How to Help Employees Beat Medical Debt and Financial Stress

2 min

Everyone struggles with finances occasionally, but those with medical debt bear a heavier burden than most. KFF, an independent source for health policy research, reports that “People with medical debt are much more likely than those without such debt to show other signs of financial vulnerability.”

This often takes the form of carrying high credit card balances and having no extra cash on hand to meet unexpected expenses.

The financial worries from “just getting by” create considerable stress and potential mental health issues that can impact both personal and professional responsibilities. To meet current financial obligations, the study found that those with medical debt are more likely to seek short-term funds from costly sources such as payday loans and pawn shops. Individuals also risk future insolvency by withdrawing needed funds from retirement accounts.

Delaying Treatment: Strategy or Tragedy?

Many individuals attempt to stabilize medical expenses by delaying or forgoing needed care, sometimes with life-threatening implications.

Yet another study reveals that:

“Forty percent of Americans admit they have delayed care due to costs, while one in six say their work has suffered due to a health issue they couldn’t afford to address.“

Impact on Job Performance

There is a clear connection between an employee’s mental health and their job performance. Although this finding reflects the perspectives of younger employees, it no doubt applies to all generations experiencing financial insecurity:

“More than 30% of Gen Z and millennials say their personal financial worries have been a distraction at work. More financial education can help workers address their financial challenges, reduce stress and improve focus and productivity.”

Employers can reduce medical financial stressors that negatively affect job and business performance and improve employee satisfaction and retention. By passing along the significant savings that a modern health plan can deliver, plan sponsors can provide better benefits and lower out-of-pocket costs for employees and their families. This includes low or no-cost plan features including surgeries, prescription drugs, and mental health telemedicine.

The Devil You Know: Why Do Employers Accept Legacy Health Plan Risks?

2 min

Employers admit that legacy insurance carriers deliver poor service and do nothing to control escalating healthcare costs. Yet they stick with the status quo, insisting that changing plans is too hard for employees. Paradoxically, this inertia carries high costs and multiple risks for plan members.

Financial distress is one of the most negative results of staying with an underperforming employee health plan. Year after year, such plans impact employee finances by reducing benefits and redirecting their wealth into ever-higher payroll contributions, deductibles, and out-of-pocket expenses.

Studies show that shifting rising healthcare costs onto employees has outpaced wage and cost-of-living increases, effectively reducing or stagnating wages and increasing income disparities. Forward-looking employers know that by making health benefits more affordable, they can improve employee satisfaction and financial security and stay competitive in a tight labor market.

Members are further harmed when legacy health plans routinely deny claims and limit patient access to network-gated providers, services, and procedures. As a result, employees are exposed to (and often liable for) high-cost, out-of-network claims that can be financially devastating.

Consider this $97,000 surprise bill for transporting an infant from a local ER to a regional hospital for life-saving treatment. Although doctors determined the transfer was the child’s best chance for survival, using the air ambulance was deemed “not medically necessary.” Coverage and multiple appeals were denied, and resolution is still outstanding.

Plan sponsors should consider how situations like this can negatively affect employees and take decisive steps to reduce the spiraling costs and uncovered claims inherent in legacy insurance plans. Perceived challenges in moving to a new and modern health plan are often overblown, especially when the change results in better benefits, lower costs, and less financial risk.

Employees are not as fragile and incapable of adapting to change as employers make them out to be. Using employees as human shields to excuse the status quo increases employee harm and risk and exposes employer plan sponsor fiduciaries to liability.

Like it or not, employers are in the business of healthcare. As with other business improvements, successful leaders advocate for change and have confidence that their employees will recognize and embrace the benefits of a member-focused health plan.

Stampede for New Weight Loss Drugs Can Bankrupt Your Health Plan

3 min

A comprehensive, member-focused prescription drug plan provides access to the most clinically effective medications at the lowest net cost. How can employers meet demands for costly semaglutide and other heavily-promoted GLP-1 drugs while balancing fiduciary responsibilities and member health?

The key is staying current on unbiased medical research before expanding a prescription drug plan formulary to include the growing number of diabetes and weight loss medications in this wildly popular new class of drugs.

Sixty percent of health systems surveyed want more “real world results” on a drug’s efficacy from sources other than pharmaceutical manufacturers. Employers should expect the same.

Long-Term Results Are Inconclusive

Emerging results are mixed, at best. What we know so far is that these drugs are too costly for most plans and patients, are over-prescribed based on consumer demand, and often do not live up to their promises. Employers should consider just how revolutionary these drugs are before moving forward.

