Moves Toward Better Health Care Price Transparency


Beginning in May 2018, the Trump administration began searching for ways to curb out-of-control prescription drug costs—referring to the initiative as American Patients First. This effort is finally seeing some traction, with the administration issuing regulations aimed at improving health care pricing transparency in May 2019.

Drug Pricing Transparency
Drug companies will now be “required to disclose to patients the list price for prescription drugs in TV ads,” according to the Department of Health and Human Services (HHS).

More specifically, the rule requires prescriptions covered by Medicare or Medicaid that cost $35 or more per month for a typical course of therapy to be disclosed. Drugs under that threshold are unaffected.

HHS points out that the 10 most commonly advertised drugs range in price from several hundred to several thousands of dollars for a typical month of treatment.

This rule will take effect July 9, 2019. Employers should prepare for increased employee questions regarding drug costs.

President Trump’s Plan to Combat Surprise Medical Billing
On May 9, 2019, President Donald Trump delivered a speech criticizing the practice of surprise medical billing. He announced a general plan of attack and hinted at a few specifics for curbing the trend. Here are the four main regulatory aspects called out by the president, suggesting that they might be tackled first:

  1. In emergency situations, patients shouldn’t have to “bear the burden” of out-of-network costs.
  2. Balanced billing should be prohibited for emergency care.
  3. For scheduled non-emergency care, patients should receive an “honest” bill up front—including an itemized list of out-of-pocket expenses the patient must cover.
  4. Patients should not receive a surprise bill from out-of-network providers they did not choose themselves.

Lower Health Care Costs Act
Just a few weeks after the president’s speech on combatting surprise medical billing, the Senate Health Committee proposed a bipartisan bill called the Lower Health Care Costs Act.

The Lower Health Care Costs Act has five main components, including:

  1. Addressing surprise medical bills
  2. Lowering the cost of prescription drugs
  3. Improving transparency
  4. Improving public health
  5. Improving the exchange of health information

The Senate Health Committee Chairman Sen. Lamar Alexander said that “Republicans and Democrats in the United States Senate have announced this proposal of nearly three dozen specific bipartisan provisions that will reduce the cost of what Americans pay for health care. These are common sense steps we can take, and every single one of them has the objective of reducing the health care costs that you pay for out of your own pocket.”

The proposed legislation also includes a provision that would require benefits brokers to disclose their fees and any incentives they may receive from insurers. This provision would create a new level of transparency between employers and their benefits brokers, as many employers aren’t aware of the inner workings of health plan agreements or renewals.

What’s Next?
The Lower Health Care Costs Act is just proposed legislation at the moment, meaning that there are no compliance obligations to meet. However, Sen. Lamar Alexander, bill co-sponsor, hopes that the bill will be on the Senate floor for a vote by July of this year.


Consociate Health Expands Community Focused Healthcare Model in the Midwest


New Chief Business Development Officer Ziad Rubaie brings proven track record in building strategic partnerships to drive results for clients

DECATUR, IL – Illinois-based Third-Party Administrator (TPA) Consociate Health has developed a reputation for building strategic partnerships that deliver innovative solutions to its clients in today’s complex healthcare landscape. Today, the company announced an aggressive team expansion to deliver healthcare administrative services and high-performance network development throughout the US.

Existing partnerships with nearly 20 healthcare systems have allowed Consociate to perfect its community centric model using data integration strategies and data driven decision support resources. That success and the need for more patient-centered service from TPAs industry-wide, led to a decision to expand.

Spearheading these efforts will be Ziad Rubaie, a respected sales and marketing leader in the Healthcare industry with more than 24 years of experience leveraging an impressive network of healthcare consultants to build strategic partnerships.  Ziad comes to Consociate after a 9-year successful tenure at CastiaRx, formerly known as LDI, where he established and delivered nationwide pharmacy solutions that exceeded industry results. He also developed unique value propositions that positively impacted PBM services and overall business development opportunities.

also served as Executive Vice President of Sales and Marketing for Essex Dental & Vision Benefits, a subsidiary of Delta Dental of Missouri. During his tenure, he oversaw a greater than 318 percent growth in revenue for Essex.  Rubaie started his healthcare career in 1995 with many roles including Assistant Vice President of Sales Healthscope Benefits.

“Consociate is always looking for talent that advances our culture of innovation and growth and we continue to recruit leadership that have track records of delivering proven solutions.  Ziad’s expertise in bringing together strategic healthcare partnerships that drive solutions for clients and their members is highly respected in the industry and we are excited to welcome him to our team,” said Consociate President Darren Reynolds.

For more than 40 years Consociate Health has partnered with employers of all sizes to deliver employee benefit program consulting and administrative services. As a Third-Party Administrator (TPA), Consociate has built a reputation for exceptional accuracy, customer service and a focus on helping employers with innovative cost containment solutions.

Through data analytics, Consociate provides its clients with personalized analysis of their plans to ensure they have quality data and are using that data to make educated decisions.

