MyHealthGuide Newsletter
News for the Self-Funded Community
5/20/2013
Published weekly by MyHealthGuide, LLC (www.MyHealthGuide.com). This Newsletter is for personal, non-commercial use only. This weekly newsletter is FREE OF CHARGE to subscribers. Subscribe free. Send news, press releases and announcements to mailto:Info@MyHealthGuide.com.
TABLE OF CONTENTS
Pay-Plus™ Solutions and RedCard Form a Healthcare Payment Alliance
The Assist Group Enhances Claim Review Service With DRG Validation
The StayFit™ Plan Announces Our Newest Client: Gilbane, Inc.
Cigna Teams with MDLIVE to Offer Access to Offer Telehealth Round the Clock
Stratose Offers TPAs and Others Network Solutions to 4 of the Top 5 Dental Plans
CareHere Opens New On-Site Health and Wellness Center in Covington, KY
URAC Appoints Kylanne Green as President & Chief Executive Officer
Risk Strategies Company Adds Jim DiFalco as Executive Team Leader of Captive Program
Pay-Plus™ Solutions Announces Art Hoath as Executive Vice President of Sales
Data Dimensions Appoints New Execs, David Hiller, Shawna Schultz to Head Two New Business Units
One Call Care Management Names Kevin English Chief Financial Officer
ECHO CEO, William Davis, Addresses CORE Compliance at NG Healthcare Payers Summit
Market Trends, Studies, Books & Opinions
The above article references two studies:
Legal, Legislative & Regulatory News
Employer Will Pay $50,000 to Settle EEOC's First GINA Lawsuit
Self-Insured Employers Must Tell Employees about Health Insurance Exchanges
Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain Studied
Editorial Notes, Disclaimers & Disclosures
Pay-Plus™ Solutions and RedCard Form a Healthcare Payment Alliance
MyHealthGuide Source: Premier Healthcare Exchange (PHX), 5/7/2013, www.phx-online.com
Clearwater, FL -- Pay-Plus™ Solutions, Inc. (PPS) announced at the recent Fifth Annual PHX Forum that it has formed a strategic alliance with RedCard Systems, LLC (RCS), a leading provider of production and distribution of outgoing healthcare claims correspondence. This alliance enables a seamless interface between PPS and RCS thus benefitting customers of both companies by providing access to RedPlus™, the comprehensive, healthcare payment solution that delivers payments "from Ink to e".
"Because each healthcare provider has a unique business operation, Payors need flexible payment options. Our alliance with PPS and the creation of the RedPlus solution enables us to deliver fast and reliable payments and explanation of payments in either a paper or an electronic format from one single source, said Eric Schaefer, President of RedCard. We are excited about working closely with PPS and how the creation of the RedPlus comprehensive solution will bring value to both the Payor and Provider markets."
"The alliance with RedCard brings together the marketplace experience, customer service performance and innovative technology that both corporate cultures possess and enables the delivery of our unique "Ink to e" solution, stated
Jay Ver Hulst, President of Pay-Plus™ Solutions, Inc. In fact, it's what Payors have been seeking. Reducing the complexity of dealing with multiple vendors, achieving rapid implementation and ensuring outstanding customer service are fundamental goals that Payors say they need, as they look to comply with the new payment requirements associated with healthcare reform legislation and RedPlus fulfills those needs and more."
To learn how RedPlus delivers the "Ink to e" solution, visit us at www.RedPlusonline.com.
About Pay-Plus™
Pay-Plus Solutions, Inc. (PPS) delivers easy, fast and reliable electronic payments and explanation of payments to healthcare providers. The PPS system utilizes a patent pending process to deliver funds electronically via credit card or its own private ACH network. Explanation of Payment ( EOP) is made directly to healthcare providers via PDF, Excel, 835 files, or other means by setting up the delivery method on the PPS Provider Web Portal. PPS is the only system designed exclusively for healthcare that combines banking functions, claim payments and remittance advice with integration of traditional paper processes. Visit www.ppsonline.com.
About RedCard
Based in St. Louis, Missouri, RedCard provides data management and BPO services for the production of ID Cards, enrollment materials, checks, electronic payments, EOBs, and letters. RedCard utilizes its proprietary DOCS™ system to manage all facets of these communications with innovative document designs, enabling a payer to enjoy substantial savings while creating an enhanced member/provider experience. Visit www.redcard.com and www.redplusonline.com.
About PHX
Premier Healthcare Exchange (PHX) was incorporated in 2001. The company provides advanced cost management solutions for health plans that combine claim processing automation with professional services to deliver a timely, centralized approach to healthcare cost management. This approach results in a significant reduction in payment errors, appreciable improvement in the time needed to bring claims to resolution and in savings that substantially reduce the healthcare costs of its clients. Contact Leo Garneau, Chief Marketing Officer, SVP, at lgarneau@phx-online.com, (888) 311-3505 ext. 296, and visit www.phx-online.com.
TriZetto's TPA Solution for ICD-10 Readiness Has Fast Start for Mutual Assurance Administrators, Inc. and Mercy Benefit Administrators
MyHealthGuide Source: TriZetto Corporation via Business Wire, 5/15/2013, www.TriZetto.com
Mutual Assurance Administrators, Inc.
DENVER -- TriZetto Corporation announced that Mutual Assurance Administrators, Inc. (MAA), a multi-site third-party health insurance TPA supporting health benefits administration for more than 115,000 member lives, has upgraded to the new version of TriZetto's QicLink™ enterprise core administration system.
TriZetto's QicLink solution helps TPAs increase administrative efficiency and effectiveness through greater automation, increased auto-adjudication and reduced manual intervention in claims processing. The new 5.00 version of the system supports ICD-10 compliance, providing data load, maintenance and inquiry functionality for TPAs migrating to the greatly expanded diagnosis and procedure code set. Because the ICD-9/ICD-10 crosswalk functionality is integrated within the QicLink application, clients such as MAA are able to perform ICD code translation processing within key functions such as claims adjudication, exception processing and pre-certification case management. ICD-10 functionality also is incorporated in the company's QicLink-integrated ClaimsExchange® electronic connectivity service.
"With TriZetto's QicLink 5.00 release, we now have streamlined, automated ICD-10 and HIPAA 5010 capabilities," said Jeff Knox, chief technology officer at MAA. "MAA truly is ahead of the game; we're where we need to be to support our clients, capture and use data to drive wellness initiatives and help each customer build a healthier workforce."
MAA's initiatives in population health management also are bolstered by the relational database capabilities of the 5.00 and earlier versions of TriZetto's solution.
"MAA has effectively employed the relational database functionality to populate its data warehouse and enhance disease management and wellness programs in concert with the TPA's healthcare partners," said Scott Ray, TriZetto's senior vice president of benefits administration services and application management services. "The relational database capability of TriZetto's QicLink system also supports a more efficient portal, easing MAA's collaboration with its partners on behalf of clients."
Completed in just hours, the upgrade to TriZetto's QicLink 5.00 version consolidated the systems of three offices onto a single data center site in MAA's Oklahoma City offices. "I could not have asked for more from TriZetto; we worked together to complete this major upgrade while maintaining strong client satisfaction," said Knox. "The upgrade was completely transparent to our customers.
"MAA has been a TriZetto [and RIMS] client since early 1984," Knox added. "Reflecting back, I think it is saying something that we have been able to make this partnership work successfully for so long."
Mercy Benefit Administrators
On 5/9/2013, TriZetto Corporation announced a rapid, successful upgrade to the new version by Springfield, Mo.-based Mercy Benefit Administrators. The TPA administers the self-funded medical claims of approximately 8,300 members who are primarily patients of Mercy, the country's sixth-largest Catholic healthcare system.
