Blue Daily

• High drug prices, greater utilization and higher provider rates are causing insurers to pay out more in claims than they collect in premiums.
• Rising premiums are slowing the hiring process for small businesses.
• Blue Cross is tackling affordability by working to bring down the price of prescription drugs, partnering with providers to reward value over volume and investing in healthier communities.

• Financial losses due to health care fraud account for 3% to 10% of health care costs.
• Health care fraud takes on many forms, including durable medical equipment, services not rendered, telemarketing fraud and more.
• More than 100 doctors have been charged with health care fraud in Michigan alone over the last decade.
• If you suspect fraud, you can call the Blue Cross toll-free Fraud Hotline at 844-STOP-FWA.

• Review your medical history, consider upcoming services and consult with your primary care provider to determine the type of coverage you require.
• Compare premiums, out-of-pocket costs and coverage details among available plans, including HMO and PPO options.
• Look into Flexible Spending Accounts or Health Savings Accounts to set aside pre-tax funds for eligible medical expenses and make health care more affordable.

• The fee-for-service model floods the health care system with high-cost care, fragmented experiences and outcomes that don’t always match the price tag.
• Instead of paying higher prices for greater volume, we need to align how hospitals are paid with the outcomes they deliver.
• Moving hospitals into value-based payment models means evolving toward a system that pays for what works and rewards providers for keeping people healthy.

• Health systems say consolidation allows them to improve efficiency and quality, but research shows it rarely saves patients money or improves outcomes.
• When health systems consolidate, they gain leverage — and they may use that leverage to raise prices.
• We need hospitals to adopt a better model of payment that rewards outcomes, not the volume of services provided. The value-based care model represents a solution.

• A recent survey revealed 76% of small businesses struggle to hire due to health care costs and 83% said these costs impact investment in other business areas.
• Hospital and prescription drug costs significantly outpace the current 2.3% inflation rate, hindering health insurance affordability for small businesses, according to the survey.
• Experts advocate for a shift to value-based care, focusing on patient outcomes rather than the current fee-for-service model.

Medically Reviewed by: Michael Kobernick, M.D.