| < 1 min
A new WTW medical trends survey projects healthcare costs will rise over 10% in 2025. That’s an increase of over 9% from last year plus back-to-back increases of 7% or more in previous years. This whopping five-year cumulative cost drain of 47% exceeds all other business expense increases.
| December 18, 2024
| 3 min
Employer health plan sponsors who stay with outdated, status quo insurance carriers perpetuate practices that benefit the insurer instead of the insured. Author-surgeon Dr. Marty Makary asserts that health plan freedom only comes into reach when employers abandon the chronic condition of “groupthink.”
| December 6, 2024
| 2 min
Employers are wise to routinely seek the right combination of employee benefits to attract, engage, and retain top talent—all while staying within budget. Although outside forces may try to influence these decisions, the best way to create a winning benefits package is to engage directly with employees.
| August 4, 2024
| < 1 min
An American Psychiatric Association (APA) survey reveals that 43% of American adults feel anxious in 2024 — up from 37% in 2023 and 32% in 2022. The primary driver is the economy (77%), which creates financial stress and insecurity that can affect employee productivity.
| July 18, 2024
| < 1 min
Consumers are spending hundreds of dollars on self-administered tests that claim to quantify their cellular health and biological age. While doctors are cautious about the value of such tests, it’s important to acknowledge the underlying desire to improve one’s health based on the results.
| July 2, 2024
| < 1 min
Legacy insurance companies allege that their fully insured employee health plans shield employers from undue risk. But this illusory “protection” includes excess insurance expense, no cost-control mechanisms, no transparency into claims data, and denials of coverage.
| June 21, 2024
| 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.”
| May 21, 2024
| 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.
| May 10, 2024
| 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?
| May 2, 2024
| 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.
| April 18, 2024
| 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.”
| April 10, 2024
| 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.
| April 5, 2024
| 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.
| February 19, 2024
| < 1 min
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.
| January 23, 2024
| < 1 min
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.
| December 27, 2023
| 2 min
In the latest whitewashing of our ever-more costly healthcare system, hotel-like hospitals with “therapeutic art collections” and haute cuisine are touted as “better for healing.” The notion that “sickness is a journey” is often taken at facilities that invest more in luxury amenities than clinical quality.
| December 6, 2023
| < 1 min
The results from the Commonwealth Fund 2023 Health Care Affordability Survey are grim. American consumers continue to struggle with unsustainably high costs and inadequate coverage. Unsurprisingly, nearly 40% forgo or delay needed care and don’t fill prescriptions to avoid risking financial ruin.
| October 30, 2023
| 1 min
Vitori Health is thrilled to announce its acquisition of Flume Health’s third-party administrator (TPA) operations. This strategic purchase complements Vitori’s significant growth and adds talented new team members, further enabling it to deliver industry-leading health plans and remarkable member services.
| October 11, 2023
| 2 min
Vitori Health, a national precision-built health plan solution that provides a high-performing alternative for mid-market employers and their employees, announced today its Vitori Vantage product, an industry first 36-Month Level Premium Plan.
| September 6, 2023
| < 1 min
When the HIPAA Privacy Rule was enacted in 1996, its intent was to protect personal medical records and health information. This goal has since been weaponized by legacy health insurance carriers who withhold data from fully-insured plan sponsors to obscure their justification for higher premiums.
| May 7, 2023
| < 1 min
Medicare patients cheered when the Inflation Reduction Act capped monthly insulin costs at $35. Then drug manufacturers controlling 90% of the market set this $35 cap for everyone by bypassing the PBM middlemen. To protect their black box of profits, insiders expect PBMs to raise employer premiums.
| April 28, 2023
| 2 min
Healthcare costs are spiking to record levels and burdening the nation’s employers. Significant portions of premium dollars pay for inpatient hospital services, with employers paying 200% or more of Medicare prices. “Plan sponsors as plan fiduciaries have to take action. They can’t just stand for it.”
| April 13, 2023
| 2 min
Medical directors adjudicating claims are supposed to examine patient records, review coverage policies, and use their expertise to approve or deny claims. But at Cigna, they spend only 1.2 seconds on each case and instantly reject millions of claims without even opening the file.
