Thursday, 28 March 2013
Virtus Benefits featured in article

A Ray Of Hope For Affordable, Convenient, Quality Health Care  BY: BRETT NELSON, FORBES.COM

There are few palatable prescriptions for the ailing health care industry, but telemedicine continues to provide some welcome relief.

Steven Brill’s recent 24,000-word cover story in Time captured, in demoralizing detail, all that’s wrong with America’s bloated, dysfunctional health care system. How about a ray of hope?

It’s called telemedicine. Say you have symptoms of a sinus infection or the flu, or even need a trip to the emergency room. Rather than wait days for a diagnosis from your primary doc, a telemedicine service can get a bona fide physician on the phone, by email, or on a video screen via Skype in 60 minutes or less—24 hours a day, seven days a week.

“Our health care system is broken in many ways, but telemedicine is a game-changer,” says Daniel McGugin, partner at Virtus Benefits, an employee benefits provider in Nashville, Tenn.

Good Medicine For Small Business

McGugin shared one case study involving a 150-person trucking company he’ll call “Abecee Transportation.” (Virtus won’t release real client names.) This month Abecee faced a 17% increase in its health insurance premiums. To ease the pain, the company considered switching to a plan with a higher deductible. That would have saved $150,000 a year in premiums; it also would have aggravated Abecee’s employees who would be forced to pay a bigger portion of their medical bills from their own pockets.

Enter telemedicine. In 2012 Abecee paid $120,000 in claims for “non-emergent” doctor visits (the sniffles and such), including expensive trips to the ER. According to a recent study by AmeriDoc—a leading telemedicine provider, along with Teledoc and Consult A Doctor—17,000 patients with access to a telemedicine plan reduced their number of visits to doctors’ offices by 30%, and to hospitals by 60%. At those same proportions, Abecee would save roughly $65,000 in claims. Cost of AmeriDoc’s telemedicine plan: $24,000.

As for Abecee’s employees, they’d get to keep their health benefits while not wasting productive hours schlepping to a doctor’s office or an ER. A 2010 report by Press Garney, a health care consultancy in South Bend, In., found that the average ER wait time is a little over 4 hours. AmeriDoc guarantees that doctors in its network respond within an hour.

Health premiums are only going higher and employers will continue to shift the burden to employees through high-deductible plans,” says McGugin. “We’re telling all of our clients to take a hard look at telemedicine.”

To be clear, telemedicine is no substitute for traditional insurance. Nor is it particularly cheap for individuals buying it in the open market. Individual telemedicine plans cost roughly $120 a year (including dependents), plus a $30 “consult fee” per call. (Employer-sponsored plans generally don’t charge a consult fee.)

If you’re a healthy male, have no preexisting medical conditions and are willing to take chances, you might want to pair telemedicine service with a super-high-deductible insurance plan that has a rock-bottom premium. That combo provides access to affordable treatment for non-emergencies while cushioning the financial blow of a catastrophic illness or accident. Other target customers include those who simply can’t afford traditional insurance but want access to basic care.

You can sign up for telemedicine service by calling a provider directly or working through a broker like McGugin. The cost is the same—providers pay the broker fee, not you.

Point Of No Return

While telemedicine isn’t new (hospitals have used phones to serve remote rural areas for 40 years), less than 1% of Americans have access to it. Expect more to join the ranks—and soon—thanks to affordable high-speed Internet connectivity and, of course, rocketing health costs.

The Society of Actuaries just released a study estimating that premiums on individual health plans will jump 32% over the next three years. Towers Watson, an HR consulting firm, found that 70% of companies with more than 1,000 employees will offer high-deductible plans ($1,250 minimum deductible) this year, up from 59% in 2011. And Rand Corp. estimates that, within a decade, half of all workers with employer-sponsored health care (including government employees) will have high-deductible plans.

All that bad news is good for David Lindsey, CEO of AmeriDoc. Founded just five years ago, the Dallas company has quietly amassed 1.3 million paying patients (not including dependents). That number is on track to triple by the end of the year, says Lindsey.

AmeriDoc’s network includes 290 doctors (some licensed in multiple states) who agree to be on call when they aren’t seeing patients on-site. Lindsey claims he has enough capacity to handle current members, though he looks to add more white coats all the time. “Doctors inquire every day about joining the network,” he says. A big reason: more patients per hour with little additional overhead. “They hate dealing with insurance companies. [Telemedicine] is how they’re going to get paid in the future.”

To control quality (and avoid malpractice suits), AmeriDoc records all visits electronically and stores the data for seven years. Customer-service staffers review random samples of calls every week; they also call every patient within two days after a consultation. “We call three times,” says Lindsey. “If [the member] doesn’t respond, we assume all went well. We’ve never had a malpractice claim.”

Lindsey concedes that, thus far, a lot of subscribers use telemedicine to “shop for prescriptions” without having to visit a doctor. Viagra is a big request—one that AmeriDoc’s physicians routinely deny without the requisite heart-rate and blood-pressure tests.

Meanwhile, AmeriDoc’s remote-delivery menu of services is expanding. The company created a finger-prick blood-testing pack that lets patients take their own samples and mail them in sterilized packs to a lab to measure testosterone, cholesterol and glucose levels. Next month AmeriDoc will roll out another self-blood test that aims to detect future cardiovascular disease.