"Our early conversion to TriZetto's QicLink 5.00 release allows us to incorporate the advantages of the product into our marketing efforts this summer, well ahead of open enrollment," said Jennifer Johnson, manager of claims administration for Mercy Benefit Administrators. "The ICD-10 readiness of TriZetto's platform puts us one step ahead of many others. It's a differentiator that can drive RFPs and help win new customers. The new version of TriZetto's solution gives us an edge when we promote our products and services at conferences."
Johnson said TriZetto's enterprise system "positions Mercy Benefit Administrators as a leader in ICD-10." The solution syncs the TPA with the compliance initiative of Mercy health system, she added, as well as with the provider's innovative model of care delivery and strategy as an accountable care organization. "Now, with our enterprise technology well in hand, we can focus fully on customer service. With the enhanced functionality of TriZetto's solution, Mercy Benefit Administrators can say ‘We are' instead of ‘We will,'" said Johnson.
The 5.00 release of TriZetto's QicLink enterprise solution enables clients with its clinical-editing module to define edits by network. This capability allows benefit administrators to apply different rules and actions for specific in-network claims than those for other in-network and out-of-network claims. Additionally, the 5.00 version offers a consumer-directed healthcare module that requires no adapter hardware or software to enable real-time web service requests and responses.
Click to Tweet: Mutual Assurance Administrators upgrade to TriZetto's QicLink 5.00 to increase efficiency and #ICD-10 compliance. #healthcare
About Mutual Assurance Administrators
Mutual Assurance Administrators, Inc. (MAA) is a full-service third-party administrator providing services for self-funded employers throughout the United States. Founded in 1975, MAA is headquartered in Oklahoma City, with full-service operations located in Bartlesville, Okla.; Springfield, Mo.; Little Rock, Ark.; Memphis, Tenn.; and Dallas. We are one of the few TPAs in the nation to offer both medical administration and disability management administration (i.e., workers compensation). As one of the nation's leading TPAs, our flexible approach to benefits management allows our clients to establish the best possible programs to meet their specific needs. Visit www.maa-tpa.com.
About Mercy Benefit Administrators
Mercy Benefit Administrators is a full-service third-party administrator based in Springfield, Mo., providing a comprehensive range of self-funded health benefit administration, COBRA administration and network pricing. Direct contracts to an extensive network with award-winning facilities give clients the best network savings solutions available. Visit www.mercy.net/practice/mercy-benefit-administrators/.
About TriZetto
TriZetto delivers world-class information solutions that enable healthcare organizations to work more efficiently and collaboratively to deliver better health. Its solutions reach 200,000 care providers, streamline processes for more than 360 payers and touch over half the U.S. insured population. TriZetto solutions help health plans and TPAs increase administrative efficiency, improve the cost and quality of care, and succeed in the retail healthcare market. Its solutions help physicians and health systems simplify business processes and execute strategies for population health management and accountable care. TriZetto's healthcare experience, innovative solutions and comprehensive services help simplify healthcare for everyone. Visit www.trizetto.com.
The Assist Group Enhances Claim Review Service With DRG Validation
MyHealthGuide Source: The Assist Group, 5/12/2013, www.assistgroup.com
THE ASSIST GROUP ENHANCES CLAIM REVIEW SERVICE WITH DRG VALIDATION
Posted on May 12, 2013
Lakewood, CO -- Expanding the ClinAssistsm claim review service, The Assist Group (TAG) has announced the addition of DRG claim validation to its suite of comprehensive cost containment services.
The ClinAssist service will provide an innovative approach to DRG claims validation and recovery of confirmed over-payments on behalf of the segment of payors that pay claims based on DRG methodology. The service will include an appeal-proof step to ensure recovery of overpayments by obtaining a signed provider confirmation of the hospital's agreement to the audit findings. The Assist Group handles all documentation requests. This service also ensures no balance billing to patients, no provider recourse and deep realized savings.
"We have listened to our clients and will be utilizing decades of claims review experience to offer this expanded service," says Bob Malone, CEO of The Assist Group. He continues, "extensive experience allows TAG to go beyond other claim review services and find additional savings for clients, at no financial risk to them."
DRG validation is just one of a suite of services The Assist Group offers to help payors achieve botton-line savings and attain strategic cost-containment goals.
About The Assist Group
Founded in 1999, The Assist Group serves health care providers, insurers, reinsurers, third party administrators, and managing group underwriters in the review of catastrophic medical claims. The company is a national leader in the delivery of a comprehensive approach of claims review utilizing physicians, nurses, pharmacists, attorneys and coding experts. This professional team thoroughly evaluates each claim, identifies appropriate savings, and recommends a strategy for claim resolution. Call 877.631.9080 and visit www.assistgroup.com.
The StayFit™ Plan Announces Our Newest Client: Gilbane, Inc.
MyHealthGuide Source: The StayFit™ Plan, 5/14/2013, www.thestayfitplan.com and www.simplicityhealthplan.com and www.gilbaneco.com
CLEVELAND, OH -- The StayFit™ Plan, a division of Simplicity Health Plans® has been awarded a 24-month contract for comprehensive wellness services to Gilbane, Inc. The StayFit™ Plan will assist Gilbane with the implementation of a strategic wellness program that will include objective and subjective measures to address Gilbane's population health risks. The Gilbane myHealth Wellness program will identify population health risks through biometric screening (Know Your Numbers) and include health education, health challenges and Financial Wellness via the proprietary Health Index Calculator™ to engage eligible program participants in health behavior change.
The StayFit™ Plan partnership will assist Gilbane with implementing a wellness program that is focused on the four critical factors that drive 75% of today's chronic disease and provide meaningful interventions that address the population health risks, personal economic and integrate all aspects of Gilbane's health benefits programs.
The StayFit™ Plan model provides a focused, yet simplified approach to achieving healthcare affordability through wellness program design. The StayFit Plan of wellness consultants are trained to encompass all aspects of an employer's programs and services, ensuring that our clients are maximizing not only their wellness investment, but their health benefit investments. The StayFit Plan technology, administered by Simplicity Health Plans, offers a flexible solution that allows employers to create a platform to serve their exact wellness needs, making administration a success and the end-user experience easy.
"The StayFit™ Plan delivers a program that is truly strategic and consultative. The StayFit Plan wellness consultant incorporates all aspects of our company including our benefit design, EAP and our safety program. The StayFit Plan wellness model and services ensures that all aspects of our business are included in the wellness equation. We are very excited about this partnership and the impact it is having on our program." said Pierre LaPerriere, Vice President Human Resources, Gilbane Inc.
The StayFit™ Plan is dedicated to helping employers improve the health, wellbeing and financial wellness of their employees. We use proprietary technology and certified wellness subject matter experts to work with our clients to deliver "the next generation of wellness" that results in participant engagement and healthcare affordability.
About The StayFit™ Plan a division of Simplicity Health Plans
The StayFit Plan is a national health and wellness company that uses its own superior technology and patent pending products to impact your employees' overall well-being. The StayFit Plan is your strategic and trusted wellness advisor. In conjunction with our clients, we create a comprehensive health and wellness program that is focused on the key factors that drive 75% of illness and claims cost. We excel at integrating with existing benefit programs and services. We make pertinent health content available to participants through digital mobile delivery to drive "just-in-time" messaging to help individuals engage in behavior change by refocusing the participant using personal economics. Contact Lisa Holland at (216-367-3092), stayfitinfo@simplicityhealthplans.com and visit The StaytFit™ Plan at www.thestayfitplan.com and Simplicity Health Plans at www.simplicityhealthplan.com.