| April 4, 2023
| 3 min
High-deductible health plans (HDHPs) shift cost to employees and families, often with distressing health and financial impacts. HDHPs were introduced years ago by the legacy insurance carriers as a way to deflect responsibility for rising healthcare costs away from themselves.
| March 28, 2023
| 2 min
Mary B. skipped appointments and delayed chemotherapy when her cancer returned. Steven L. reduces refills by taking his thyroid medication every other day instead of daily. Others cancel needed care because they can’t afford time off from work and the additional costs of childcare and transportation.
| March 21, 2023
| 2 min
Hospital and health system mergers have become rampant and are typically announced with glowing press releases promising greater access to better and more affordable health care. However, research into the results of consolidation exposes outcomes that run counter to these promises.
| March 14, 2023
| 3 min
Corporate boards have historically relegated employee and workforce concerns to management. In 2020, COVID-19’s dramatic impact on operations and employee health began changing that perspective in significant ways, leading to a more expansive approach to how boards fulfill their responsibilities.
| March 7, 2023
| 2 min
Pharmaceutical companies insist that outrageous prices drive the development of innovative medicines. And industry groups claim that Medicare pricing reform and the Inflation Reduction Act of 2022 will send innovation “light years back into the dark ages of biomedical research.” Don’t believe them.
| February 25, 2023
| 2 min
“In the mosaic floor of the opulent atrium of a house excavated at Pompeii is a slogan ironic for being buried under 16 feet of volcanic ash: Salve Lucrum, it reads, “Hail, Profit.” That mosaic would be a fitting decoration today in many of health care’s (corporate) atria.”
| February 18, 2023
| 2 min
The healthcare industry continues to feed its addiction to obscene profits instead of better, more affordable patient care. While Americans are bombarded with relentless direct-to-consumer advertising (DTCA) pushing dubious drugs to an unwary public, health plan sponsors can provide a much-needed antidote.
| February 8, 2023
| 3 min
Health Affairs has launched a timely analysis of physician, hospital, and other health care provider prices in private-sector markets and their impact on overall spending. We applaud this pursuit of definitive answers but until such truths are revealed, employers won’t have any cost relief any time soon.
| January 31, 2023
| 3 min
As healthcare costs continue to rise, many employer health plan sponsors struggle to cover their employees without breaking the bank. Unfortunately, many keep returning to the same old solutions: a monopoly of legacy insurance carriers with high-priced plans and suboptimal benefits and member support.
| January 26, 2023
| < 1 min
From stagnant wages to crushing medical expenses, employee net income has plummeted, preventing American workers from saving adequately for retirement. Pending legislation seeks to alleviate this crisis while a growing number of employers are boosting retirement benefits by reducing health care costs.
| December 29, 2022
| 2 min
From targeting the Affordable Care Act to clamoring for COVID relief funds, annual federal healthcare lobbying expenditures have risen a staggering 70%. Nearly $714 million has been spent influencing legislation to favor the industry and maintain obscene profits. Who’s spending all this money?
| December 17, 2022
| 2 min
Multiple studies affirm that millions of Americans are underinsured or completely uninsured. These grim results include the 54% of the population covered by employer health plans. While outrageous healthcare and premium costs are part of the problem, it’s clear employers need to step up and do better.
| December 10, 2022
| < 1 min
In the ongoing battle for talent acquisition and retention, 2 in 3 employers plan to expand their employee benefits program in the next 12-18 months. Yet 8 in 10 say out-of-control health care costs impede their ability to stay competitive. Is it really possible to compete without overspending? Absolutely!
| November 30, 2022
| 2 min
A study published in the journal Radiology confirms what we already know — that there’s no rational explanation for wildly divergent costs for the same test at the same hospital or even between hospitals. And with every negotiation, it appears that hospitals hold the winning hand.
| November 23, 2022
| 2 min
The Inflation Reduction Act is a great first step toward lowering prescription drug prices and out-of-pocket expenses for Americans covered by Medicare. What’s unknown is how this will impact future Rx costs for members of employer-sponsored plans. How can employers cut costs now without reducing care?
