Last month we highlighted how both cost and utilization are increasing when it comes to prescription drugs. Much of the increase is due to the rise in specialty medications. This trend is national, across all industries, and continues to be of great concern. The rising costs of medications result in potential barriers for patients’ ability to afford and/or access the drugs they need to be as well as possible.Related to the surge in specialty medications—which often means patients receiving very expensive yet effective, life-altering biologic therapies—it’s helpful to know about the biosimilars that are emerging slowly on the market.Here is some background on this valuable drug product option, which you can expect to read more about in the coming months and years.Defining biosimilarsThe Public Health Safety Act defines biosimilarity to mean, “The biological product is highly similar to...

Healthcare experts, employers, and consumers alike recognize the significance prescription drugs have in today’s world. Thanks to clinical innovations in the pharmaceutical world, especially when it comes to specialty medications, more people can better manage their health conditions with new medications on the market. In recent years breakthroughs have had a positive impact on people living with chronic medical conditions such as diabetes and other complex medical conditions e.g., rheumatoid arthritis, Crohn’s disease, cancer, and Alzheimer’s disease.In the fall of 2021, a Kaiser Family Foundation tracking poll noted that six in 10 adults take at least one prescription, with a quarter of them taking four or more regularly. These prescriptions, while life-changing, also come at a cost—for both the employee and the employer. Since prescription drugs are such an integral part of healthc...

BY CYNTHIA MCGRATH | December 16, 2021Unstoppable healthcare costs are eating up resources that companies and governments could better use to advance other important priorities. Healthcare rate increases will jump around 5% in 2021, according to a recent SHRM article. Not only does this hamper employers’ abilities to focus on their missions, but it also impacts HR departments’ ability to attract and retain employees by their attractive compensation and wellness offerings.The go-to strategy of moving employees to high-deductible health plans has inadvertently created adverse financial and health consequences. The Mass Health Policy Commission reports that 46% of the state’s adults skipped needed healthcare in 2019 due to unaffordable out-of-pocket costs. The numbers were especially alarming for low-income and people of color, but even high-income people were not immune. A new study fro...

BY CYNTHIA MCGRATH | November 15, 2021Primary care practices, which are crucial in providing coordinated, efficient, and high-value care, were severely impacted by the pandemic. Primary Care Providers (PCPs) closed or limited their practices to ensure capacity for COVID-19 patients and patients stayed away to avoid potential exposure. Twenty to forty percent of the PCP practices surveyed in June 2020 by the Mass Health Policy Commission and Massachusetts Chapter of the American College of Physicians stated that they were considering consolidating, selling, or closing their practices.Underinvestment and a fee-for-service reimbursement arrangement that pays providers based on the number of services provided decimated PCP finances that no longer had a steady flow of income from in-person visits and tests. This method of paying PCPs is misaligned with the benefits of primary care:Total-pe...

BY CYNTHIA MCGRATH | October 21, 2021The Mental Health Crisis and Its Effects on Employees and EmployersThe pandemic has upended lives and led to increased rates of stress, anxiety, depression, and substance abuse. Seventy-six percent of U.S. employees surveyed report at least one symptom of a mental health condition in the past year according to Mind Share Partners’ 2021 Mental Health at Work Report. Centers for Disease Control and Prevention data suggests that the mental health of younger people and minorities has been especially impacted.Mental health affects employers’ ability to retain employees. Fifty percent of employees left their jobs for mental health reasons in 2020, including those caused by workplace factors like overwhelming and unsustainable work (Mind Share Partners’ report). These numbers are higher for younger workers, LGBTQ+, Black, and Latinx employees. Sixty-eight...

BY CYNTHIA MCGRATH | SEPTEMBER 14, 2021To borrow from actor John Krasinski, we can all use some good news – especially in healthcare. One of our member school employees has a story that makes us smile. Are you familiar with a mobile hospital, also known as a mobile ER department and mobile urgent care? We weren’t, but we’re excited to share “Susan’s” experience.Susan recently fell and suffered multiple fractures. She’s recovering well and has faithfully stuck to a strength and conditioning regimen to improve her mobility. While she was recuperating, she got an upper respiratory infection that required medical attention. Due to her lack of mobility, she couldn’t travel to the hospital without using an ambulance. Her doctor suggested using a mobile hospital service.With the Delta variant of COVID raging across the country, staying out of an emergency room - unless it’s critical - is pru...