About Gilbane Inc.
Gilbane Inc., based in Providence, Rhode Island, is one of the largest privately held family-owned real estate development and construction firms in the industry. Proudly family-owned and operated since 1873, our rich history combines with our extensive knowledge of today's ever-changing demands, allowing us to deliver the best facility solutions for our clients. Gilbane is a three-time member of the FORTUNE100 Best Companies to Work For" list for 2009, 2010, and 2011.Gilbane Inc. comprises two operating companies: Gilbane Building Company and Gilbane Development Company. These two often work jointly as one company to provide integrated expertise in finance, property development, planning and commercial construction. Visit www.gilbaneco.com.
Data Dimensions Announces Another Record Year for Sales Fueled by Increased Demand for its Workflow Automation Tools
MyHealthGuide Source: Data Dimensions, 5/6/2103, www.datadimensions.com and www.olimtech.com
Janesville, WI -- Data Dimensions Corp, a leading provider of workflow automation services, announced another record sales year for its enterprise outsourcing solutions. This marks Data Dimensions 20th consecutive year of revenue growth for its business process outsourcing services focused on workflow automation.
"In today's intensely competitive environment, the velocity and accuracy of information matter more than ever. Our results are proof that the market has recognized that Data Dimensions provides both outcomes without compromise," said Data Dimensions President and CEO, Jon Boumstein. "We provide our customers with total capture solutions that convert even the largest volumes of documents into the most accurate digital data and deliver it downstream with the highest velocity."
The year was also marked by strong growth of the company's subsidiary, Olim Technologies Group. Collybus, Olim's leading Enterprise Content Management suite, is leading this growth. Sales of new Collybus software modules more than doubled, providing customers with more of the workflow tools they demand.
"Customers are demanding more intelligence earlier in their document workflow processes to speed up business outcomes, so if your workflow is not scaled or designed with the needed intelligence, it may be time to rethink your workflow process," said Data Dimensions Vice President of Business Development, Constantine Moshos.
About Data Dimensions
Since 1982, Data Dimensions has been helping clients better manage business processes and workflows by bridging the gap of automation, technology, and physical capabilities. As an innovative leader in the area of information management and business process automation, we provide a complete range of outsourcing and professional services including mailroom management; document conversion services; data capture with OCR/ICR technologies; physical records storage and electronic retrieval services through our state of the art Tier III data center. Call 800-782-2907 and visit www.datadimensions.com.
About Olim Technologies Group
Olim Technologies Group, A Data Dimensions Company, provides business process optimization software, managed services, Collybus Enterprise Content Management (ECM), networking solutions and custom development. Founded in 2003, Olim's focus has been on providing businesses with technology solutions to optimize and automate processes. Call 262-432-2375 and visit www.olimtech.com.
Cigna Teams with MDLIVE to Offer Access to Offer Telehealth Round the Clock
MyHealthGuide Source: Cigna (NYSE: CI), 5/10/2013, www.CIGNA.com and www.MDLive.com
BLOOMFIELD, CT & SUNRISE, FL -- Global health service company Cigna announced it will work with MDLIVE, a leading telehealth provider of online and on-demand health care delivery services and software, to offer eligible Cigna health plan customers access to 24/7/365 online video or telephone consultations with Board-Certified Internal Medicine, Family Practice, and Pediatric physicians.
The collaboration is reflective of the two companies' common goals of offering access to quality, affordable health care with a superior customer experience.
"We are committed to offering our customers services that help improve their health and make their lives easier -- and MDLIVE represents anytime, anywhere access to quality care," said Jackie Aube, the head of product development at Cigna. "MDLIVE's telehealth services enable our increasingly mobile and time-constrained customers to schedule a virtual consult with a Board Certified physician and resolve a non-emergency medical issue in less than one hour. It's cost-effective and convenient for minor illnesses such as allergies, pink eye and sinus infections."
MDLIVE offers the nation's largest telehealth network, specializing in online and on-demand health care delivery services with fully integrated software that allows information to be easily captured and transferred to a patient's primary physician. MDLIVE physicians are state-licensed, U.S. Board Certified and credentialed following national credentialing guidelines and have an average of 15 years of practical experience. Eligible Cigna health plan customers will be able to choose a convenient appointment time or request to speak to an available health care professional on demand (average response time of 11 minutes) for non-emergency medical issues such as cold and flu, rashes, sinus issues and headaches for children and adults.
Cigna will begin offering the MDLIVE program to several self-insured employers interested in testing this approach with their employees as part of their health program effective January 1, 2014.
"As the leading telehealth provider in the nation, we are especially pleased to team with Cigna, one of the world's pre-eminent health service companies," said Randy Parker, CEO of MDLIVE. "We have a closely shared vision for bringing the best technology to bear on providing consumers with an experience never before seen in health care that focuses on each person as an individual, accessible where and when they want it, and in a confidential and convenient virtual environment. We are proud to work with Cigna and look forward to a relationship that will literally re-define how quality health care can be available to all, and on their own terms."
Cigna has been a frontrunner in offering reimbursable "virtual house calls" nationally since 2007. Cigna's initial telehealth offering was through RelayHealth, which offers webVisit® consultations using an online, structured interview format to communicate eligible health plan customers non-urgent, routine health issues to their Cigna-contracted physician.
MDLIVE will add the new dimension to Cigna's portfolio of convenience care and telehealth options, making access to care more convenient, affordable for customers and appropriately compensating health care professionals for their services while continuing to support the existing patient-doctor relationship.
To watch a short video on MDLIVE services please view here: www.mdlive.com/cignavideo.
About Cigna
Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has approximately 78 million customer relationships throughout the world. Visit www.cigna.com.
About MDLIVE
Founded in 2006, MDLIVE is a leading telehealth provider of online and on-demand health care delivery services and software that benefit patients, hospitals, employers, payers, physician practice groups and accountable-care organizations. Headquartered in Sunrise, Florida, MDLIVE works with Board Certified physicians in 49 states to provide around-the-clock virtual health care. Visit www.MDLive.com.
Stratose Offers TPAs and Others Network Solutions to 4 of the Top 5 Dental Plans
MyHealthGuide Source: Stratose, 5/16/2013, www.stratose.com
ATLANTA, GA -- Stratose, a leader in cost containment services for medical, dental and workers' compensation payors, is pleased to share its growing portfolio of dental cost containment products and solutions.
"Stratose was first-to-market in introducing an out-of-network cost containment program to the dental industry. Our innovative dental solutions have changed how dental plans think about providing access to dental networks, claim savings and value to their policyholders and members," says Tina Ellex, President of Stratose.
Stratose presents a nationwide aggregated dental network comprised of proprietary and leased dental PPO networks which serve to identify innovative saving strategies including PPOs, out-of-network cost containment, and hybrid savings solutions. Stratose provides a blend of savings opportunities crafted through EDI repricing, provider data management, signed negotiations, and audit or fee schedule reductions.
The Stratose family of dental networks totals approximately 220,000 dentist access points nationwide, using a strategy that brings value to both payors and members through contracted discounts averaging 20-30%. "We are committed to our continued growth and plan to extend our proprietary network in addition to adding new partner networks. Our network offering often adds as many as 10,000 unique belly buttons to a national carrier's existing network." said Dr. Roma Virani, Executive Vice President of Dental, for Stratose.
The Stratose carrier (medical-dental carriers as well as standalone dental carriers), TPA and Blue Cross clients have expanded their focus beyond their proprietary networks to find savings on every possible claim. Stratose now manages dental network solutions for 4 of the top 5 dental plans across the country reducing cost and delivering savings to both the plan and the member.
