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Abuse of discretion in benefits denial. 滥用自由裁量权拒绝福利。
Benefits quarterly Pub Date : 2013-01-01
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引用次数: 0
Accountable care organizations--the promise, perils and pathway to value for plan sponsors. 负责任的医疗机构——计划发起人的承诺、风险和实现价值的途径。
Benefits quarterly Pub Date : 2013-01-01
John Stenson, Michael Thompson
{"title":"Accountable care organizations--the promise, perils and pathway to value for plan sponsors.","authors":"John Stenson,&nbsp;Michael Thompson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>If the potential of accountable care organizations (ACOs) is realized, they could significantly transform how health care is delivered and financed, bringing the promise of high-quality affordable health care within reach. This article explores the root causes that have handicapped the value in the health care delivery system historically and the critical requirements to overcome those issues. The authors describe how commercial and Medicare ACOs attempt to address those issues, the potential land mines in the transition to a new paradigm and the principles plan sponsors should consider in understanding and integrating ACOs into their health care benefits strategy.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32260725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
HSA programs for groups: employer versus employee responsibilities. 团体HSA计划:雇主与雇员的责任。
Benefits quarterly Pub Date : 2012-01-01
Whitney R Johnson
{"title":"HSA programs for groups: employer versus employee responsibilities.","authors":"Whitney R Johnson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Employers implementing a health savings account (HSA) program face a shared compliance burden with their employees. The law dictates that all HSAs are individual accounts that must be opened by an Internal Revenue Service (IRS)-approved custodian or trustee. The individual account features combined with a required third-party custodian place much of the compliance burden for HSAs on the employee and custodian rather than the employer. Employees are compensated for the additional burden because HSAs give them more control over their health care money, and employers are generally pleased with their own reduced compliance burden. The shared compliance responsibilities, however, create confusion and misunderstanding for both employers and employees. This article distinguishes between the responsibilities of the employer and the employees for HSAs.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wellness strategies for smaller businesses. 小型企业的健康策略。
Benefits quarterly Pub Date : 2012-01-01
Marc Neely
{"title":"Wellness strategies for smaller businesses.","authors":"Marc Neely","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>While innovative smaller companies are implementing employee wellness programs, many smaller firms may point to a lack of resources, such as staffing and financial resources, to establish and sustain a wellness program. The uncertain economy and rising health care costs have caused many smaller businesses to focus on core business strategies to keep the doors open and the business going. However, innovative companies realize that building a culture of health is a long-term business strategy directly related to improving the bottom line. This article highlights one company's approach to wellness and the results of the company's programs. It also outlines the components of a successful wellness program and suggests practical implementation steps for smaller businesses.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Scope of discovery--benefits determination. Crosby v. Louisiana health service, 647 F. 3d 258 (5th Cir 2011). Relevant evidence may go beyond just administrative record. 发现范围——利益确定。Crosby诉路易斯安那州卫生局，第647 F. 3d . 258(2011年第5联邦法院)。相关证据可能不仅仅是行政记录。
Benefits quarterly Pub Date : 2012-01-01
{"title":"Scope of discovery--benefits determination. Crosby v. Louisiana health service, 647 F. 3d 258 (5th Cir 2011). Relevant evidence may go beyond just administrative record.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Determining the value of wellness programs. 确定健康计划的价值。
Benefits quarterly Pub Date : 2012-01-01
Ronald G Barlow, Don Weber
{"title":"Determining the value of wellness programs.","authors":"Ronald G Barlow,&nbsp;Don Weber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recent advances can give companies a solid set of return on investment (ROI) measurements on their health improvement programs, provided they are willing to invest in both wellness programs and measurement efforts that effectively gauge those programs' merit. As this article explains, choosing the right methodology will depend on the health improvement programs being evaluated, data and resources available, and the degree of precision desired by management. The authors discuss the different measurement methodologies and various measurement considerations. They conclude that using several methods and multiple iterations under varying sets of assumptions is often useful, not only for calculating ROI but also for providing companies a framework for continual program tracking and improvement.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erisa preemption. King v. BlueCross BlueShield, 439 Fed.Appx. 386, 2011 WL 3822023 (5th Cir. 2011). ERISA preemption applies even to former beneficiaries, or those whose benefits have been canceled by a plan, as long as the claims relate to the plan. Erisa抢占。金诉蓝十字蓝盾案，439联邦快递。386, 2011 WL 3822023(2011年第5期)。ERISA优先权甚至适用于以前的受益人，或者那些福利被计划取消的人，只要索赔与计划有关。
Benefits quarterly Pub Date : 2012-01-01
{"title":"Erisa preemption. King v. BlueCross BlueShield, 439 Fed.Appx. 386, 2011 WL 3822023 (5th Cir. 2011). ERISA preemption applies even to former beneficiaries, or those whose benefits have been canceled by a plan, as long as the claims relate to the plan.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fiduciary duty. Faber v. MetLife, 648 F.3d 98, 2011 WL 3375530 (2d cir. 2011). Providing postdistribution banking services does not continue the ERISA fiduciary relationship. 信托责任。Faber v. MetLife, 648 F.3d, 2011 WL 3375530 (2d cirr . 2011)。提供分销后银行服务并不延续ERISA信托关系。
Benefits quarterly Pub Date : 2012-01-01
{"title":"Fiduciary duty. Faber v. MetLife, 648 F.3d 98, 2011 WL 3375530 (2d cir. 2011). Providing postdistribution banking services does not continue the ERISA fiduciary relationship.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The medical home bends cost curve. 医疗之家使成本曲线弯曲。
Benefits quarterly Pub Date : 2012-01-01
Sandra M Wood
{"title":"The medical home bends cost curve.","authors":"Sandra M Wood","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>While the Affordable Care Act is trying to manage health insurance, as well as mandating coverage, a number of projects around the country are trying to manage the underlying cost of health care. By bringing back the concept of a true primary care physician, who provides 90% of your care and coordinates with your specialists, these programs are bending the curve of health care cost trends. Most are seeing a reduction in emergency room visits and hospital days in the double digits. Others that are taking fee-for-service insurance out of the picture altogether are experiencing even higher reduction rates. The goal is to increase patient health, which includes the patient having an active role in understanding his or her condition, treatment options and self-care strategies. It is estimated that if all Americans had access to a medical home, our nation could save $37 billion annually.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30882002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Guiding consumers through the complex health care system. 引导消费者通过复杂的医疗保健系统。
Benefits quarterly Pub Date : 2012-01-01
Rob Webb
{"title":"Guiding consumers through the complex health care system.","authors":"Rob Webb","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>If the U.S. health care system is to improve, consumers must make better health care decisions. An innovative solution is that of the health advisor. Whether labeled a health concierge, health guide, health advocate or health coach, the advisor's function is to guide patients through the health care system in an informed way, much like how financial services advisors help customers navigate the financial system. This article reviews the current state of health care and explains why personalized communications through health advisors can address systemic cost drivers as well as reduce strain on employees' wallets, boost employees' health and improve the plan sponsor's bottom line.</p>","PeriodicalId":79563,"journal":{"name":"Benefits quarterly","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31161418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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