Health Insurance Industry Issues and Legislation

Payors, health system and health are increasing turning to digital heath solutions. 97% of employers, 86% of health systems and 84% of health plans expect to maintain or increase spending on digital solutions in the coming year. All groups indicated increased consumer demand, improved health outcomes and cost saving as the top reasons.

Hospital service prices have increased 220% since 2000, more twice the rate of inflation. A study from Rice University researchers analyzed the relationship among hospital prices, operating costs and profits. They found that higher inpatient prices were linked to increased profits, not differences in operating costs or quality at higher and lower priced hospitals. They also found that higher outpatient prices are not associated with higher operating costs, just higher profits.

A hospital operated on a premature baby with respiratory distress syndrome and acute infarction of the small intestine. The bill $1,052,272. The PPO discount reduced the bill to $863,684. HHC's attorney negotiator identified the hospital decision maker and got to them to agree the proper amount for the services provided was $526,636, saving our client an additional $337,047. Real people delivering serious savings.

Congress, in response to the COVID-19 pandemic, passed legislation to temporarily allow high deductible health plans (HDHP) to provide telehealth service benefits before plan deductibles are met. They have extended the law repeatedly since 2020. It presently applies to plan years beginning before January 1, 2025. If legislation to extend HDHPs will need to start imposing telehealth deductibles from January 1, 2025.