About Stratose
Stratose is a marketplace leader, providing comprehensive solutions for managing healthcare costs. Stratose utilizes proprietary technology and a suite of products and services to deliver industry leading discounts on medical, dental and workers' compensation billings, by accessing direct provider contracts, PPO networks, provider negotiations, proprietary repricing including Medicare, to achieve industry leading savings for its national client base. Contact Deby Bickford at 404-459-7201, ext. 5234, marketing@stratose.com and visit www.stratose.com.
CareHere Opens New On-Site Health and Wellness Center in Covington, KY
MyHealthGuide Source: CareHere, 5/7/2013, www.CareHere.com
Editor's Note: The president of CareHere also serves as the president and publisher of this Newsletter.
Covington, KY -- CareHere is pleased to announce the addition of its newest clinic, CTK Health and Wellness Center. The clinic will be located on the first floor of 303 Court Street in downtown Covington and is set to open May 22.
The on-site clinic will provide the employees and their dependents, of the City of Covington and Kenton County with primary care services and generic brand prescriptions, as well as occupational health services.
"We are extremely pleased to open a one-stop-shop for employee healthcare in the heart of Covington," said Sherry Carran, Mayor of Covington. "CareHere's high-quality, low-cost brand of employee healthcare will give the employees of these two public agencies access to the low cost health and wellness resources they need to live healthier lives, while saving taxpayers dollars."
When asked about the new CTK Health and Wellness Center, Judge/Executive Steve Arlinghaus believes it will improve the long-term health of our city and county workforce population. "Our hard-working city and county employees deserve outstanding, cost-effective healthcare," said Arlinghaus. "This excellent new facility will not only provide access to the care they need, it will also promote a healthier, more productive workforce."
About CareHere, LLC
Founded in 2004, CareHere, LLC is a Brentwood, TN based company that specializes in providing on-site healthcare through self-insured employers by making healthcare easier, better and more affordable. On-site healthcare is a proven concept Fortune 1000 companies have enjoyed for years to lower employee health benefit cost. Presently, CareHere manages over 100 clinics nationwide where wellness and case management are integrated with on-site healthcare resulting in measurable savings and healthcare trend reductions. Contact Bernie Livers, VP Marketing, at (615) 376-9623, BLivers@CareHere.com and visit www.CareHere.com.
URAC Appoints Kylanne Green as President & Chief Executive Officer
MyHealthGuide Source: URAC, 5/15/2013, www.URAC.org
Washington, DC -- Kylanne Green, a recognized leader in hospital and health plan services, has been appointed President and Chief Executive Officer of URAC, the Board of Directors announced. Ms. Green will take the organization's helm officially on July 22.
URAC is one of the nation's largest private accreditation bodies, with cutting-edge data analytics, education, and measurement programs designed to promote continuous quality improvement at a wide range of health care organizations. URAC accredits health insurance plans, utilization review organizations, pharmacy benefit managers, specialty pharmacies, accountable care models, and many other emerging models of care. Recently, URAC was certified by the Centers for Medicare & Medicaid Services (CMS) to accredit health plans offered on new state health insurance marketplace plans as part of the Affordable Care Act.
"At a very pivotal moment, we are extremely gratified to have a leader of Kylanne's caliber to take the reins of URAC," said John D. Jones, Chairman of the URAC Board of Directors. "Both URAC and the system itself are at a crossroads and Kylanne's leadership will be critical in helping us to chart a new path forward. In the coming months, URAC will be spearheading a wide range of new accreditation programs to fit with the changing times and we can't think of anyone more capable to lead the charge than Kylanne."
"The fundamental changes taking place throughout health care present tremendous opportunities for those organizations with the vision to seize upon them," said Ms. Green. "Given its strengths, URAC is uniquely positioned for this moment and will increasingly play a leadership role with health plans, providers, employers, and policymakers in advancing a more accountable, patient-centered system. I am deeply honored to have been chosen to lead URAC and look forward to making URAC a truly best-in-class organization."
A registered nurse and adult nurse practitioner by background, Ms. Green brings a wealth of health care and corporate affairs expertise to URAC. Prior to assuming her new role at URAC, Ms. Green served as Executive Vice President and CEO of Managed Care Services at Inova Health System. Based in Northern Virginia, Inova Health System is a not-for-profit, preeminent regional health system. She served in various executive capacities at Inova since 1999.
Ms. Green also has a distinguished background in the health plan arena. She spent the first 16 years of her career in ambulatory care delivery and operations with Kaiser Permanente in Colorado and Northern Virginia. She was Chief Operating Officer of Aetna Health Plans of the Mid-Atlantic, and was the Chief Operating Officer of the Health Insurance Association of America during the height of the Clinton health care reform debate. She has served on numerous Boards of Directors in health care, and is a member of the Advisory Board of the College of Health and Human Services of George Mason University. She is a past Congressional appointee to the Council of Graduate Medical Education and is a past Chairman of the Board of URAC.
About URAC
URAC, an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system and provides a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.
As a leading national accrediting organization, URAC accreditation programs span the health care spectrum. URAC is recognized by State and Federal regulatory agencies for these programs. Most notably, the Administration has recognized URAC as an approved accreditor for health plans participating on health insurance exchanges. Visit www.URAC.org.
Pay-Plus™ Solutions Announces Art Hoath as Executive Vice President of Sales
MyHealthGuide Source: Pay-Plus™ Solutions, Inc. (PPS), 4/29/2013, www.ppsonline.com
Clearwater, FL -- Pay-Plus™ Solutions, Inc. (PPS) a leading provider of electronic payment solutions for healthcare Payors and Providers announces the addition of Art Hoath as its new Executive Vice President of Sales. In his new role, Art assumes the responsibility of managing the daily operation of the PPS sales team and enhancing its penetration within the TPA and Healthcare plan markets.
Art's extensive experience in the Healthcare market along with his reputation as a successful leader of sales teams is well documented in roles ranging from Senior Sales Executive with Enquiron where he managed its National Sales team to double digit growth to his successful tenure in Senior Sales leadership positions at PMSI, Premier Prizm Solutions and American Hearing Aid Associates (AHAA).
"It's an exciting time to be joining PPS. The growth of the organization is astounding and the potential that lies ahead is phenomenal. Our core products are proven winners and the introduction of RedPlus into the market is a game changer. I look forward to working with a team of talented professionals who share an aggressive vision of success here at PPS," stated Art.
"There is a considerable amount of energy and opportunity in the marketplace that is directly related to our business. This phenomenon has created a need for us to recruit an experienced, forward thinking professional who possesses the ability to build a dynamic sales team that will enable us to capitalize on the full potential the market affords, said Jay Ver Hulst, President of Pay-Plus™ Solutions, Inc. I am very pleased about the addition of Art to our Senior Management Team. Throughout his career he has demonstrated the ability to drive sales as both an individual performer and as a sales team leader. His contribution will be invaluable to the achievement of both the short and long term goals of a growing company like ours."
About Pay-Plus™
Pay-Plus Solutions, Inc. (PPS) delivers easy, fast and reliable electronic payments and explanation of payments to healthcare providers. The PPS system utilizes a patent pending process to deliver funds electronically via credit card or its own private ACH network. Explanation of Payment ( EOP) is made directly to healthcare providers via PDF, Excel, 835 files, or other means by setting up the delivery method on the PPS Provider Web Portal. PPS is the only system designed exclusively for healthcare that combines banking functions, claim payments and remittance advice with integration of traditional paper processes. Visit www.ppsonline.com.
