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Happy Holidays!

We are pleased to present the Winter issue of the MMS newsletter. As we enter 2009 we want include some timely information on year end tips, house cleaning and helpful articles.

As guidance for 2009, we are seeing various industry patterns.  These are heady economic times and we remain cautiously optimistic with the new presidential administration.  There are many proposed legislations on the table as well as free reports from PriceWaterHouse Cooper reports on what “Employers Want” and “9 Trends for 2009”.

We have seen recent consolidations with recent mergers between GHI and HIP to form EmblemHealth. Both non profits follow the Empire Blue Cross for-profit conversion of 5 years ago and covered in my blog.

Insurers such as Aetna, Empire and Oxford have been dropping Pharmaceutical Benefits Management companies and using their own resources instead.  As self acting PBMs’ they can negotiate effectively by using their large numbers.  This trend has not gone unnoticed by Pharmacy retailers such as CVS and Walgreens who must compete with mail order PBMs’.

Pharmaceutical Corps are bracing themselves for brand expirations on 80% of the most commonly prescribed drugs within 2 years.  They have issued double digit rate increases while simultaneously manufacturing generics of their own drugs. This will make sense as generics average 1/4 the cost of brands.  In fact, this will be a significant future cost saver as Rx have doubled in 10 years and represents over 25% of our insurance costs.

Insurers are saving members 20-40% by including value added discounts or reimbursements for gym membership, weight management programs, alternative medicine & holistic healing, vision, laser vision care, dental , hearing care and vitamins/natural supplements.

The technology investments will improve patient care and the public is already seeing early payoffs. Various online medical sites have helped inform patients and advocacy.  Insurers such as Empire actually offer a $5 Copay to interact with one’s doctor online.

In addition, “consumer driven healthcare plans” are taking off as copays have risen.  Its not unusual to find plans with specialist $50 copay.  As a result our consumers have been re-evaluating whether it makes sense to self insure on rare items such as hoispiatls and surgeries.  The HSA (health Savings Account) a model, especially the one form Aetna, has become actually a high end plan since the savings are significant enough to self insure and have universal coverage. The average PPO plan is $650/single while an HSA at $370/single only asks that you self insure on $1500.  The invisible hand leading you say?  Agreed!

Perhaps things will be more localized as hospitals have consolidated and have a virtual monopoly in LI and Bronx as an example.  Insurers such as Oxford, Aetna and Atlantis already offer localized NYC plans which are 30% less expensive but have a limited NYC network.

Our agency has strived to be ahead of the curve and keep our clients within budget regardless.  We have employed creative tools, personalized advise and latest technologies in the past and plan on adding to this model going forward.  We thank you all for reading our material, referring us business and most of all believing in us!

Once again thank you and we wish you and your family a wonderful Holiday Season!

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