Essential data analytics allow Consociate Health to integrate claims, eligibility, financial and other healthcare data into a consolidated system database; analyze member health and then identify cost drivers; monitor health plan utilization; and forecast employer healthcare costs which allows them to develop a strategy to manage and control healthcare costs for employers and members.

Earlier this month, Consociate was recognized on a national stage for excellence in data accuracy, using key analytics to transform the customer experience. The Illinois based company received the Commitment to World-Class Data award at the 4th Annual Benefit Focus Celebrate Community Awards, recognizing companies that have transformed the benefits experience for their employees and consumers, empowering them to make the best decision for their personal needs.


Consociate Health Wins National Commitment to World-Class Data Award


As reported on Nashville Medical News, Yahoo! Finance, Daily Herald, WSIL, Virtual Strategy Magazine, and CISION PRWeb

Benefitfocus awards Consociate Health industry-wide recognition for transforming the benefits experience for their customers through data accuracy

DECATUR, IL – Illinois-based Third-Party Administrator (TPA) Consociate Health has been recognized on a national stage for excellence in data accuracy, using key analytics to transform the care management experience. Consociate Health received the Commitment to World-Class Data award, from Benefitfocus, at their 4th Annual “Celebrate Community” Awards. Consociate Health was selected among a strong pool of finalists including TPA national industry leaders like Capital District Physicians’ Health Plan, The Hartford, MetLife, and Nova Healthcare Administrators.

“This award displays Consociate Health’s commitment to deliver data that impacts the efficiency of care management decisions, improves outcomes and lowers health plan costs for our clients”, said Consociate Health’s President, Darren Reynolds. “This meaningful health plan data, the efforts of our team and our partnership with Benefitfocus, allows us to manage health care costs for employers as well as enable health care systems to make the strongest possible recommendations related to treatment of chronic conditions.

Through data analytics, Consociate Health provides its clients and/or their consultants with personalized analysis of their health plans to ensure the use of quality data in making educated decisions. Essential data analytics allows Consociate Health to integrate claims, eligibility, financial and other healthcare data into a consolidated system database; analyze member health and then identify cost drivers; monitor health plan utilization; and forecast employer healthcare costs which allows them to develop a strategy to manage and control healthcare costs for employers and members.

“We believe in order to truly perform a valuable service to our clients and their plan members, we need to be more than just a claims processor. We pay claims, and we pay them accurately, but it’s what we do with the claims data that sets us apart,” Client Relations Consultant Sarah Bigger said. “World-class data, delivered via the Benefitfocus platform, gives us the necessary information to help an employer manage their healthcare budget and improve the health and productivity of their employees.”

Consociate Health has been an innovator in integrating population health analytics with health care systems for the management of their employee populations. Today, they integrate data and tools into health care systems’ Accountable Care Organizations (ACO’s), Clinically Integrated Networks, wellness programs and direct to employer initiatives. The deployment and integration of data and these support tools in improving the health of the communities they serve was a key factor in earning this award.


IRS Announces HSA Limits for 2019


On May 10, 2018, the IRS released Revenue Procedure 2018-30 to announce the inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2019. These limits include:

  • The maximum HSA contribution limit;
  • The minimum deductible amount for HDHPs; and
  • The maximum out-of-pocket expense limit for HDHPs.

These limits vary based on whether an individual has self-only or family coverage under an HDHP.

The IRS limits for HSA contributions will increase for 2019. The HDHP maximum out-of-pocket limits will also increase for 2019. The HSA contribution limits will increase effective Jan. 1, 2019, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2019.


IRS Updates Employer Guide for 2018 Tax Changes to Fringe Benefits


The IRS recently released the 2018 version of Publication 15-B—Employer’s Tax Guide to Fringe Benefits, which contains information for employers on the tax treatment of fringe benefits. The 2018 version is significant because it incorporates the changes made by the new tax law—the Tax Cuts and Jobs Act—to the following fringe benefits:

  • Qualified transportation plans
  • Moving expense reimbursements
  • Employer-provided meals
  • Employee achievement awards

Employers that offer fringe benefits should review the 2018 version of Publication 15-B and work with their tax advisors to implement the tax changes.


IRS Announces Second Change to HSA Family Contribution Limit


Earlier this year, a tax law change for 2018 reduced the health savings account (HSA) contribution limit for individuals with family high deductible health plan (HDHP) coverage from $6,900 to $6,850. On April 26, 2018, the IRS announced that, for 2018, taxpayers with family HDHP coverage may treat $6,900 as the annual contribution limit to their HSAs.

Why was the limit changed again?

After the IRS reduced the HSA limit for individuals with family HDHP coverage, it received feedback from various stakeholders, including employers, that the change would be disruptive and costly to implement. For example, some individuals with family HDHP coverage made the full $6,900 HSA contribution before the limit was reduced, and many other individuals made annual salary reduction elections for HSA contributions through their employers’ cafeteria plans based on the $6,900 limit.

In response to these concerns and others, the IRS issued Revenue Procedure 2018-27, which allows taxpayers with family HDHP coverage to use the original $6,900 HSA contribution limit for 2018.