Risk Strategies Company Adds Jim
DiFalco as Executive Team Leader of Captive Program
MyHealthGuide Source: Risk Strategies Company, 5/14/2013,
www.risk-strategies.com
SACRAMENTO, CA and BOSTON, Mass. -- Risk Strategies Company
(RSC), a national insurance brokerage and risk management firm headquartered
in Boston, has named Jim DiFalco as Executive Team Leader for RSC's Credit
Union Health Benefits of America (CUHB) Employee Benefits Captive program.
Jim will co-lead RSC's efforts to increase CUHB's national expansion into
credit unions seeking an alternative to traditional medical insurance plans
or programs.
"With medical premiums increasing ten to fifteen percent annually, there is
pent-up demand for cost-effective solutions among mid-market employers,
desperately seeking alternatives to traditional health insurance plans,"
said Fred Cannon, Executive Vice President, Risk Strategies Company. "We are
excited to add Jim DiFalco, an experienced self-funding and captive
management executive, to help accelerate the growth of CUHB and take
advantage of this market opportunity."
Jim's background includes six years with Blue Shield of California, a $9
billion health plan focused on the California market. At Blue Shield, Jim
managed the development and distribution of self-funded products to mid-size
and large employers, Taft Hartley groups and Public Sector entities. His
accomplishments include a 700 percent increase in the premium and client
base of Blue Shield's stop loss business.
More recently, Jim served as Vice President of Business Development for
WorldMed Assist, a leader in medical travel facilitation for consumers. Jim
expanded WorldMed's offering to the corporate market adding the company's
first 40,000 covered members. Jim also was Vice President of Sales for
Andreini and Company where he built a $1 million pipeline for Andreini's
Employee Benefits Captive program.
Jim has an undergraduate degree from Swarthmore College and an MBA from Pace
University. Contact Jim at
- Jim DiFalco
Executive Team Lead
(650) 762-0457
jdifalco@risk-strategies.com
About Risk Strategies Company
Ranked in the top 65 brokers in the country, Risk Strategies Company is a
national brokerage firm distributing property and liability insurance and
employee benefits insurance products to both privately held and publicly
traded commercial clients.
Risk Strategies focuses on client risk management challenges and delivers
pragmatic, cost-effective financial and business solutions. As a broker with
a strategic focus, RSC employs a diverse range of skills outside of the
traditional insurance sector. By placing a greater emphasis on creativity,
innovation, efficiency, flexibility and specialized industry knowledge, we
consistently deliver practical, cost-effective results to our clients.
Visit www.risk-strategies.com.
Data Dimensions Appoints New Execs, David Hiller, Shawna Schultz to Head Two New Business Units
MyHealthGuide Source: Data Dimensions, 5/13/2103, www.datadimensions.com
Janesville, WI -- Following recent announcements celebrating a record sales year and immense company growth, Data Dimensions Corp, a leading provider of workflow automation services, is undergoing another transition. The company has announced that their operations department will be split into two distinct business units; a commercial business division and a government business division.
"We are in the midst of very exciting times in Data Dimensions' history. As we continue to build on our recent successes, we know that it is critical we remain focused on customer delivery. With the creation of the two business units we will be able to continue our mission to deliver an uncompromising commitment to quality, responsiveness and integrity to achieve our goals through our customer's success and growth," said President and CEO, Jon Boumstein.
David Hiller, Executive Vice President & General Manager of Government Division
Responsible for overseeing the government business division in the position of Executive Vice President & General Manager of Government Division will be the most recent addition to the Data Dimensions team, David Hiller. Hiller's background includes a number of strategic executive positions, most recently as the President of the Printery in New Berlin, WI.
Shawna Schultz., Executive Vice President & General Manager of Commercial Division
Directing the company's commercial business division is Shawna Schultz. Schultz has been with Data Dimensions since 1994 in various roles including Director of Client Services, Chief Operating Officer, and now as Executive Vice President & General Manager of Commercial Division.
Both of the new General Managers will be responsible in seeing that their divisions continue to meet and exceed client expectations by delivering timely and accurate data.
About Data Dimensions
Since 1982, Data Dimensions has been helping clients better manage business processes and workflows by bridging the gap of automation, technology, and physical capabilities. As an innovative leader in the area of information management and business process automation, we provide a complete range of outsourcing and professional services including mailroom management; document conversion services; data capture with OCR/ICR technologies; physical records storage and electronic retrieval services through our state of the art Tier III data center. Call 800-782-2907 and visit www.datadimensions.com.
One Call Care Management Names Kevin English Chief Financial Officer
MyHealthGuide Source: One Call Care Management (OCCM), 5/15/2013, www.onecallcm.com and www.yourmsc.com
PARSIPPANY, NJ -- One Call Care Management (OCCM), the nation's leading partner in providing specialized services that lead to faster, more efficient and cost-effective resolution of claims, announced that Kevin English joined the executive management team as Chief Financial Officer.
Joe Delaney, President & CEO of One Call Care Management, commented on the new appointment: "We are pleased to have a financial executive of Kevin's caliber and experience join the OCCM team. Kevin will lead the financial strategies of our corporate enterprise and various business units. In addition, his prior experience with acquisitions, business unit integration, strategic sourcing and financial planning are critical to the future continued growth and expansion of OCCM."
"I am excited to join One Call Care Management," said English. "The company is dynamic and has unparalleled in-depth expertise in the workers' compensation industry. OCCM leadership and team members are very passionate about delivering outstanding service and value to clients, and they're dedicated to ensuring that injured workers return to work faster as a result of prompt treatment from high quality providers. I look forward to contributing to the company's financial success."
Mr. English has over 21 years of experience in financial management and senior leadership positions. Prior to his appointment at OCCM, English served as Chief Sourcing Officer at PSS World Medical, Inc (PSSI). Prior to that, he served as Senior Vice President, Finance. In this role, he successfully led the planning and execution of a global sourcing initiative, compliance efforts with Sarbanes-Oxley, centralization of the company's purchasing function, and establishment of Corporate Shared Services. Also during his long tenure with PSSI, Kevin served as Chief Financial Officer for Diagnostic Imaging, a former subsidiary of PSSI that was divested in November 2002.
About One Call Care Management
One Call Care Management (OCCM) is the nation's leading provider of specialized services to the workers' compensation industry that lead to faster, more efficient and more cost effective claims resolution. From high-end diagnostic procedures, to post-discharge and in home and complex care management, to transportation and language services, to superior dental programs and other medical specialties, OCCM provides reliable, consistent connections to care that enable maximum medical improvement and superior outcomes. Visit www.onecallcm.com and www.yourmsc.com.
ECHO CEO, William Davis, Addresses CORE Compliance at NG Healthcare Payers Summit
MyHealthGuide Source: ECHO Health, Inc., 5/17/2013, www.echohealthinc.com
Austin, TX -- Recently, ECHO Chairman of the Board and CEO, William Davis, had the distinct honor of presenting at the 2013 NG Healthcare Payers Summit. Senior decision makers in the healthcare payer industry from across the U.S. attended the summit, which took place May 6 -- 8 at the Barton Creek Resort & Spa in Austin, TX. The attendees were particularly interested in Mr. Davis's presentation on how ECHO's payment solutions address key CORE requirements.
Highlights from the presentation featured examples of CORE compliant services, such as the consolidation of multiple statements/funds, fast and regulation-compliant delivery of electronic statements, and other cost-saving benefits that reward the bottom line.
"We have developed a unique, single-consolidation electronic delivery payment process that improves processing efficiency and lowers administrative costs," said Davis. "And, we are fully prepared to meet the challenges of today's volatile healthcare environment."
