Dennis Hillen

"Additionally, since 2019, the share of total spending by Medicare, Medicaid and commercial insurers in primary care has steadily declined;" - --- Great point to consider...new efficiencies (Phone based telehealth, community based Urgent Cares, Concierge MD services, etc.) might also account for the fewer visits to traditional points of entry (translation: MOST expensive) such as ER's. That alone has likely translated to untold millions in decreased spending on claims. Great read, Thomas, thanks for sharing your "shore life peace of mind" today!

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The Optum Rx announcement about their new model starting 1/1/25 is making the rounds on here. As PBMs develop new approaches, it is even more vital that self-funded employers, TPAs, Health plans, and brokers have a pharmacy benefit consultant on top of the changes and with the ability to compare PBMs despite the ever-growing variability! This is where the team at Innovative Rx Strategies comes in and ensure you can still find the right fit regardless of the ever-changing landscape! https://lnkd.in/gfEkUnuB #Pharmacists #Pharmacybenefits #PBM #dontjustspreadsheet!

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Episode 2 of #CoffeeTalk is LIVE! Just wrapped up a discussion in Nashville about the importance of short-term care insurance. Did you know about the nuances of Medicare outpatient observation status? Let's talk solutions! Share your thoughts in the comments below. #seniorcare #shortterm

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The 12th edition of the America’s Health Rankings 2024 Senior Report provides a comprehensive overview of the state of health care for our senior population in the United States. As a geriatrician committed to the quality of care and well-being of our seniors, I find the data compelling to celebrate areas where progress has been made, and identify areas where challenges exist. Together, we can be united in helping our seniors live happier and healthier lives! Read the full report: https://lnkd.in/gEVCxSac

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A people-first mindset is crucial as digital technologies and AI become bigger influences in healthcare. In fact, Gail Boudreaux, president and CEO of Elevance Health, discussed at CES 2024 how tech and data-driven insights can promote more proactive and personalized care. Here are some key points she made during her keynote address. https://ow.ly/eref30sEKnY

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Who: Ben Krambeck Where: West Des Moines, IA What: A 60 Minutes-style Interview Why: To share the powerful story of ClaimDOC We hope you enjoy this journalistic look at how ClaimDOC came to be. #rbp #referencebased #medicalpricing #medicalbilling #healthinsurance #insurance #claimdoc #selffunded

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With the healthcare delivery system in the US facing various challenges, the evaluation of healthcare consolidation on Capitol Hill is crucial. The scrutiny reflects good intentions, but there are concerns about whether the underlying issues will be addressed thoughtfully. Partisan politics could impact care delivery and healthcare professionals. It's essential to monitor this trend closely as its implications may be more far-reaching than anticipated. #healthcare #healthcareconsolidation #enterpriseriskmanagement

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Individual insurance markets such as ACA Marketplace (aka Obamacare) and Medicare Advantage have annual regulatory changes that means plans annually evaluate expansion, exiting, or scaling back their footprint. BCBS Kansas City exited the Medicare Advantage market with their 32k members which caused me to think about those scenarios. This is not a post about the impact to the BCBS KC members nor how BCBS KC made the decision since it's a tough one and I have the same view from the balcony as my favorite Muppets, Waldorf and Statler. 𝐇𝐚𝐭𝐞 𝐭𝐡𝐞 𝐆𝐚𝐦𝐞, 𝐧𝐨𝐭 𝐭𝐡𝐞 𝐏𝐥𝐚𝐲𝐞𝐫𝐬: Regulatory and price change is a constant and individual members are making annual decisions. It's more like a cyclone than tail winds and head winds which means plans have to decide their threshold or risk being whipped around by the wind. 𝐊𝐧𝐨𝐰 𝐰𝐡𝐞𝐧 𝐭𝐨 𝐟𝐨𝐥𝐝 𝐭𝐡𝐞𝐦, 𝐤𝐧𝐨𝐰 𝐰𝐡𝐞𝐧 𝐭𝐨 𝐡𝐨𝐥𝐝 𝐭𝐡𝐞𝐦: At some point, the regulatory conditions get more favorable and plans that exited consider re-entering. It's always more costly to re-enter than you think due to acquisition costs, regaining market trust, and you have to offer lower-prices/richer benefits than the plans that stayed. 𝐍𝐞𝐯𝐞𝐫 𝐜𝐨𝐮𝐧𝐭 𝐲𝐨𝐮𝐫 𝐦𝐨𝐧𝐞𝐲 𝐰𝐡𝐢𝐥𝐞 𝐲𝐨𝐮'𝐫𝐞 𝐬𝐢𝐭𝐭𝐢𝐧𝐠 𝐚𝐭 𝐭𝐡𝐞 𝐭𝐚𝐛𝐥𝐞: What about staying in the market and shrinking your service area? There's often regulatory rules against this approach, fixed costs don't go down, and your market will still consider that to be an exit. While this can be an appealing middle ground, it doesn't usually pencil out. Also, I just quoted more Gambler lyrics since it's fun. The opening line doesn't really have anything to do with the commentary. 𝐔𝐩𝐬𝐢𝐝𝐞>𝐃𝐨𝐰𝐧𝐬𝐢𝐝𝐞? This is the only truly helpful information that I am offering. A talented CFO that I worked with drilled into my skull that you also have think of if the upside is greater than the downside for staying in the market. To simply paraphrase, if there's a 50% change of making $1 million, but losing $10 million, well to quote my new favorite song, 𝘛𝘩𝘦𝘳𝘦'𝘭𝘭 𝘣𝘦 𝘵𝘪𝘮𝘦 𝘦𝘯𝘰𝘶𝘨𝘩 𝘧𝘰𝘳 𝘤𝘰𝘶𝘯𝘵𝘪𝘯'/𝘞𝘩𝘦𝘯 𝘵𝘩𝘦 𝘥𝘦𝘢𝘭𝘪𝘯'𝘴 𝘥𝘰𝘯𝘦 https://lnkd.in/gKMjhjGW

