In this recent Benefits Law Journal article, Jack Towarnicky, aequum member, identifies a number of the statutory requirements designed to improve health care claims processing – changes that were included in Health Reform and subsequent laws. Jack asserts that health reform mandates and bureaucratic solutions may not be the most cost-effective option to achieve the desired outcomes. He notes that many are too inefficient for most plan sponsors and participants to use, and that they are subject to a significant amount of regulatory and subregulatory restraints (for example, we are now on our 68th set of Health Reform sub-regulatory guidance,, see: Department of Labor, Affordable Care Act Implementation Frequently Asked Questions, at: https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/aca-implementation-faqs). Other statutory changes would offer no more than a temporary respite.
Jack concludes by suggesting some proactive measures that plan sponsors can voluntarily adopt which will improve healthcare outcomes – including Advanced Explanation of Benefits, Prior Authorization, Consumer Engagement, and Value-Based Care Initiatives.
aequum can guide you in pursuing those and other cost-effective solutions such as Reference Based Pricing and Health Savings Account-capable health coverage.