When asked about the value of the NG Summit, Davis replied, "It was a great opportunity to share new ideas on how to adapt to the industry changes that lie ahead. I am grateful to NG Healthcare Payers for allowing me to share ECHO's CORE compliance efforts with other industry leaders."
About NG Healthcare Payers Summit
The NG Healthcare Payers Summit brought together senior decision makers from across the U.S. healthcare payers industry to focus on the latest IT solutions available to them, and identify the strategies some are employing to comply with this newest wave of mandates in the reforming healthcare payer market. Visit www.ngpayerssummitus.com.
About ECHO Health, Inc.
ECHO Health, Inc. is the leading provider of electronic healthcare payment solutions, serving over 25,000 ERISA health plans and fully insured groups. ECHO processes over 30 million claims and pays more than $6 billion annually to providers and members through industry-leading TPAs.
Founded in 1997, ECHO is a privately owned and family held company located in Westlake, Ohio. Call 440.835.3511, ext. 118 and visit www.echohealthinc.com.
Market Trends, Studies, Books & Opinions
The Health Spending Decline Due to Economy & Self-Funded Employers Not ObamaCare -- But ObamaCare May Squash Favorable Trend
MyHealthGuide Source: 5/13/2103, Wall Street Journal Article
To the surprise of both political parties and planners of all types, American health-care spending appears to be slowing down. The health growth rate has flattened out at about 3.9% over the last three years--a record low since the 1960s and down from the old normal of 6.2% to 9.7% in the 2000s.
This is rare good economic news, given that health cost growth sends federal entitlement spending soaring and erodes middle-class wage increases. Can this trend last? Maybe, though not with the Affordable Care Act looming to quash any progress.
At first most observers assumed the slowdown was temporary, an artifact of the 2007-2009 recession and weak recovery. As people lost jobs and thus their insurance, or simply had less income, health spending fell in tandem.
Reflecting this view, the Kaiser Family Foundation and the Altarum Institute recently estimated that underlying economic conditions are responsible for 77% of the current health spending deceleration and that this dip will end when GDP rebounds. Yet health spending growth rates started to decline in 2002, and a provocative paper in the New England Journal last summer suggested that a robust moderation began in mid-2005.
Now comes new evidence that the moderation is durable, and that it is structural--the result of permanent changes in the health system itself rather than the business cycle. These papers look at the historical relationship between GDP and the share of the economy devoted to health care and were published last week in the journal Health Affairs.
White House Claims Credit for Decline
The Harvard economist and sometime White House adviser David Cutler and Nikhil Sahni argue that the slowdown has been larger and longer than it should otherwise be. By their model, the recession explains only 37% of the slowdown, and other variables 8%, not Kaiser's 77%.
President Obama naturally says he deserves most of the credit for the slowdown, even though it began well before ObamaCare passed in 2010. His Council of Economic Advisers argues in its 2013 report to Congress that the economy explains just 18% and that the balance includes "early responses to the Affordable Care Act."
But the White House also says that everything that goes wrong in health care is still the fault of Republicans or of private insurers, even though the law was passed (with zero Republican votes) to end the industry's alleged abuses.
Harvard Explanation of Decline: Innovative Health Plans from Self-Funded Employers
A more plausible explanation is offered by Michael Chernew and some Harvard colleagues. Their model suggests that market choice and competition helped produce the slowdown, especially among Mr. Obama's preferred villains. Hide the children: the insurers.
Dr. Chernew investigated changes in the insurance mix at large businesses from 2008 to 2011. Even as these firms did better than their smaller counterparts, their workers shared more of the costs of their own care through higher deductibles, co-pays and new benefit designs. "Rising out-of-pocket payments," he writes, "appear to have played a major role in this decline, accounting for approximately 20% of the observed slowdown."
In a word, patients make better decisions when they have the right incentives and information. Old-style first-dollar insurance coverage is declining in the private economy because employees prefer cash wages and employers can't afford to finance ever-more expensive benefits. One way commercial insurers have responded is with plans that steer consumers to higher-value hospitals, doctors and other providers in return for lower out-of-pocket costs. Think of the way drug formularies encourage generic pharmaceuticals over name brands.
Mr. Obama's economists speculate instead that regulations are requiring providers to be less inefficient, which would be the first time in history that is true. ObamaCare also outlaws most of the experimentation and innovation that is the most likely driver of the slowdown.
Self-Funded Employers Free of Regulations & Taxes
Large businesses that self-fund employee benefits operate mostly free of regulations and taxes under a law known as ERISA which cover covers 60% of the 149 million Americans with job-based coverage, up from 54% in 2005 and 49% in 2000 as businesses have fled government micromanagement.
But everyone else--Medicare, Medicaid and the individual and small-business insurance markets--is now under federal control, and many more will join them if ObamaCare inspires businesses to dump workers into its subsidized "exchanges." The law's actuarial rules and benefit mandates prohibit what the government defines as excessive cost sharing, even as trillions of dollars in subsidies will be pumped into the system to inflate spending growth again.
That will be terrible for the fisc--Dr. Cutler estimates entitlement spending will be $770 billion lower over a decade if the current slowdown holds--and it is another reminder of what a squandered opportunity "health-care reform" was. It increasingly looks as if ObamaCare passed amid a national correction in the health markets that no one in Congress or the White House understood, much less noticed, so naturally Washington moved to create new problems when the old ones were starting to fix themselves.
The Slowdown In Health Care Spending In 2009--11 Reflected Factors Other Than
The Weak Economy And Thus May Persist
MyHealthGuide Source: Michael Chernew, Alexander Ryu, Teresa Gibson, M. Richard
McKellar, 5/2013,
Health
Affairs Abstract - Chernew
During and immediately after the recent recession, national health
expenditures grew exceptionally slowly.
- During 2009--11 per capita national health spending grew about 3 percent annually, compared to an average of 5.9 percent annually during the previous ten years.
Policy experts disagree about whether the slower health spending growth was temporary or represented a long-term shift.
This study examined two factors that might account for the slowdown:
- job loss and
- benefit changes that shifted more costs to insured people.
Based on an examination of data covering more than ten million enrollees with health care coverage from large firms in 2007--11, researches found that these enrollees' out-of-pocket costs increased as the benefit design of their employer-provided coverage became less generous in this period.
Researchers conclude that such benefit design changes accounted for about one-fifth of the observed decrease in the rate of growth. However, we also observed a slowdown in spending growth even when we held benefit generosity constant, which suggests that other factors, such as a reduction in the rate of introduction of new technology, were also at work.
Our findings suggest cautious optimism that the slowdown in the growth of health spending may persist--a change that, if borne out, could have a major impact on US health spending projections and fiscal challenges facing the country.
If Slow Rate Of Health Care Spending Growth Persists, Projections May Be Off By $770 Billion
MyHealthGuide Source: David M. Cutler and Nikhil R. Sahni, 5/2013,
Health
Affairs Abstract - Cutler
Despite earlier forecasts to the contrary, US health care spending growth
has slowed in the past four years, continuing a trend that began in the
early 2000s. In this article we attempt to identify why US health care
spending growth has slowed, and we explore the spending implications if the
trend continues for the next decade.
Researchers find that the 2007--09 recession, a one-time event, accounted for 37 percent of the slowdown between 2003 and 2012. A decline in private insurance coverage and cuts to some Medicare payment rates accounted for another 8 percent of the slowdown, leaving 55 percent of the spending slowdown unexplained.
Researchers conclude that a host of fundamental changes--including less rapid development of imaging technology and new pharmaceuticals, increased patient cost sharing, and greater provider efficiency--were responsible for the majority of the slowdown in spending growth.