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To Join me at Aon’s Midwest Region Healthcare Symposium for a two-day discussion on navigating the complexities of commercial risk in healthcare. Industry leaders, innovators, and experts will share their insights, experiences, and best practices. DM me for registration/hotel details and about the Navy Pier cruise outing. #Aon #AonBetterDecisions #Healthcare #MedicalMalpractice #CyberClaims #LegalUpdates #ParametricSolutions #ERM #RiskManagement

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Humana expects to exit Medicare Advantage markets in 2025, company executives told investors. "We expect benefit levels, plan stability and choice for seniors to be negatively impacted by the final MA rate notice, which is not sufficient to address the current medical cost trend environment and regulatory changes," CEO Bruce Broussard said. CMS published its final MA rate notice for 2025 earlier this month. The agency slightly cut benchmark payments and continued phasing in coding changes. Humana previously said the agency's rates were lower than its expectations. Other payers have signaled they will likely cut benefits to accommodate the rate notice. CFO Susan Diamond said the company will expect to see membership decline as it exits markets. "We are anticipating net membership declines in 2025, largely because we do plan to exit certain plans and counties," Ms. Diamond said. "Whether that is incrementally larger or smaller based on the other plans will be very dependent on what we see across the competitive landscape." Humana will share more information on the size and scope of plan exits after bids are submitted in early June, Ms. Diamond said. Though the company is anticipating a decline in 2025 membership, the company upped its 2024 membership guidance. Humana expects to add 150,000 Medicare Advantage members in 2024. [EXTERNAL LINK] - https://lnkd.in/gUbErpyC

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This article is worth a read on the how the disruption may play out this AEP.

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As Bob Dylan famously sang, "The Times They Are A-Changin'." Indeed, we're facing some possible changes to Medicare Advantage that could impact us all. It’s important to stay informed and prepared as we navigate these shifts. By understanding what's on the horizon, we can continue to provide the best service and advice to our clients. But amidst all these changes, there’s one thing that remains steadfast and reliable: Hospital Indemnity! It’s the perfect complement to any Medicare plan, offering additional peace of mind and financial protection. Hospital Indemnity is a true constant in an ever-evolving landscape, and it continues to be a "win-win" for both agents and clients. Now is the time to leverage the stability of Hospital Indemnity to make a real difference. By educating our clients on its benefits, we not only enhance their coverage but also reinforce our role as trusted advisors. This product bridges the gap between Medicare Advantage and Supplement plans, ensuring comprehensive protection for our clients. Let’s embrace the opportunity to make a positive impact. Get out there, share your knowledge, and start selling! Every conversation you have is a chance to make someone’s life a little easier and a lot more secure. Together, we can navigate these changes and come out stronger on the other side. Remember, success is not just about numbers; it’s about the lives we touch and the peace of mind we provide. So, let's all be winners! Stay positive, stay motivated, and let’s make a difference in the lives of our clients. #Medicare #Motivation #StayPositive #ClientCare

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Did you know that over half of all eligible Medicare beneficiaries are now enrolled in Medicare Advantage, and between 2018 and 2022 total MA-EGWP enrollment increased by nearly 27%? As health care costs continue to climb, public sector purchasers increasingly turn to MA-EGWPs to maintain or enhance coverage while reducing immediate costs and long term liabilities. Read more https://lnkd.in/dibKkCgA from the National Policy Institute for Public Employee Health Care Policy's Report underscoring the significant role MA-EGWPs play in retiree benefits.

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Did you know 93% of care providers recommend digital health tools to elevate the quality of care? Learn how to leverage digital innovation within the employee benefits you offer. Read our white paper to learn more. #HR #digitalhealth #employeebenefits https://ow.ly/LitU30sEAif

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New #Primarylit alert- https://lnkd.in/gSV9Rzpj Data from this study has been previously shared but now we have the full report. Patients don't continue on GLP-1s. It does vary by agent, but even at the top end, the persistence did not reach 50% at one year. In order to appreciate the impact of GLP-1 in obesity, they have to be continued as a maintenance medication or weight rebounds. Employers who cover for weight loss struggle to absorb the cost as is. With this, 50% of that cost, at least, might be waste? #GLP1 #Pharmacists #Pharmacybenefits #research

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CorVel: where compassion meets innovation. Delve into our insightful white paper to discover how a patient-centered approach to claims management can help streamline your processes and improve outcomes. #ClaimsManagement

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