MSSC Business Case: Transforming Healthcare Benefits Introduction: In July 2014, the Municipal School District of Shelby County (MSSC) Trust was formed in Memphis, Tennessee, following the merger of Memphis City Schools and Shelby County Schools. This Trust, comprising four municipal school districts and three cities, aimed to provide superior healthcare benefits to their employees. Challenges: Financial Crisis: Memphis City Schools faced a growing financial crisis due to decreasing funding since 2008. Healthcare Benefits: The newly formed city school systems needed to establish their own benefits structures, meeting the State of Tennessee's requirement for equal or superior benefits compared to the merged district. Solutions Implemented by Sherrill Morgan: Self-Insurance Plan: Provided MSSC greater control over healthcare spending. Stop-Loss Insurance: Managed risk by securing stop-loss insurance, establishing predictable funding projections. TPA/ASO Selection: Managed the plan, paid claims, issued ID cards, and controlled costs using direct contracts. Strategic PBM Selection: Selected a PBM specializing in innovative solutions for government entities, focusing on drug effectiveness. Direct Hospital Negotiations: Controlled costs, improved outcomes, and gained greater savings through direct negotiations with hospitals and local facilities. Innovative Plan Design: Co-Pays Only Plan Design: Eliminated deductibles and coinsurance, providing employees with predictable out-of-pocket expenses and benefiting providers by removing the need for balance billing. Outcomes and Results: Financial Stability: Transitioned from no cash reserves to an expected $22 million in cash reserves by 2025. Cost Reduction: Achieved a 19% reduction in pharmacy spend. Healthcare Cost Control: Maintained year-over-year increases in healthcare costs between 1-3%, significantly lower than the national average of over 10%. Ongoing Improvements: Opened on-site medical clinics, added Reference Based Pricing, negotiated direct contracts, restructured medical plan benefits, and implemented innovative approaches in drug coverage. Conclusion: MSSC's partnership with Sherrill Morgan has led to remarkable financial security and superior healthcare benefits for its employees. This business case highlights the innovative strategies and continuous improvements that have made MSSC a model of effective healthcare management. Read the full business case here -

Understanding the Future of US Health Insurance: Key Trends & Forecasts to 2030 Sherrill Morgan invites you to explore critical insights into the evolving landscape of US health insurance. The way Americans receive health coverage is constantly changing, driven by powerful demographic shifts, policy developments, and economic factors. Staying ahead of these trends is vital for stakeholders across the healthcare spectrum. Our latest analysis, "Forecast of US Health Insurance Payor Mix by Age, Ethnicity, and Sex," delves deep into the current state and future projections of health insurance coverage in the United States. Key Highlights from the Report: High Coverage Persists: In 2023, roughly 92% of the US population had health insurance, continuing historically high rates. Employer Insurance Dominates: Employer-Sponsored Insurance (ESI), both fully-insured and self-insured, remains the primary source of coverage, covering about 53.7% of individuals. Government Programs Crucial: Medicare and Medicaid/CHIP each cover approximately 18.9% of the population, playing significant roles. Uninsured Rate Stable, But Concerns Remain: While the overall uninsured rate held at 8.0% (around 26.4 million people), there's a concerning uptick in uninsured children. Future Shifts: The report analyzes how factors like an aging population, ethnic diversity, potential policy changes (like Medicaid redeterminations), and economic conditions will reshape the payor mix by 2030. Detailed Segmentation: Gain a deeper understanding with forecasts broken down by specific age groups, ethnicities, and sexes. Why This Matters: Understanding these projections is essential for employers managing benefits, healthcare providers navigating reimbursement, policymakers shaping regulations, and individuals planning for their future healthcare needs. Dive Deeper: Get the full, comprehensive analysis and detailed forecasts. Read the full article on LinkedIn: Forecast of US Health

The Challenge: Navigating the traditional medical device reimbursement landscape is fraught with complexity. Reliance on hospital purchasing decisions, VAC approvals, and opaque insurer negotiations creates significant hurdles for innovative technologies seeking market access.     The Opportunity: A powerful, alternative pathway exists. This report explores a vital strategy gaining traction: securing coverage and reimbursement directly from self-insured health plans. Representing a significant majority (~65%) of the employer-sponsored market, these plans offer unique advantages.   Why Self-Insured Plans Are Different: Direct Risk, Direct Incentive: Employers assume the financial risk for employee healthcare costs, driving a keen focus on value, cost management, and customizable solutions. ERISA Flexibility: Governed primarily by federal ERISA law, these plans have substantial freedom in benefit design, coverage criteria, and network construction, largely bypassing state-level insurance mandates. This flexibility allows for tailored coverage of specific medical devices. Growing Trend: Direct Contracting: Employers are increasingly bypassing traditional intermediaries to contract directly with providers and other entities, seeking greater cost control, transparency, and quality.   Inside the Report: Leverage Plan Design & Direct Contracting   This comprehensive analysis provides a strategic roadmap for medical device manufacturers, market access teams, healthcare strategists, and benefits consultants. Discover how to:   Navigate the Self-Insured Environment: Understand the dynamics of risk, administration (including the role of TPAs), regulatory landscape (ERISA), and market size. Master Direct Contracting: Learn the mechanisms for establishing direct relationships with employers/TPAs and the growing market trends. Integrate Devices via Plan Design: Explore strategies for modifying benefit structures, coverage criteria, preferred networks, Centers of Excellence (COEs), and member incentives to ensure device adoption. Demonstrate Compelling Value: Understand the crucial evidence requirements—beyond clinical efficacy—focusing on cost-effectiveness, total cost of care impact, and workforce productivity relevant to employers. Contrast Models: See a clear comparison between the direct-to-plan approach and traditional hospital-centric sales models, highlighting key differences in decision-makers, reimbursement flow, and commercial strategy.   Takeaway: Success in the self-insured market requires a shift towards a payor-centric, value-driven approach. This report details how to build the business case, engage the right stakeholders, and leverage plan design to secure dedicated reimbursement pathways for your medical technology.   Ready to unlock this market? Read the full article here - https://www.linkedin.com/pulse/leveraging-plan-design-direct-contracting-secure-payor-soqne%2F/?trackingId=l4Q7gewRslFJk9Yt7%2FFyDQ%3D%3D   Or listen to the article -