If these trends continue during 2013--22, public-sector health care spending will be as much as $770 billion less than predicted. Such lower levels of spending would have an enormous impact on the US economy and on government and household finances.
Legal, Legislative & Regulatory News
Employer Will Pay $50,000 to Settle EEOC's First GINA Lawsuit
MyHealthGuide Source:
- Kathryn McGovern, 5/14/2013, Thompson Blog
- US EEOC, 5/7/2013, EEOC Press Release
An Oklahoma employer will pay $50,000 to settle the first lawsuit the
federal government filed to enforce the Genetic Information
Nondiscrimination Act. The case, Civil Case No.: 13-CV-248-CVE-PJC, was
filed in the U.S. District Court for the Northern District of Oklahoma.
The U.S. Equal Employment Opportunity Commission, which is tasked with
enforcing GINA, filed suit against Fabricut, Inc., a fabric distributor.
EEOC alleged that the company:
- (1) violated the ADA when it refused to hire a woman as a memo clerk because it regarded her as having carpal tunnel syndrome; and
- (2) violated GINA when it asked for her family medical history in its post-offer medical examination.
The employee in question, Rhonda Jones, worked as a temporary clerk for Fabricut. When her temporary assignment was ending, she applied for a permanent position.
Case Background
Fabricut made Jones an offer and sent her to its contract medical examiner
for a pre-employment drug test and physical, according to EEOC. At the exam,
she was required to fill out a questionnaire and disclose disorders in her
family medical history. The questionnaire asked about the existence of heart
disease, hypertension, cancer, tuberculosis, diabetes, arthritis and "mental
disorders" in her family. After the exam, the examiner concluded that
further evaluation was needed to determine whether Jones had carpal tunnel
syndrome.
Fabricut told Jones she needed to be evaluated by her personal physician and
to provide the company with the results. Her doctor informed the employer
that Jones did not have carpal tunnel syndrome. Despite the letter, the
company rescinded its job offer. According to EEOC, Jones urged the employer
to reconsider but it refused.
In addition to the monetary settlement, Fabricut will distribute
nondiscrimination policies to employees and provide anti-discrimination
training to employees with hiring responsibilities.
"Although GINA has been law since 2009, many employers still do not
understand that requesting family medical history, even through a contracted
medical examiner, violates this law," Barbara Seely, a regional attorney
with EEOC, in a press release.
David Lopez, EEOC's general counsel, reminded employers that the commission
considers GINA enforcement a priority. "When illegal questions are required
as part of the hiring process, the EEOC will be vigilant to ensure that no
one be denied a job on a prohibited basis," he said.
Self-Insured Employers Must Tell Employees about Health Insurance Exchanges
MyHealthGuide Source: Self-Insurance Institute of America, 5/14/213,
www.SIIA.org
The Department of Labor (DOL) last week issued model
language for the "Exchange Notice" that most self-insured group plans will
be required to send to plan participants.
The DOL also issued guidance explaining:
- What employers are required to send the Exchange Notice
- When the notice must be delivered.
- Who the notice must be delivered to.
- How the Exchange notice can be delivered.
Below is a brief summary of the guidance along with a link to the model language. The model language can be accessed on-line at: www.dol.gov/ebsa/pdf/FLSAwithplans.pdf
What Employers Are Required to Send the Exchange Notice?
- In general, an employer that (1) employs one or more employees and (2) has at least $500,000 in annual revenue is required to send an Exchange notice. Also, hospitals, health and mental institutions, certain schools, preschools, elementary and secondary schools, institutions of higher education, and federal, state, and local government agencies are subject to this new requirement.
Who Must Receive the Exchange Notice?
- The Exchange notice must be sent to ALL employees - both part-time and full-time. The notice does not have to be sent to dependents of the employees.
When Must the Exchange Notice Be Delivered?
- The Exchange notice was originally required to be sent out in March 2013, but the new guidance now indicates that the Exchange notice must be delivered no later than Oct. 1, 2013. An employer can deliver the notice before Oct. 1, 2013 if the employer chooses.
- In the case of new employees hired AFTER Oct. 1, 2013, an employer must provide the Exchange notice within 14 days of the employee's start date.
How Can the Exchange Notice Be Delivered?
- The Exchange notice may be provided by first-class mail.
- Alternatively, the Exchange notice may be provided electronically, but only if the electronic delivery is made in accordance with DOL's electronic disclosure safe harbor rules.
Additional Exchange Notice Information
It is interesting to the see the type of information that an employer must include about the employer's health plan in the notice (e.g., whether the employer offers coverage to all or only some employees and who are eligible employees under the plan, and whether the employer offers dependent coverage and who are eligible dependents). An employer also has the option to include additional information specific to the lowest-cost self-only plan. This is intended to equip the employee with the appropriate information about the cost of the employer plan, which is required if an employee happened to apply for a premium subsidy.
About SIIA
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 SIIA Washington Counsel, Chris Condeluci, at 202/463-8161, ccondeluci@siia.org and visit www.SIIA.org.
Osteopathic Manual
Treatment and Ultrasound Therapy for Chronic Low Back Pain Studied
MyHealthGuide Source: Annals of Family Medicine, 4/2013,
AFM Abstract & Article
Osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic
low back pain where found to be effective according to a study published in
the Annals of Family Medicine.
The study was a randomized, double-blind, of OMT and UST for short-term
relief of nonspecific chronic low back pain among. The 455 patients
were randomized in four cells (2X2 matrix) of
- OMT + UST ,
- sham OMT + UST,
- OST + sham UST, and
- sham OST + sham UST
Six
treatment sessions were provided over 8 weeks. Intention-to-treat analysis
was performed to measure moderate and substantial improvements in low back
pain at week 12 (30% or greater and 50% or greater pain reductions from
baseline, respectively). Five secondary outcomes, safety, and treatment
adherence were also assessed.
Study findings
- There was no statistical interaction between OMT and UST.
- When patients receiving OMT were compared to patients receiving sham
OMT, there was
- 38% who achieved moderate improvements in low back pain at week 12
- 41% who received substantial improvements in low back pain at week 12.
- Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.
- Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study.
- Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group.
- Ultrasound therapy was not efficacious.
Researchers conclude that OMT regimen met or exceeded the Cochrane Back
Review Group criterion for a medium effect size in relieving chronic low
back pain. It was safe, parsimonious, and well accepted by patients.
About Low Back Pain and Costs
Low back pain is primarily responsible for more than 20 million ambulatory medical care visits and $100 billion in costs annually in the United States. When low back pain persists for 3 months, it is considered chronic and may cause progressive physical and psychological effects.
Although practice guidelines recommend considering spinal manipulation for chronic or persistent low back pain, a Cochrane Collaboration review concluded that spinal manipulation is not more effective than sham interventions for short-term relief of chronic low back pain.
The effectiveness of spinal manipulation remains controversial among family physicians. Osteopathic manual treatment (OMT) is delivered by osteopathic physicians in the United States, and by osteopaths in many other nations. No trial of OMT has conclusively found efficacy in relieving low back pain 8–13 or achieved a status of low risk of bias.
High-quality trials of ultrasound therapy (UST) are also needed to assess its efficacy compared with sham procedures.