  • Weight loss varies by individual. Some lose a great deal of weight; others lose less or none at all. It’s also important to note that GLP-1 drugs do not work alone. Their effectiveness requires a concurrent commitment to exercising and eating healthy foods in smaller portions.
  • GLP-1 inhibitors do not reverse diabetes. They simply manage it, just like many safer and less expensive medications. Long-term remission can only be achieved through weight loss and permanent lifestyle and dietary changes. While Ozempic can help with weight loss, this two-pronged approach is essential for reversing diabetes.
  • Patients routinely experience serious side effects… from “Ozempic face” and persistent gastrointestinal problems to headache, fatigue, and retinopathy. A large study revealed that nearly 17% of patients taking semaglutide, the active ingredient in Ozempic and Wegovy, discontinued the medication because of side effects. Patients need to evaluate the long-term impact of these side effects on their overall health.
  • To maintain weight loss and mitigate (but not reverse) diabetes, GLP-1 medications require “lifelong use to maintain their effectiveness” while prolonging their side effects. Stopping drug therapy reverses many benefits that may have been realized and sometimes exacerbates the original condition.
  • These drugs are being used to treat a growing number of “off-label” conditions, including substance abuse disorders and cardiac health. Although results are promising, more research into long-term safety and effectiveness is needed before GLP-1s are widely prescribed for these conditions.
How Employers Can Support Member Health

Continued peer-reviewed research into this new class of drugs is needed to determine long-term cost effectiveness, side effects, and safety. Until then, proven alternatives to GLP-1s are and have been readily available to support members’ health and weight loss needs.

  • The “original” weight loss medications, which have been in use for the last 10-20 years, continue to be a viable alternative for many patients. These widely available drugs produce, on average, half the weight loss at less than 1/30th the price.
  • Bariatric surgery has significantly fewer side effects and superior long-term results for both weight loss and diabetes remission. Bariatric surgeon, Dr. Mir Ali, says that for those who meet the criteria, bariatric surgery “has the highest success rate for weight loss and long-term remission of many medical conditions.”
  • Endoscopic sleeve gastroplasty (ESG) is a one-day procedure that works well for almost everyone. Over a 5-year period, ESG sustained greater weight loss than semaglutide at a significantly lower cost ($33,583 less).

Employers should be offering modern health and prescription drug plans that include appropriate exclusions and authorization triage protocols to control cost and ensure that these medications, if used, are for the right patient, for the right reason, for the correct intended outcome, and at the right cost.

Survey Says… Employees Want Lower Health Plan Costs and Better Benefits

2 min

Americans have long struggled with a dysfunctional healthcare industry and legacy insurance plans that cost too much and don’t deliver. Instead of focusing on what’s wrong with the status quo, a recent study asked employees to prioritize what future health plans should offer.

Source | BuzzRx Survey

Employers can (and should) align with the survey results when choosing an employee health plan by prioritizing:

  • Lower Costs
    Reducing insurance premiums, co-pays, and deductibles is a clear baseline. Equally important is for employers to provide built-in access to employee financial assistance and no-cost options for prescription drugs, common surgical procedures, and mental health care.
  • Expanded Services
    Remote telehealth services became essential during the pandemic. They have since been embraced by both patients and providers as a convenient and effective way to deliver high quality medical and therapeutic care. Every employee health plan should include them, ideally at no cost to the employee.
  • Less Complexity
    Who doesn’t need help navigating complex medical systems and bureaucratic digital paper trails? Employees deserve robust online tools and a dedicated support team to get the most from their health plan. This is especially important for Gen Z and other younger employees.

It’s no secret that robust health benefits, retirement plans, and other perks help attract and retain a talented and dedicated workforce. Conversely, the survey reveals that 1 in 6 respondents “dislike their job but stay for health benefits.” The corollary to this is that employees will leave for less costly, better health benefits. This means that employers should be proactive in prioritizing what current and potential employees want most in a health plan.

Employers and benefits advisors who really want to make a difference can choose a compassionate, member-focused health plan that saves up to 30% in health care costs, enhances benefits, and delivers an exceptional member experience.

Why Are Patients Being Billed for “Free” Preventive Health Care?

2 min

The 2010 Affordable Care Act (ACA) deemed certain types of preventive services to be “essential health benefits” that should be free. Yet this potentially lifesaving care often results in unexpected patient bills sent by what a BenefitsPRO article calls “America’s ever-creative medical billing juggernaut.”

The article highlights several instances of patients receiving surprise (and often illegal) invoices:

  • Additional bills of $1,000 for the radiologist’s reading fee and $236 for equipment and facility charges for “free” mammograms
  • A $450 bill to biopsy a polyp found during a “free” colonoscopy
  • A $111 “consultation” charge added to a no-cost preventive care visit because the patient responded positively to a question about “additional health concerns”

The medical establishment continues to erode the ACA’s guarantees of no-cost preventive care by exploiting gray areas of the law and redefining which aspects of a medical encounter it covers. When patients are blindsided by bills for care that should be free, it discourages them from seeking both preventive screenings and needed follow-up care, threatening their health and productivity in the workforce.