Bottom line on telemedicine, says Lindsey: “It would be irrational if you did not call it a ray of hope for American health care.”

Posted on 03/28/2013 4:57 PM by Brett Nelson
Wednesday, 6 March 2013
Virtus Exchange Announcement


As previously shared with you, in 2014, individuals and employees will have an opportunity to buy their benefits through a Public or Private web based Exchange, as an alternative to the traditional method of buying benefits.  Private health care exchanges enable employers to offer a wider range of benefits so their employees may choose a plan best suited for them and their families.

The Virtus Marketplace will be powered by a leader in Benefits Administration, and Exchange & HRMS software.  This proven, state-of-the-art Benefits Exchange technology solution is designed to provide a full suite of contemporary features and functionality to support a comprehensive Benefits Marketplace.  Mission critical functions such as Employer Shopping, Employee Shopping, Personalized Plan Selection Guidance, Defined Contribution, Enrollment, Plan Administration, Billing and Data Managtement are all delivered online through a single, secure application.

The Virtus Marketplace partners with a cloud-based, on-demand software provider that revolutionizes the way healthcare and employee benefits are bought, sold and managed with a comprehensive array of integrated services including benefits administration, decison support, payroll and HRIS technology.

We look forward to visiting with you about what this might mean to you as well as your employees.

David T. Johnson, RHU, GBA

Senior Partner, Virtus Benefits LLC

Posted on 03/06/2013 10:17 PM by David Johnson
Friday, 1 March 2013
HHS Releases Final Rule for Health Insurance Market Reforms

The U.S. Department of Health and Human Services released a final rule on Feb. 22 that implements key provisions of the Affordable Care Act (ACA), including the requirement to cover people with pre-existing conditions. The final rule further implements the following five provisions of ACA that are applicable to non-grandfathered health plans:

Guaranteed Issue

Effective January 1st, 2014, individual health insurance plans will be guaranteed issue subject to open and special enrollment periods in the individual market. In other words, health insurance companies will be prohibited from denying coverage to people because of a pre-existing condition or any other health factor. In addition, individuals will have special enrollment opportunities in the individual market when they experience certain significant life changes, similar to those in the group market today.

Fair Health Insurance Premium Rating

Effective January 1st, 2014, health insurance companies offering coverage to individuals and small employers can vary premiums based on age, tobacco use, family size and geography. The rule implements the age rating at no greater than 3:1 and tobacco use rating at 1.5:1.

States can choose to enact stronger consumer protections than these minimum standards. In addition, starting in 2017, states have the option of allowing health insurance issuers that offer coverage in the large group market to offer such coverage through the marketplace. For states that choose this option, these rating rules also will apply to all large group health insurance coverage. These rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.

Guaranteed Renewability

The final rule reaffirms existing protections that individuals and employers have with respect to coverage renewal. For example, these protections will prohibit issuers from refusing to renew coverage because an individual or employee becomes sick or has a pre-existing condition. In other words, health insurance companies must renew coverage subject to certain exceptions such as non-payment of premium.

Single Risk Pool

Insurers are required to maintain a single statewide risk pool for claims experience in the individual market and single statewide risk pool for the small group market, unless a state chooses to merge the individual and small group pools into one pool. The single risk pool provision prevents insurers from segmenting enrollees into separate rating pools in order to increase premiums at a faster rate for higher-risk individuals more than lower-risk individuals, as is often the practice today. Premiums and annual rate changes will be based on the health risk of the entire pool.

Catastrophic Plans

The final rule also includes provisions for enrollment in catastrophic plans. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing-providing. Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market.

Updated Rate Review

In preparation for the market changes in 2014 and to streamline data collection for insurers and states, the final rule also amends certain provisions of the rate review program. Specifically, it adds standards for assessing premium increases in Effective Rate Review Programs. And, to monitor rate increases across the markets, all rate increases must be reported with those that are 10 percent or higher still subject to review.

Posted on 03/01/2013 4:12 PM by Virtus Benefits
Friday, 1 March 2013
Virtus Benefits Private Exchange

Have even two consecutive days passed without you hearing something related to Exchanges as part of the Affordable Care Act (ACA)?  My guess is no and that is primarily because, despite your position on the ACA, government exchanges are part of our future and will soon be in the lives of our employees and their families.

However, a positive outcome of this market and legislative shift in health insurance delivery is the introduction of private exchanges.  Virtus Benefits is pleased to announce that we have entered into an agreement that will soon be finalized providing us our exclusive private exchange as a result of our affiliation with Benefit Advisors Network.

What does this mean to you as an employer?  Exchanges will change the way health insurance and all other traditional and non-traditional employee benefits are purchased.  The purchasing process will move from one that is less employer based to one that is employer sponsored but more individual based.  In other words, employees will be able to make benefit choices specific to their needs, stage in life, view of risk, and financial status. 

Is a Private Exchange for everyone?  No; however, it is another option that we are able to present to you in an effort to accomplish your long term benefit goals.  The Virtus Benefits Exchange promises to offer Benefit Decision Support Tools backed with a fully-staffed Call Center and a wide array of product choices for your employees.

We look forward to talking with you about this new capability in the coming months.  Please let us know of any questions you might have in the interim.


David T. Johnson, RHU, GBA

Senior Partner, Virtus Benefits
Posted on 03/01/2013 4:32 PM by David Johnson
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