Medical Stop-Loss Providers Ranked by Annual Premium Survey
Source: MyHealthGuide
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 other.
| Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and correction is
encouraged. |
||||||
| Stop-loss Provider | Years Providing Stop Loss | Associated Carriers / MGUs | Annual stop-loss Premium (Millions) |
Capital /Equity (Millions) |
Source | |
| 1. | CIGNA | $1,672 2012 |
CIGNA 2012 10-K, page 42 3/15/2013 | |||
| 2. | Sun Life Financial | $839.9 2012 |
Sun Financial
Release, 5/2/2013 |
|||
| 3. | HCC Life Insurance Company | >35 Years | HCC Life (A.M. Best Rated: A+) Perico Life (A.M. Best Rated: A+) |
$835 2012 |
Craig Kelbel, President & CEO 3/25/2013 |
|
| 4. | Symetra | >36 Years | Symetra Life Insurance Company (A.M. Best Rated: A) (Block - $475M MRM - $255M) |
$730 2012 |
$2,174 12/31/2012 |
David Fry, SVP, Symetra; Mike McLean, President Medical Risk Managers, Inc. 3/21/2013 |
| 5. | HM Insurance Group | >30 Years | HM Insurance Group (A.M. Best Rated: A-) |
$695 2012 |
$474 12/31/2012 |
Mike Sullivan, President & COO 5/31/2013 |
| 6. | ING Employee Benefits |
> 35 Years | ReliaStar Life (A.M. Best Rated: A) |
$555 2011 |
$2,104 12/31/2011 |
Joe Keller, ING Employee Benefits, 10/25/2012 |
| 7. | Independence Holding Company | Standard Security Life Insurance
Company of New York, Madison National Life, Independence American Insurance Company |
$280 | MyHealthGuide Estimate. 7/1/2011 |
||
| 8. | Companion Life | $225 | Philip Gardham, Vice President,
Specialty Markets, 8/16/2011 |
|||
| 9. | National Union Fire Insurance Company of Pittsburgh | AIG Benefit Solutions | $188 4/2013 |
Jeff Gavlick, VP,
Stop Loss Products, AIR Benefit Solutions. 5/17/2013 |
||
| 10. | Zurich North America | $130 | Tracey Brennan, Zurich North America.
7/22/2011 |
|||
| 11. | Munich Re Stop Loss, Inc. | AAIC, TransAmerica | $110 2012 |
Susan McGrath Bowman, Chief Operating Officer, Munich Re Stop Loss, Inc. 4/25/13 |
||
| 12. | The Union Labor Life Insurance Company (ULLICO) | >25 Years | ULLICO (A.M. Best Rated: B++) |
$84 2012 |
$210 12/31/2011 |
Victor Moran, Second Vice President, Actuarial Operations. 2/25/2013 |
| 13.
|
Markel Insurance Company | <5 Years | Markel Insurance Company (A.M. Best Rated: A-) |
$3 | $3,388 12/31/2011 |
Mark Nichols, Managing
Director. 7/20/2012 |
| NA |
United States Fire Insurance Company (A.M. Best Rated: A) |
NA | IOA Re, Vista Underwriters | NA | $1,000+ |
AM Best, MGU Websites 1/22/2013 |
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.
- ACE America
- Aetna
- Amalgamated Life
- American Fidelity Assurance Company
- American National Life Insurance Company of Texas
- BEST Re
- Blue CrossBlue Cross Blue Shield (various regions)
- Gerber Life Insurance Company
- Lloyd's of London
- Nationwide Life Insurance Company
- Pan American Life
- QBE Insurance Company
- Trustmark Insurance Company
- UnitedHealthcare
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:
- Ratings from Best, S&P, Moodys and others (data collection began 6/2012)
- Capital size of the insurance company (data collection began 6/2012)
- Reinsurance purchased and from whom
- Length in the business (data collection began 6/2012)
- Number of open litigation claims
- Is stop-loss a core business or ancillary business?
- Percentage of risk retained vs. ceded
- Average stop-loss claim processing turn-around time
- Percentage of claims denied
Should reader interest indicate such measures are important, this Newsletter will attempt to collect and report.
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
May 20-21, 2013
Washington Legislative Update presented by
International Foundation of Employee Benefit Plans (IFEPB). From election implications to health care
reform and recently passed fiscal cliff legislation, the 2013 Washington
Legislative Update is a must-attend event. Hear from Washington insiders as
you plan for the future. Stay informed and educated about the
complex regulations, policy initiatives and proposed legislation
that impact your benefit plans. Session include:
- Impact of Fiscal Cliff Legislation on Employee Benefits
- What to Expect in the Second Term of the Obama Administration
- Will Taft-Hartley Plans Survive the Affordable Care Act?
- Update on ACA Implementation
- Entitlement and Tax Reform
- DOL Update
The Capital Hilton, Washington, DC. Information and Registration: www.ifebp.org/Education/schedule/1312washingtonUpdate.htm
May 23, 2013 - Webinar
8:00pm ET (5:00 PM Pacific Time)
Case Studies in Diagnostic Errors -- Errors in Diagnosing Dizziness
presented by Best Doctor, Inc.
According to the American Academy of Family Physicians, dizziness accounts
for an estimated five percent of all primary care clinic visits, yet a final
diagnosis is not obtained in about 20 percent of cases. Dr. Martin Samuels
(Best Doctor and Chairman,
Department of Neurology, Brigham and Women's Hospital; Professor, Harvard
Medical School), hosts a panel of specialists for a 45-minute webinar
exploring major contributors to diagnostic errors for patients experiencing
dizziness. Topics:
- Mistakes in differentiating a basilar stroke from benign peripheral vertigo
- Confusing benign vertigo with syncope caused by an underlying serious cardiovascular disease
- Missing a serious (but treatable) otolaryngological disorder
Registration: http://bit.ly/16fEi0E
Contact Justin Joseph at 617.963.1156 or
jjoseph@bestdoctors.com.
May 19-22, 2013
2013 TriZetto Healthcare Conference p presented by TriZetto. TPAs, health
plans,
health systems and physician practices gather to collaborate on solutions and
strategies that can increase the efficiency and effectiveness of the
business of healthcare. Palm Springs, CA. Keynote speakers: Nancy-Ann DeParle, guest scholar in economic studies at the Brookings
Institution and lecturer at Harvard Law School, is one of the nation's
leading experts on healthcare and regulatory issues. While counselor to
President Obama and director of the White House Office of Health Reform, DeParle played a leading role in crafting the Affordable Care Act, an
historic piece of legislation. Michael Millenson, president of Health
Quality Advisors LLC, is author of the critically acclaimed book, Demanding
Medical Excellence: Doctors and Accountability in the Information Age, and a
visiting scholar at Northwestern University's Kellogg School of Management.
Information: Follow on Twitter #TZHC13 and visit www.trizetto.com.
May 29-30, 2013
Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance
Institute of America (SIIA). Chase Park Plaza Hotel. St. Louis, MO.
Contact 800-851-7789 and visit
www.SIIA.org.
June 4, 2013 - Webinar
2:00 - 3:15 pm ET
Cleveland Clinic Case Study: How We Created a Culture of Health and
Responsibility for Our Own Employees presented by
Cleveland Clinic. Learn how Cleveland Clinic produced a successful initiative to manage the care of
employees with chronic conditions. The program provides financial incentives
to employees who achieve certain clinical benchmarks through participation
in wellness and prevention programs. The result: improved quality of life
for employees and a reduction in both cost and utilization of medical
services.
During this webinar, attendees will:
- Learn how proper financial incentives can engage employees and drive clinical outcomes
- Discover why obesity should be treated as a chronic disease and co-morbidity
- Find out how coaching and behavioral health tools can support chronic disease care
- Learn how integration of wellness and chronic disease programs can create synergies
Webinar Presenter: Bruce Rogen MD MPH, Chief Medical Officer, Cleveland Clinic Employee Health Plan, Cleveland Ohio. