. While healthcare costs continued to rise in 2021, the rate of increase slowed for medical services and prescription drugs.