| November 8, 2022
| 4 min
Vitori Health has been recognized as a Market-Shaping Enterprise (MSE) by Catalyst for Payment Reform (CPR). Independent and influential, CPR’s thought leaders empower health care purchasers to proactively improve today’s dysfunctional healthcare market. Vitori is proud to advance this mission.
| November 1, 2022
| 3 min
Paying healthcare claims should be transparent, less costly, and stress free but for many plan sponsors, it is anything but. Insurance company discounts off price-blind billing fuel rising costs, and referenced based pricing (RBP) antagonizes providers and members alike. A better approach is Fair Market Payment™ (FMP).
| October 26, 2022
| 2 min
America... the land of the free and the home of the world’s highest health care costs and lowest life expectancy. While you may be familiar with such global comparisons, you may be surprised by the wide disparities in health care quality, affordability, and access, between and even within our states.
| October 14, 2022
| 2 min
A new study shows that 71% of US employers expect moderate to significant increases in healthcare costs over the next three years, including a 6% rise in 2023. While the need to manage costs is clear, it's shocking that 1-in-4 employers plans to shift costs to employees through higher contributions.
| October 7, 2022
| 2 min
According to the National Institutes of Health, telehealth services have been around since the 1920s using the limited technologies of their time. A century later, virtual care has become commonplace thanks to the global pandemic... and it is here to stay, especially for mental health services.
| September 27, 2022
| 2 min
Saying things have “gone to the dogs” implies a worsened situation. However, a recent study by the Journal of the American Medical Association (JAMA) shows that dogs have a leg up and humans get the short end of the stick, paying more for commonly prescribed drugs used to treat both people and pets.
| September 22, 2022
| 3 min
Technology leaders and top executives from US hospitals and health systems met recently to focus on healthcare affordability and transforming the patient financial experience. Although many good ideas were generated, the definition and expectation of affordability clearly varies by stakeholder.
| September 9, 2022
| < 1 min
While patients grapple with runaway costs and the indignities of the U.S. healthcare system, the largest health insurance firms posted solid year-over-year earnings growth for the first half of 2022. In fact, experts don’t think they’ll struggle at all despite worrisome economic conditions.
| September 2, 2022
| 2 min
Consumers cheered when the Hospital Price Transparency rule took effect in January 2021, requiring that facilities publish their payer-specific negotiated rates for drugs and services. Despite the positive news, there remains a blatant lack of compliance that continues to keep patients in the dark.
| August 24, 2022
| 2 min
Americans spend about $500 billion a year on prescription drugs with no visibility into the processes that set prices or the comparative effectiveness of drugs approved for the same clinical purpose. This opaqueness makes it impossible to ensure that prices are aligned with the value a drug provides.
| August 19, 2022
| 2 min
The Health Rosetta is an innovative blueprint for high performance health plans that is transforming the benefits experience for employers and plan members. Vitori Health supports this mission and is proud to sponsor and attend the upcoming Health Rosetta Summit in Denver.
| August 10, 2022
| 2 min
The landmark No Surprises Act became effective January 1, 2022 to protect consumers from surprise medical bills from out-of-network providers and facilities. Greedy industry stakeholders are fighting to remove these long overdue protections. Is anyone surprised?
| August 2, 2022
| 2 min
Employers take great care to choose the best possible health plan for their members. But to get value from their plan, employees must understand common health insurance terms to make sound health care decisions. A recent study shows how a lack of literacy is resulting in confusion and higher costs.
| July 26, 2022
| < 1 min
Is laughter really the best medicine? Sadly, it is mightily needed to offset these tragic “health care” experiences. While it’s easy to shake our heads at the absurdity of the American healthcare system, it’s hard to laugh at its outrageous and often heartbreaking impact on patients.
| July 19, 2022
| 2 min
The war for talent has escalated thanks to “The Great Resignation,” a pandemic-driven trend in which employees are quitting their jobs in record numbers. While some change careers, most seek new positions that better align with their priorities, which include higher pay and better health benefits.
| June 16, 2022
| 2 min
Twenty years ago, nearly two-thirds of doctors were independent practitioners. Today, only one-quarter remain independent. This mass exodus is being driven by financial pressures, marketplace competition, and the politics of health care. Which begs the question: where have all the doctors gone?
