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TABLE OF CONTENTS
Advanced Medical Strategies Partners with The Phia Group on Innovative NetworkDx
MyHealthGuide Source: Advanced Medical Strategies, 4/18/2014, www.mdstrat.com and www.phiagroup.com
Lynnfield MA -- Two powerhouse healthcare cost containment firms, The Phia Group, LLC, and Advanced Medical Strategies, have combined to create NetworkDx, a new, patent pending software as a service (SAAS) subscription-based offering that provides healthcare payors comprehensive analysis of the provisions in PPO contracts.
One of the most frequent struggles that any healthcare payor faces is PPO contract analysis. The larger the network, the more labor intensive the contract review process. With the Affordable Care Act substantially increasing the number of businesses that self-insure, more companies will be directly providing for their employees' healthcare, thus increasing an already ubiquitous need for cost assessment. Knowing what the contract specifies for coverage is imperative.
Before NetworkDx, contract and network analysis was performed individually, with some analyses taking as long as six months. NetworkDx drastically reduces this time, making accurate analyses quickly available to any subscriber with internet access (including smart-phones).
Without using specific contractual language, comprehensive summaries inform subscribers of the extent of their contractual rights for in-network claims. NetworkDx analyzes and summarizes payors' audit rights, usual and customary charge definitions, dispute resolution procedures, and miscellaneous provisions with a direct, user-friendly interface.
"Many benefit plans are bound by contracts they either don't understand or have never seen. Examining the network agreements compiled by this new NetworkDx software makes a problematic task significantly less daunting," explains Adam V. Russo, Esq., Chief Executive Officer of The Phia Group, LLC. "Advanced Medical Strategies, a Massachusetts based firm, has taken advantage of our expertise and a decade's worth of contractual review, and created a clear, concise, and useful feedback tool that users can access through on-line software."
NetworkDx subscribers will be able to utilize the database to evaluate networks prior to signing a PPO contract; accessing NetworkDx's review of applicable contract terms, without divulging any propriety information. Only NetworkDx offers this cross-network, convenient and comprehensive service with contract information added to the database regularly.
"Our clients, old and new, have supported AMS by subscribing to PredictDx; verifying their desire for innovative, data driven products based on real time claims experience. We couldn't be more pleased to have developed NetworkDx with another excellent company, The Phia Group. We anticipate our clients will value NetworkDx and they can look forward to an even faster pace of innovation from us. We plan to introduce more useful new products to support them in their daily efforts to remain competitive and profitable," states Peter Borans, President of Advanced Medical Strategies.
About Advanced Medical Strategies
Advanced Medical Strategies is a physician-lead organization bringing innovative solutions to the healthcare payor industry. Based in Lynnfield, MA, Advanced Medical Strategies has been offering world-class claims review and cost containment services since 2003. Contact Danae Lambeth, National Sales Director, at (781)-224-9711 x107, email@example.com and visit www.mdstrat.com .
About The Phia Group
The Phia Group, LLC, headquartered in Braintree, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. The Phia Group’s overall mission is to reduce the cost of plans through its recovery strategies, innovative technologies, legal expertise, and focused, flexible customer service. Visit www.phiagroup.com .
Planwatch and HealthCare Strategies Inc. Ensure Healthier Employees & Save Money
MyHealthGuide Source: ProServe Health Informatics (Planwatch), 4/18/2014, www.plan-watch.com and www.hcare.net
Stow, OH -- ProServe Health Informatics (Planwatch) and HealthCare Strategies Inc. (HCS) are joining forces to integrate financial and plan modeling with clinical Risk Stratification reporting to provide one of healthcare's most comprehensive reporting and data analytics tools.
Both companies are answering a demand in the marketplace for data transparency, trend analysis, budgeting, and health and wellness effectiveness. It is estimated that data analytics will save over $300 billion in health care costs in the US. Health care reform has changed the landscape of health care and understanding the trends and health of a population has never been more important.
"HealthCare Strategy's clinical dashboard and Medical Management services offer the tools to improve member health while reducing healthcare costs. By marrying our two analytic products, clients will benefit from seeing the financial details of today while forecasting clinical outcomes for tomorrow," says Georgeann Seuffert, Vice President of Sales, Planwatch.
Jan Albert, HCS' CEO and Founder adds, "When it comes to healthcare, data-driven solutions save money and allow you to make solid decisions. Working together, we'll identify opportunities to maximize clients' healthcare investment. It's a synergy that promises to bear great savings and long-lasting favorable outcomes through clinical and financial reporting."
