| 5/1/2010

Getting a Handle on Costs

Mail-order pharmacies often cost employers much more for generic drugs than retail pharmacies, says Dan Ross.

After 20 years in the employee benefits industry, including 17 years at Cigna, Dan Ross is using his expertise to help private companies and other large employers find ways to trim their healthcare expenses.

Consider, he says, prescription drug coverage. Most employers assume that retail pharmacies cost significantly more than mail-order pharmacies, but thanks to hidden fees and other costs imposed by pharmacy benefit managers (PBMs), the mail-order prescriptions often cost employers significantly more for generic drugs than they’d pay using a community pharmacy. “There’s no reason you should let an insurance company handle your prescription drug benefit because they mark up the drugs like you wouldn’t believe. You can figure an extra $10 to $15 per employee, per month,” says Ross, CEO and founder of MedVision, a Tampa-based consulting company that helps self-insured companies get more bang for their healthcare dollar.

Dan Ross, CEO of MedVision, helps self-insured companies save on healthcare expenses.

Ross recommends that clients farm out some options like prescription drug benefits to providers other than insurance companies. Ross also gets his clients to focus on preventive healthcare and managing chronic disease, which he notes is the No. 1 driver of healthcare costs. MedVision has also partnered with companies like North Carolina-based Biologics, which provides strategies to elevate cancer care while lowering cancer costs — a key considering that cancer can absorb 15% to 25% of an employer’s annual healthcare budget.

In the year since Manatee County schools hired MedVision, ER visits are down 70%, breast cancer claims and expenses are down 20%, back pain claims are down 20% and preventive office visits are up 66%. Other clients include the Archdiocese of Miami, Sarasota County government and Moffitt Cancer Center.

— Amy Keller

Multicultural Marketing

United-Healthcare’s PlanBien targets the more than one-third of Hispanics who don’t have insurance.

Of all major racial/ethnic groups, Latinos have the lowest rates of health insurance coverage; more than one-third of Hispanics in the U.S. are uninsured. To bridge that gap, UnitedHealthcare recently rolled out PlanBien in south Florida and other heavily Latino parts of the country, including Arizona and Colorado. The plan provides bilingual online provider directories that list physician offices with Spanish-speaking doctors and staff, Spanish-speaking customer service representatives who can help participants locate Spanish-speaking doctors, and specialized educational materials in Spanish.

The company has created similar products for other ethnic groups. UnitedHealthcare’s “Generations of Wellness” initiative offers African-American members an online directory of African-American doctors, health tip fliers about conditions that disproportionately affect African-Americans, such as high blood pressure, high cholesterol, diabetes and obesity, and an online wellness center with exercise suggestions and healthy recipes.

— Amy Keller

Tags: Healthcare