BY CYNTHIA MCGRATH | UPDATED AUGUST 10, 2021Colleges and universities should require COVID-19 vaccines for all students who plan to attend in-person classes, according to an April 14 New York Times editorial. The authors posit that vaccine mandates are the fastest way to return to normalcy by achieving herd immunity – with 70 percent to 85 percent of the population having some form of immunity. Since certain vaccines are already required for school attendance, the COVID-19 vaccine shouldn’t be any different.However, the decision to mandate COVID-19 vaccines for employees and/or students isn’t straightforward. From a legal standpoint, requiring vaccines that are under emergency-use authorization is unclear. This could become a moot issue soon as public-health experts expect full U.S. Food and Drug Administration (FDA) authorization of the Moderna, Pfizer BioNTech, AstraZeneca, and Jans...

BY CYNTHIA MCGRATH | August 9, 2021Racial justice protests and the disproportionate impact of COVID-19 on communities of color have shone a light on the need for organizations to improve diversity, equity, and inclusion (DE&I). The higher education industry has taken a leading role in tackling these challenges by evaluating and implementing policies that seek to ensure that all residents – regardless of gender, race, ethnicity, gender identity, or sexual orientation – have the same opportunity to thrive. Recent New England Journal of Higher Education and Higher Education Today editorials have encouraged colleges and universities to act now to eradicate disparities and promote economic vitality.Numerous studies have shown that gender, race, and ethnicity have a marked influence on a person’s health. The systemic disparities in the health status of population groups have significant...

BY CYNTHIA MCGRATH | MARCH 18, 2021The U.S. is spending nearly 20% of its Gross Domestic Product on healthcare services, which crowds out other needed products and services. Most other countries limit spending by imposing tight budget constraints on spending. Why are healthcare cost rising so quickly? “I’ve heard excessive estimates that 20-30% of rising costs are due to waste,” said Stuart Altman, Ph.D., Sol C. Chaikin Professor of National Health Policy at The Heller School for Social Policy and Management at Brandeis University. “Those of us in the healthcare policy arena haven’t been able to figure out where all that waste is.” Although representing a higher percentage than other countries, administrative spending only comprises 8% of total healthcare spending.Excessive use of hospital and physician services aren’t to blame for high spending either. Annual hospital and physician v...

BY CYNTHIA MCGRATH | DECEMBER 15, 2020It’s a challenging, yet critical, time to increase your employee engagement efforts. The education sector is facing significant challenges due to enrollment drops and the costs of COVID prevention and monitoring. The usual ways of communicating – in-person meetings and quick chats by the water cooler – are no longer possible with many employees working from home. At the same time, many employees are trying to juggle work and family life. Childcare is in short supply, and many school-aged students need help navigating online classes. Social isolation is adversely affecting employees’ mental health; anxiety is 51% higher and depression is 65% higher than pre-COVID, according to the National Alliance of Healthcare Purchaser Coalition’s October 2020 Mental Health Index.“Before developing any employee communication, focus on the message,” says Bob Simp...

BY CYNTHIA MCGRATH | NOVEMBER 12, 2020Amidst the pain, anxiety, and budget hits caused by the coronavirus, one bright spot has been reduced healthcare spending. Medical claims dropped precipitously as provider groups closed or limited their practices to ensure capacity for COVID-19 patients. Most elective procedures were canceled or postponed. Patients also stayed away to avoid potential exposure. After a drastic reduction of costs in March, April, and May, claims costs returned to normal levels in June and July, as reported at the New England Employee Benefit Council’s October 15 Healthcare Cost Control Solutions Program.According to the State’s Division of Insurance, in Massachusetts:For August and September, payments came in 5%-20% higher than normal due to catch up demand as well as the increased costs associated with deferred care.For October and beyond, the agency projects 10% h...

BY CYNTHIA MCGRATH | OCTOBER 7, 2020The Trends and Why They Could Get WorseThe pandemic has upended everyone’s life and the strains are showing in the escalating rates of anxiety and depression. In March, 32% of U.S. adults reported that their mental health had been negatively affected due to worry and stress over the coronavirus. This rate jumped to 53% in the Kaiser Family Foundation’s July Tracking Poll. Adults are also reporting specific negative impacts including:Difficulty sleeping – 36%Difficulty eating – 32%Increases in alcohol or substance use – 12%Worsening chronic conditions – 12%Social isolation, job losses, racial tensions, and balancing work and home responsibilities are taking a toll. People who have lost their jobs or work in healthcare have seen a dramatic increase in mental health disorders. Other at-risk populations include:Older adults age 65 and over who are espec...