“The stories KFF Health News and NPR receive are likely just the tip of an iceberg. And while each bill might be relatively small compared with the stunning $10,000 hospital bills that have become all too familiar in the United States, the sorry consequences are manifold. Patients pay bills they do not owe, depriving them of cash they could use elsewhere. If they can’t pay, those bills might end up with debt-collection agencies and, ultimately, harm their credit score.”

Employers can combat these abuses with a modern health plan and exceptional concierge support from advocates who will defend members against such practices. This ensures members get all of the free preventive care they deserve without being charged for it, as well as help navigating a challenging healthcare system.

How Rising Health Care Costs Drive Wage Stagnation and Inequality

2 min

A comprehensive JAMA study analyzing 32 years of data suggests that health premiums for employer-sponsored health benefits have been rising faster than wages. These costs are often passed on to employees, further reducing or stagnating wages and increasing income disparities by race, ethnicity, and wage level.

According to JAMA, “Since the 1980s, real wages have increased among the highest earners but have been flat for most workers, leading to a widening earnings inequality. During the same period, the costs of employer-paid health care benefits have also increased substantially. As health economists demonstrate, it is generally accepted that increasing health care premiums result in lower wages for employees.”

Additionally, health care premiums as a percentage of compensation were significantly higher for Asian, Black, and Hispanic families than for White families.

The study also notes that “most employers do not adjust the health care premiums charged to workers by employee earnings; thus, the displacement of wages owing to increasing health care premiums could be particularly problematic for lower-wage workers and could be associated with earnings inequality.”

Improve Real Wages and Equity by Halting Healthcare Overspending

Instead of perpetuating this damaging dynamic, forward-thinking employers have the power to fix the healthcare cost drain on their employees’ wages. With a modern health plan that reduces overspending by 30% while improving member support, Vitori employers can use these substantial savings to lower health plan premiums and implement more equitable wage-banded premiums. They can also fund competitive benefit and business enhancements to attract and retain talent.

Looming Employer Litigation: Is J&J the Canary in the Coal Mine?

3 min

There is looming fiduciary litigation risk for employers who continue to passively patronize the legacy insurance and PBM industry with its long, public history of predatory practices. Johnson and Johnson leaders who were individually-named fiduciaries in a recent class action lawsuit can attest to this.

ERISA was designed to protect the interests of employee benefit plan participants by establishing standards of conduct, responsibility, and obligation for employer health plan fiduciaries. When mismanagement occurs, it empowers employees with “appropriate remedies, sanctions, and ready access to the Federal courts.”

Such empowerment is now playing out in a New Jersey federal court. On February 5, 2024, an explosive class action complaint was filed against Johnson and Johnson, its Pension & Benefits Committee, and individually named fiduciaries. It accuses Johnson and Johnson of breaching its fiduciary responsibilities by failing to negotiate lower prescription drug prices and burdening employees with millions of dollars in overpayments for generic drugs.

Manipulating Rx Drug Plans to Maximize Profit

As stated in the complaint, the federal Employee Retirement Income Security Act of 1974 (ERISA) requires employer health plan fiduciaries “to make a diligent and thorough comparison of alternative service providers in the marketplace, to seek the lowest level of costs for the services to be provided, and to continuously monitor plan expenses to ensure that they remain reasonable under the circumstances.”

The plaintiffs assert that Johnson and Johnson did not comply to the extent required by ERISA, and that the firm failed to engage in a prudent and reasoned decision-making process, specifically regarding prescription drug costs. According to the complaint,

“Defendants agreed to make the plans and their beneficiaries pay, on average, a markup of 498% above what it costs pharmacies to acquire those drugs…roughly 6 times as much as the PBM (or a PBM-owned pharmacy) paid for those very same drugs.”

The lawsuit exposes the predatory practices of traditional PBMs and how they conflict with ERISA’s goals and a fiduciary’s responsibilities: “No prudent fiduciary would agree to make its plan and beneficiaries pay a price that is two-hundred-and-fifty times higher than the price available to any individual who just walks into a pharmacy and pays out-of-pocket.”

What Role Do Brokers Play?

Organizations rely on brokers and Employee Benefit Consultants (EBCs) for key guidance in choosing plans that are wholly “for the exclusive benefit of participants in the plan.” It is an unfortunate truth, however, that some EBCs participate in these unethical PBM schemes for their own enrichment while purporting to act in the best interest of their clients.

EBCs are sometimes paid by PBMs in ways that incentivize them to act against the plan’s interest. For example, PBMs may promise a commission on every prescription if the EBC recommends the PBM to its clients.

Employer health plan fiduciaries cannot simply rely on the advice of third-party service providers, consultants, or experts, especially those who have conflicts of interest that may prevent them from providing advice solely for the benefit of the plan. While they can take their suggestions into account, fiduciaries must exercise independent, prudent, and impartial fiduciary judgment on all matters for which they receive advice from EBCs.