Planwatch is a product of ProServe Health Informatics. It was developed in 2005 by company co-founders who recognized both the need and the solution for an economical, user-friendly, high level data analysis and reporting system for Third Party Administrators, Insurance Companies, Self-Administered Employer Groups, Stop Loss Carriers, Cost Containment Companies and Claim Adjudication Systems. This web based product allows Third Party Administrators to gain a thorough understanding of the needs of an employer population and helps make sense of ACA mandates and changes. By streamlining the reporting process, TPAs are able to share this valuable detailed claim information to assist their broker partners in proper claims management. Planwatch reporting packages include on demand reporting, comprehensive analysis, data exploration, historical plan modeling, benchmarking and disclosure reporting. Contact Georgeann Seuffert, Vice President of Sales at (888) 275-2242 ext. 303, firstname.lastname@example.org and visit www.plan-watch.com .
About HealthCare Strategies
Founded more than three decades ago, HCS has substantially reduced costs and improved the health of hundreds of employee populations nationwide. HCS's flagship program, HealthReach Predictive Care Management, an early entrant into the predictive modeling and healthcare data warehousing field, along with member and provider outreach, has reduced clients' healthcare trends to single digits, resulting in hundreds of millions of dollars in savings. HCS provides a combination of technology and clinical solutions that include provider and member technology platforms, Utilization Management, Large Case Management and a maternity program, MaterniCare. Email email@example.com and visit www.hcare.net .
EmployerDirect Welcomes Jeff Gary as Executive Vice President of Business Development
MyHealthGuide Source: EmployerDirect, 4/14/2014, www.edhc.com
AUSTIN, TX -- EmployerDirect, a leader in value-based healthcare that helps large, self-insured employers provide transparency for the quality and cost of their employees' planned medical procedures, is pleased to welcome Jeff Gary as Executive Vice President of Business Development. Mr. Gary has more than 20 years of experience in the healthcare industry and has served in executive positions with a variety of managed healthcare organizations.
Jeff's responsibilities at EmployerDirect are to create and lead internal and external strategic business development initiatives as well as lead strategic alliance and partnership opportunities.
"Over the past 12 years, Jeff has worked with many successful companies while running his own consulting company," said Thomas Johnston, CEO at EmployerDirect. "He brings a wealth of knowledge and experience in strategic business development that will prove invaluable as we expand our employer and provider networks nationwide."
Jeff was the founder and president of The JMG Group in Austin, Texas, a strategic healthcare consulting company that focuses on innovation, revenue growth, medical spend and cost containment solutions. He is an active advisor and consultant to numerous healthcare and insurance organizations. In 2008, he formed Stratabex, LLC, a healthcare business development company that he later sold to Prescription Benefits Inc. Throughout his career, he has held leadership positions with companies including Blue Cross and Blue Shield, Humana, and UnitedHealth Group.
"At a time when healthcare costs continue to escalate, EmployerDirect offers a proven and innovative alternative for self-insured employers to generate substantial hard cost savings," said Jeff Gary. "The company's mission of improving accessibility to quality healthcare and offering an unmatched level of service is in parallel with the goals that I have been working toward."
About EmployerDirect Healthcare
EmployerDirect, a leader in value-based healthcare, transforms the way self-funded employer health plans purchase healthcare for their members, saving 30-50 percent on planned medical procedures with the potential to reduce total plan cost by 6-10 percent. The company also offers a unique medical concierge service called SurgeryPlus that assists covered members with selecting a provider, scheduling a procedure, transferring medical records, coordinating travel logistics and negotiating surgery costs BEFORE the surgery occurs. Call (888)241-8537and visit www.edhc.com .
United Claim Solutions
(UCS) Grows with Linda Myrick as Claims Editing and Special Project
Pan-American Life Insurance Group Appoints Alex Rizo as Vice President, Accident and Health
MyHealthGuide Source: Pan-American Life Insurance Group via Business Wire, 4/14/2014, www.palig.com
NEW ORLEANS -- Pan-American Life Insurance Group (PALIG), a leading provider of insurance and financial services throughout the Americas, announced the appointment of Alex S. Rizo as Vice President, Accident and Health. The newly created position reflects Pan-American Life's intent to expand its Accident and Health product offering in both domestic and international markets.
"These lines of business are an important part of our strategy to solidify Pan-American Life as a partner of choice for the insurance needs of individuals and businesses across the Americas"
"These lines of business are an important part of our strategy to solidify Pan-American Life as a partner of choice for the insurance needs of individuals and businesses across the Americas," said José S. Suquet, Chairman of the Board, President and CEO of Pan-American Life. "From that standpoint, it was vital for us to recruit an experienced individual whose knowledge and expertise will drive the growth of our Mass Marketing and Personal Accident businesses in Latin America and the Caribbean and at the same time support our U.S. GWI Group Accident, Blanket Accident and Occupational Accident business."
