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Benefits exec offers alternatives for lowering health care costs

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Looking for ways to reduce costs by figuring out how to apply the legal chaos of the Affordable Care Act to current benefit plans is one way of doing it — but there are easier ways to reduce costs for clinical visits, procedures and drugs.

Telemedicine, direct primary care and Medicaid migration are some of the best immediate cost-cutting methods, said Vaughan Reale, senior vice president of sales at BeneStream.

Many aspects of the health industry are going through major changes or are in flux and, as a result, some interesting niche markets have emerged.

Telemedicine is a cheap and easy alternative to a doctor’s visit and can cost as little as $6 per month, Reale explained at a health care event hosted by the New Jersey Business and Industry Association on Friday at Pines Manor in Edison.

“We are seeing a lot of employers (using) telemedicine because it not only reduces the cost, it reduces the frequency. It completely eliminates it, because it goes against your program. The claim doesn’t exist because I didn’t visit the urgent care center,” Reale said.

The remote care option, which began as a solution to rural care access and emergency care, has now become a new tool for physicians as well. Through phone calls, texts and video conferencing, patients can get a quick physician’s consult and even have medication prescribed — all without leaving the comfort of their home.

“You can buy these on a group contract or on an individual basis,” which means employees can opt to pull out of health savings plans and reallocate their funds to telemedicine or cheaper drug options,  Reale said.

Companies that offer telemedicine options include Teladoc, Health Tap, JeffConnect, UHC Ask A Nurse and DocOnCall 24/7. Additionally, a New Jersey-based startup, MedXCom, is in the business.

Another option is limited networks, which can be used to supplement the health insurance plan — especially those with higher deductibles. The limited networks, known as direct primary care, are a billing and payment arrangement between patients and providers, another way to avoid claims to insurance providers.

One recent example of this was Vanguard Medical Group, which offered various plans for less than $100 that would cover preventative care and certain tests — all aligning with the idea of value-based care versus the traditional fees per test or care visit.

Other providers of DPC are Med Lion, DPC Clinics and Forest Direct Primary Care, according to Reale.

One of the easiest ways to reduce costs for employees is bypassing purchase of drugs from insurance plans, and instead using legal websites such as goodrx.com, prescriptionsdrugs.com and myrxadvocate.com.

Medicaid migration is one of the newest methods of savings, which many employers still don’t know about, Reale said.

“(Employers) are consumed with health care reform and compliance, and I think we are the only company doing it. Another reason is employers cannot legally ask” the questions needed to determine if an employee qualifies for the new Medicare plans, he said.

As part of the ACA’s Medicaid expansion plan, 30 eligible states — including New Jersey — increased the income threshold for eligible enrollees.

As a result, many employers have eligible employees, but don’t realize it, Reale said.

“When you hear Medicaid, what’s the first thing you think about? Poor, below average (quality), minimal (plan designs). If we were talking seven years ago, I’d say I agree. Since the ACA, most employers have increased deductibles, and increased employee contributions, so what if I told you Medicaid has no deductibles? What if I told you Medicaid covers the entire family for free? What if I told you Medicaid covers vision and dental for the whole family?” Reale asked the audience.

Typically, this plan can benefit employers with a high number of employees who make less than $33,000 per year in industries like nursing homes, home health care, restaurants, social services, not-for-profits, security and property managers.

The low-cost insurance option from these employers is usually a limited network, and by transferring to Medicare, employees can have the same benefits for a much lower cost — zero.

One example Reale shared was at a manufacturing company that had 500 employees. A woman who was a single parent with a second child on the way was earning about $25,000 per year. She was paying $250 per month for health benefits and had a $1,350 deductible.

By moving to Medicaid, she saved the $250 per month and had a new plan with a $0 deductible and copays as low as $8, Reale said. That situation could apply to the whole of New Jersey.

Plus, employers in New Jersey who have employees in any of the 30 states can also migrate those employees to Medicaid.

“It’s all just math,” he said, of the options for reducing cost.

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Anjalee Khemlani

Anjalee Khemlani


Anjalee Khemlani covers health care. You can contact her at anjaleek@njbiz.com.

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