An Ethical Approach to Choosing a Health Plan

As demonstrated by the Johnson and Johnson lawsuit, plan participants may seek injunctive and equitable relief from fiduciaries who breach their responsibilities. Brokers and EBCs can take an active role in protecting their clients from legal action by offering principled solutions that avoid conflicts of interest and solely benefit plan participants.

“If Defendants had engaged in a prudent and reasoned decision-making process, they would have known of, and adopted, any of numerous options that…would have resulted in…cost savings for the plans and their beneficiaries. Implementing those available options would have saved the plans and their beneficiaries millions of dollars over the proposed class period.”

There is a multi-year pattern of legacy insurance carriers and PBMs failing to put the interests of employer plan sponsors and plan beneficiaries ahead of profits. Employer fiduciaries who continue to engage these underperforming entities when alternatives are clearly available do so at growing legal risk. Vitori Health eliminates this risk with member-first, industry-leading health plans that reduce overspending by up to 30%, transparent VitoriRx lowest net cost pharmacy administration, and a remarkable member experience.

Vitori Health Welcomes Art Hoath, IV as Chief Revenue Officer

< 1 minute

We are excited to announce that Art Hoath, IV has joined Vitori Health as Chief Revenue Officer. With his sustained focus on bringing value and innovation to employer health plan sponsors, Art is an excellent addition to the Vitori Health team and a strong advocate for Vitori’s mission to lower health plan costs and improve member support.

Art brings over 20 years of experience in the healthcare and self-funded employer health plan arena. He has successfully led high-powered sales teams and helped launch and grow innovative solutions for leading healthcare cost containment companies.

Art looks forward to promoting Vitori’s modern health plan and Vitori Vantage, the industry’s first 3-year level funded product, which deliver unmatched cost control and a remarkable member experience over outdated insurance plans.

“I joined the Vitori Health team because of their compassionate and impactful approach to solving the real healthcare needs of employers and their people,” says Art. “The continued success of Vitori’s innovative health plans gives our broker partners a winning hand to drive better outcomes for their clients and grow new business.”

Tim O’Brien, Vitori Health CEO, says, “I have every confidence that Art’s sales leadership will further accelerate our continued, rapid growth. Art’s solid industry experience will enhance our existing broker relationships and help us build new business partnerships.”

No Raises in 2024? Find Money to Stay Competitive and Keep Employees Happy

< 1 minute

Economic factors are turning 2024 into a potentially rough year financially for employees. Healthcare costs are expected to rise and employers are planning to scale back on raises and promotions, with many not even planning on a cost-of-living increase.

This double whammy will effectively reduce employee net compensation and disposable income. Despite the downside for retention, many employers seem willing to take this risk. Key findings of a recent survey of 600 business leaders revealed:

  • 26% of companies will not or may not give raises next year
  • Half of companies giving raises say less than half of employees will receive one
  • 52% of business leaders anticipate layoffs in 2024

Employers need to do everything possible to ensure their compensation and benefits packages remain competitive. Offering a member-first health plan from Vitori Health is a smart strategy for achieving cost control and employee retention goals.

  • Vitori Vantage, the industry’s first 3-year level premium health plan, eliminates the unpredictability of rising annual healthcare expenses. Vantage stabilizes cash flow and helps employers budget for strategic workforce investments.

Employers tethered to legacy insurance carriers with uncontrolled healthcare costs are giving up competitive advantage with fewer options for improving employee pay and benefits. It’s time to take a modern approach to employer sponsored healthcare that boosts employee satisfaction while successfully reducing plan costs.

How to Beat Fully-Insured Employer Health Plans That Deny Care

< 1 minute

It is abundantly clear that employers need to break free from fully-insured health plans with legacy insurance carriers. Premiums spiral higher with every renewal, and employees and their families are increasingly exposed to devastating denials of care and coverage… all in the pursuit of greater profit.

Despite laws to the contrary, insurers create the illusion of coverage while finding loopholes to avoid providing actual care. In its series on how the insurance industry routinely denies coverage to patients, ProPublica exposes the system’s inner workings and how it harms the people it purports to help.

For one patient, denial of cancer care had tragic results that sadly, could happen to any employee covered by a traditional, fully-insured health plan. The good news is that employers can break free from this profit-driven corruption by moving to a self-funded or 3-year level-funded health plan from Vitori Health.

Vitori removes the risk of legacy plans that cede all power to the insurance company by providing greater control over coverage and care. It also offers upwards of 30% in savings and includes low and no-cost care options to covered members.

Employers can provide real health care coverage to their valued employees.

$2,885 Average Savings Per Employee with NO Cost Shifting | Estimate Your Savings

X