| July 13, 2022
| 2 min
In a unanimous and bipartisan decision, the Federal Trade Commission (FTC) will investigate the secretive practices of six of the largest Pharmacy Benefit Managers (PBMs) in the country. Diverse stakeholders are hopeful this action will unravel years of corruption and reduce prescription drug prices.
| July 7, 2022
| < 1 min
In the third and fourth quarters, employee health plan brokers and advisors are busy closing new business and managing client renewals. This is a great time to offer next-generation plan designs that can significantly reduce expenses for employers and employees while improving overall benefits.
| July 6, 2022
| 3 min
A report by the PBM Accountability Project reveals the details of PBMs’ “evolving business models and revenue.” Despite the available financial data, the authors could not identify “the source of nearly 40% of PBMs’ total gross profit.” Can this “business as usual” become a catalyst for change?
| June 29, 2022
| < 1 min
A study published in JAMA Health Forum reveals that pre- and post-sale rebates from prescription drug manufacturers to commercial health plan sponsors are steadily increasing. Far from reducing out-of-pocket expenses for patients, this convoluted backroom strategy actually makes things worse.
| June 15, 2022
| < 1 min
Brand name inhaler manufacturers tinker with patents and use gimmicks the Food and Drug Administration (FDA) shouldn’t allow to thwart the availability of low-cost generic inhalers. And profits are so high that a tobacco manufacturer took over an asthma inhaler company to “diversity its portfolio.”
| June 7, 2022
| 2 min
In 2012, Emily Barker, a 19-year old student at the Art Institute of Chicago, fell four stories inside an improperly secured building. The accident led to paraplegia, a six-month hospital stay, countless operations, chronic pain, and a stack of bills and correspondence that inspired “Death by 7865 Paper Cuts.”
| May 10, 2022
| < 1 min
Despite new federal transparency rules, it’s hard to know what you’re paying for when medical claims and payments are automatically adjudicated. This lack of oversight creates countless opportunities for fraud, waste, and abuse, all of which increase costs for employers and plan participants.
| May 5, 2022
| < 1 min
Vitori Health actively supports industry associations whose missions align with our own. The National Association of Healthcare Underwriters, which seeks to ensure that all Americans have access to high quality, affordable health care, is one such organization.
| April 21, 2022
| 2 min
You know things are bad when a pharmaceutical executive calls out the dysfunctional and deceptive industry practices that trigger skyrocketing drug costs for prescription medicines. But if drug companies are not the culprit, as asserted by Adam Gluck, Head of US Corporate Affairs at Sanofi, who is?
| April 12, 2022
| < 1 min
Most would agree with the common adage that you get what you pay for, but that’s not the case when it comes to paying for healthcare in America. U.S. spending per capita is up to four times higher than other wealthy countries and yet shockingly, we have the absolute lowest life expectancy of them all.
| April 6, 2022
| 2 min
Medical debt is devastating the credit integrity of American consumers. The Consumer Financial Protection Bureau (CPFB) has taken steps to mitigate this doom loop and the three major credit reporting agencies are now taking action as well, no doubt in response to a greater focus on medical debt.
| March 30, 2022
| 2 min
It’s no secret that hospital charges are skyrocketing. What’s worse is that these charges are disproportionate to actual hospital costs and that patients are often on the hook for outrageous medical bills that can result in extraordinary collection actions (ECAs) against them.
| March 24, 2022
| 2 min
A report from the Consumer Financial Protection Bureau (CFPB) estimates that consumer credit reports include $88 billion in medical debt as of June 2021. The cause is a “complicated and burdensome” medical billing system that creates hard-to-fix errors that increase patient debt and reflect poorly on credit scores.
| March 8, 2022
| 2 min
The outdated health insurance system is feeling increasingly less safe and prudent for employer-sponsored health plans, making change more attractive and attainable. What’s behind this significant shift?
| March 3, 2022
| < 1 min
The U.S. Department of Justice (DOJ) and Federal Trade Commission (FTC) have done almost nothing over the past decades to protect market competitiveness and consumer interests in healthcare. Employers continue to grapple with ever-rising plan costs as members bear the brunt of fewer healthcare options at a higher cost.