As Vice President, Accident and Health, Rizo's key responsibilities will be to oversee operations, sales and product development for the Accident and Health lines of business in all of the jurisdictions that Pan-American Life currently operates in.
"Alex is a great fit for this position and for Pan-American Life," Suquet added. "I am extremely confident that with him on board in this capacity, we will strengthen our ability to deliver best in class life, health and accident solutions to clients in all of the markets where we have presence."
Rizo's previous professional experience includes his 22-year tenure with American International Group (AIG), during which time he worked across Latin America, notably in Chile, Colombia, Panama and Uruguay. Most recently he served as the Executive Director and Vice President, Consumer Division Head in Mexico. In that capacity, he managed a US$100 million division comprised of several lines of business including Accident and Health.
Rizo obtained a Bachelor of Business Administration in Accounting from Xavier University in Cincinnati, Ohio and a Master of International Management- Marketing and Finance from Thunderbird, The American Graduate School of International Management in Glendale, Arizona. He is fluent in both English and Spanish and will be based in Pan-American Life's Miami office.
About Pan-American Life
The Pan-American Life Insurance Group is a leading provider of insurance and financial services throughout the Americas. New Orleans-based Pan-American Life Insurance Company, the Group's flagship member, has been delivering trusted financial services since 1911, employing more than 1,400 worldwide, providing top-rated life and health insurance, employee benefits and financial services in 47 states, the District of Columbia (DC), Puerto Rico, and the U.S. Virgin Islands. The Group's member companies offer individual and/or group life and health insurance throughout Latin America and the Caribbean. The Group has branches and affiliates in Costa Rica, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, and 15 Caribbean markets, including Barbados, Cayman Islands, Curacao and Trinidad and Tobago. Contact Marta C. Reeves at 504-566-3112, MReeves@panamericanlife.com and visit www.palig.com .
Assist America Welcomes Mark Fiechter as Vice President of Sales
MyHealthGuide Source: Assist America, Inc., 4/17/2014, www.assistamerica.com
Princeton, NJ -- Assist America, Inc. is pleased to welcome Mark Fiechter as Vice President of Sales in the US, effective immediately.
Mr. Fiechter brings a proven track record of more than 23 years in the insurance industry, having worked for several major Accident and Health insurance companies as well as a several Managing General Underwriters. In addition to developing and managing sales teams that have continuously delivered outstanding results, he has expertise in P&L management and improvement, team building and leadership, relationship management and product development.
Prior to joining Assist America, Mr. Fiechter most recently held the position of National Sales Manager for the Insurance team at Europ Assistance USA where he managed a significant block of business, and a national sales team. While delivering profitable growth he exceeded new business goals, and managed client relationships with EA's key accounts.
"Mr. Fiechter is a key addition to the Assist America team and we are very pleased to have him head our sales efforts in the US," said Brian Mulligan, President and CEO of Assist America. "Mr. Fiechter's strong sales and insurance background is a perfect combination for us and we are proud to have him on board."
Mr. Fiechter holds a Bachelor of Science in Finance from St. Johns University as well as insurance licenses in Life, Accident and Health.
About Assist America, Inc.
Founded in 1990, Assist America, Inc. provides global emergency assistance services in partnership with various benefit plans. The company, headquartered in Princeton, New Jersey, serves more than 30 million members and over 300,000 enterprises through programs from the world's most prominent group benefit providers. Visit www.assistamerica.com .
Indigo Insurance Services
Seeks Stop Loss Sales Executive
Send resumes to Richard Greenhalgh, CLU, ChFC, Vice President, Specialty Benefits, at firstname.lastname@example.org, (617) 246-7331.
About Indigo Insurance Services
Indigo Insurance Services is a full-service insurance agency that offers a comprehensive array of specialty insurance including; stop-loss, life, disability, critical illness, cancer care and more. Employers can buy financial accounts, COBRA, FMLA, and ERISA administrative services, as well as Employee Assistance Plans. We offer customized stop-loss coverage options for employer groups headquartered outside of Massachusetts. Our underwriting partners help us to provide employers and employees with the highest degree of customer service and care. Visit www.indigo-insurance.com/products-services/stop-loss/stop-loss.html .
Should We Have Expected Obamacare's 8.2 Million Big Surprise on Employer Health Insurance?
MyHealthGuide Source: Jason Millman, 4/10/2014, The Washington Post Blog and Rand Corp. Survey
Article referred by John H. Eggertsen, Attorney at Law, Eggertsen Consulting, Inc.
There's one Obamacare number that stands out above the rest this week -- 8.2 million. That's how many people have taken up employer-sponsored insurance since September, and most of them were previously uninsured, according to a Rand Corp. survey issued Tuesday.
The Rand survey, which naturally comes with limitations, attributes the drop in the uninsured rate over the past six months mostly to gains in employer coverage. For all the predictions of employers dumping coverage for health insurance exchanges, this was a pretty surprising finding. Obamacare was actually driving millions of uninsured Americans to sign up for employer insurance.
But maybe that shouldn't have been surprising?
The Rand survey reminded me of another survey I wrote about just last week. Large employer members of the HR Policy Association, who laid out expected costs from the Affordable Care Act, said they expected the law's individual mandate will add pressure to their budgets. (The one really big caveat: HR Policy Association's report didn't account for cost savings the ACA would create.) In other words, these large employers said the Obamacare requirement for people to get insurance -- the individual mandate -- would drive more of their workers to sign up for their coverage.
"The RAND study validates large employers' projections that the individual mandate would increase take up rates, and the costs associated with those additional take ups," said Tevi Troy, president of the American Health Policy Institute, the think tank founded by the by HR Policy Association
Timothy Jost, a professor at Washington and Lee University School of Law, and a supporter of the health-care law, also said the survey from Troy's group supports the idea that the individual mandate will increase the number of those signing up for employer coverage. "This is a factor that must be considered in the lively debate about whether Obamacare is covering the uninsured," he said.
We still need some hard data before we can project enrollment in employer plans with greater confidence. The Rand survey, which was based on a nationally representative sample of 2,500 adults surveyed each month for the past few months, comes with a margin of error of 3.6 million and a 95 percent confidence rate. So that means researchers are still pretty sure at least 4.6 million gained new employer coverage since September.
The Rand report stands in contrast to the Congressional Budget Office, which in February predicted no major change in employer plan enrollment for 2014 because of the health-care law. The CBO also predicted employers would cover 2 million fewer people in 2015, 6 million fewer in 2016 and eventually flattening out at 7 million fewer people in employer plans.
State Legislative/regulatory Developments Update
MyHealthGuide Source: Self-Insurance Institute of America, 4/14/2014, www.SIIA.org
Connecticut- Assessment Update
SIIA continues to urge the Connecticut Legislature to eliminate a new assessment on self-funded health plans and met with a key senator this week to reinforce industry objections.
Last Thursday, SIIA members Dave Follansbee and Rick Parrett of Diversified Group Brokerage joined SIIA Government Relations Director Adam Brackemyre for an important meeting with Senate Beth Bye, co-chair of the Joint Appropriations Committee. Businesses, health insurance plan and their respective trade associations also had representatives in this important meeting.
Strong concerns were expressed about the proposed assessment is likely preempted by ERISA and that it serves as a disincentive for employers to voluntarily provide health coverage for their workers. Senator Bye appeared to take the input seriously and advised she and her colleagues will give the matter additional consideration.
SIIA will continue to work with stakeholders in Hartford and encourages additional association members to get involved. Stay tuned for additional updates. In the meantime, if you have Connecticut clients or business partners who want to oppose this new assessment, contact Adam Brackemyre right away.
New York - Stop-Loss Legislation
SIIA is ramping up lobbying efforts to pass legislation (S. 6917) that will protect the self-insurance market in that state for groups with 51-100 employees.
As previously reported, New York currently restricts the sale of stop-loss insurance to small groups (currently defined as 2-50 employees). In accordance with the Affordable Care Act, the small group definition changes to 2-100 employees effective January 1, 2016. So without a legislative "fix" before that date, self-insurance will effectively no longer be an option.
One immediate objective is to identify current 51-100 self-insured group health plan sponsors (private employers and unions) that would be willing to participate in a grassroots advocacy campaign. Please contact Adam Brackemyre right away should you be able to assist with this effort.
SIIA's Legislative/Regulatory Conference
If you have not already done so, make plans to attend SIIA Legislative/Regulatory Conference scheduled for April 23-24, 2014 in Washington, DC. Conference details, including registration forms, can be accessed on-line at SIIA Legislative/Regulatory Conference or by calling 800-851-7789.
The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally. Contact Adam Brackemyre, Director of State Government Relations directly at 202/463-8161, email@example.com and visit www.SIIA.org .
Patients Undergoing Noncardiac Surgery Increases Major Bleeding
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 3/31/2014)
Editor's Note: The following is a recurring article. This Newsletter is often asked by readers for a list of medical stop-loss providers and their respective premiums. Below the first of a recurring article that attempts to lists stop-loss providers and annual premiums. Sources includes press releases, AM Best reports, conference presentations and more.
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
April 24, 2014
April 30, 2014 11:00AM - 12:00PM EDT
May 7-9, 2014
The conference will end with a Networking Reception. Early bird
registration begins now. Regular registration begins on May 1. Visit
www.goasny.org. February 10-11, 2015
February 10-11, 2015