BY CYNTHIA MCGRATH | AUGUST 25, 2020Healthcare Cost Trends and ChallengesSince the COVID-19 pandemic hit the United States in force in March, there’s been a dramatic impact on medical claims:Medical claims have dropped precipitously as provider groups closed or limited their practices in order to ensure capacity for coronavirus patients and patients stayed away to avoid potential exposure. Most elective procedures were canceled or postponed. Provider practices have or are in the process of reopening, but traffic is not back to usual levels;Mental health care has skyrocketed as people face increased anxiety, stress, and social isolation. Much of this care transitioned to telehealth platforms, enabling patients to receive care in the comfort and safety of their home; andPrescription drug costs have largely been unaffected – spending continues to climb.These trends factor into the five r...

BY CYNTHIA MCGRATH | MAY 20, 2020The COVID19 crisis is hitting the higher education industry particularly hard. Four-year colleges may face a loss of up to 20 percent in fall enrollment, according to a recent survey cited in Inside Higher Ed. Carlos Santiago, the Massachusetts commissioner of higher education, says in a recent Boston Business Journal article that no event has changed the nature of the higher education sector as much as the coronavirus pandemic. He projects that enrollment-driven and tuition-dependent colleges and universities will be especially vulnerable to closing or merging with other institutions.Human Resources departments are on the frontlines of trying to bring costs under control. Furloughs, layoffs, early retirement incentives, and benefit cuts are all strategies for reducing costs. Recognizing that collaboration between colleges and universities could help H...

BY CYNTHIA MCGRATH | FEBRUARY 18, 2020Tackling rising costs and gaps in healthcare quality remains a challenge. One of the hottest trends over the last few years to address these needs – high-deductible plans and consumerism – is on the decline. A January 2020 report by Lively, a Health Savings Account (HSA) platform, found that the average American spends 96% of their HSA contribution on qualified expenses instead of saving money toward future expenses, a primary benefit of HSAs.“The concept of consumerism – having patients shop for care – hasn’t worked, and employers are moving away from these programs,” said Ellen Kelsay, Chief Strategy Officer, and Future President and CEO of the National Business Group on Health (NBGH), a coalition of large employers and industry partners, at a recent New England Employee Benefits Council event. Instead, employees are looking for employers, healt...

By CYNTHIA MCGRATH | DECEMBER 17, 2019We use a silo approach to healthcare. A podiatrist treats your foot or ankle; a cardiologist ­ your heart; and a dermatologist ­ your skin. Primary Care Physicians do their best at coordinating all of your care. However, your mental health is often overlooked no matter which kind of physician you’re visiting. “Treating the whole person is critical for quality of life,” said Teri Weber, Senior Vice President, Spring Consulting Group. “You can’t talk about someone’s health without including behavioral health.”Patients with complex medical conditions frequently suffer from other conditions, including behavioral health issues. The 2011 SYNTHESIS initiative by the Robert Wood Johnson Foundation found that:68% of adults with mental disorders have medical conditions; and29% of adults with medical conditions have mental disorders.Responding to this need, ...

By CYNTHIA MCGRATH | February 4, 2019How do we go about improving care for our employees while reducing costs? That’s the conundrum facing most employer healthcare purchasers. According to Workpartners, edHEALTH’s data warehouse, 5% of our insureds represent over 50% of our claim costs. Our Board made the strategic decision to target these high-cost claimants. We believe it will be a triple win: an opportunity to reduce costs, improve care for our members, and benefit our participating schools.edHEALTH’s premium trends have consistently been lower than the industry. Over the last four years, we’ve averaged premium increases of 2.7% per year. That’s much better than national trends of 4.1% (Kaiser Family Foundation), and even better when employer cost shifting is factored in. We have made very few benefit changes since our inception in 2013. The first step in launching our population h...

BY TRACY HASSETT | October 31, 2016When we started edHEALTH three ago, I never imagined I’d be an employee of edHEALTH, that we’d reach so many of our goals so quickly, that we’d have a website, or that I’d be writing my first blog!If you’re reading this blog, you’re either already a member of edHEALTH, you’re an edHEALTH partner, or you’re interested in learning more about edHEALTH.  No matter what your reason is, you’ve come to the right place. For those of you who don’t know me, my name is Tracy Hassett and I am the president of edHEALTH.  I have been in this role since September 1, 2015.  Prior to this role, I was vice president of Human Resources at Worcester Polytechnic Institute .  While at WPI, I was one of a number people from several institutions who spent more than three years looking at ways to address the ever-increasing rise of healthcare costs for our institutions, our ...