| March 2, 2022
| 2 min
In the early days of COVID, America’s nurses were rightly celebrated as heroes. Many nurses had hoped that such long overdue recognition might lead to needed reforms, but that optimism seems to have faded. In fact, nurses are leaving hospitals in droves. Some are even abandoning the profession.
| February 3, 2022
| 2 min
Many school systems rely on property taxes for most of their budget. When a school district in Chester County, Pennsylvania challenged the charitable results of three nonprofit hospitals owned by Tower Health, they exposed the unethical practices that allow many nonprofit hospitals to beat the system. The school district won.
| January 26, 2022
| 2 min
A recent article posted to JAMA Network reveals how the dysfunctional interests of insurers, hospitals, pharmaceutical companies, and PBMs ultimately reduce quality of life for U.S. employees through financial distress induced by the health benefits market.
| January 20, 2022
| < 1 min
In 2008, a box of 30 prescription suppositories sold for less than $200. In 2021, the same box cost $10,000 — an outrageous increase of 4,900%. Is there any better example of how employer health plan sponsors and patients are getting shafted by a dysfunctional health care industry?
| January 13, 2022
| < 1 min
It's not always apparent that the ability to control costs is directly impacted by how an employee health plan is funded. From fully-funded to self-insured, choosing the right insurance model is key to optimizing reimbursement and maximizing value and savings.
| January 6, 2022
| < 1 min
How can an image be worth a thousand words when it leaves you speechless? How can anyone justify why trillions of dollars in doctor services, drugs, and medical care expenditures exceed the Consumer Price Index, with hospital services exceeding at a whopping 347%?
| December 8, 2021
| 2 min
As we approach two years of coping with COVID-19 and its latest variants, there is a burgeoning need for mental health services. The American Psychological Association (APA) describes it as a “health care tsunami” with 84% of psychologists reporting an increase in demand for anxiety treatment since the start of the pandemic.
| December 2, 2021
| < 1 min
2020 was a very good year for pharmaceutical manufacturers. According to an independent analysis by the Institute for Clinical and Economic Review (ICER), Americans spent an additional $1.67 billion on seven drugs whose price increases were not supported by new or improved clinical evidence. And this was after pharmaceutical rebates and other concessions!
| December 1, 2021
| 2 min
In an interview with Mergermarket, a leading provider of M&A data and intelligence, Tim O’Brien, CEO of Vitori Health, shared that he would consider acquisitions as part of the firm’s overall growth strategy.
| November 30, 2021
| 3 min
We are living in a time when leadership is at a premium. This is especially true as we adapt to a “new normal” in our personal and professional lives. In the healthcare arena, the premium on leadership is multiplied by several factors.
| November 21, 2021
| < 1 min
A woman in California received treatment for a broken foot at a reputable orthopedic facility. She was happy with their service until she looked at her bill: $809 for a plastic walking boot that costs about $80 on Amazon. She assumed it was a typo but after contacting the facility, she was shocked to learn the charge was correct.
| November 18, 2021
| 2 min
When evaluating a traditional employee health plan, employers and brokers typically focus on premiums, deductibles and co-pays, and the nuts and bolts of the plan’s coverage. Customer service is an afterthought. Historically, it has been enough that employees can call a toll-free number when they have questions.
| November 11, 2021
| < 1 min
Imagine you’ve been hired as the CFO of a well-known regional health system. You’re told during your interview that they’re looking for someone who can make difficult changes to address systemwide financial and accounting issues.
| November 9, 2021
| 2 min
Payment disputes between insurers and providers are nothing new. Even with their secret, self-serving network contract arrangements, these relationships have been perpetually uneasy.
| November 2, 2021
| 2 min
When your mission is to deliver a lower cost, better health plan that's unsurpassed in the industry, you need a Chief Executive Officer who not only shares that mission, but has the experience and entrepreneurial mindset to shake things up and blaze a unique path.
| October 26, 2021
Vitori Health has eliminated the excess costs and conflicts of interest in legacy health plans and upgraded what really matters – payment controls and the member experience.
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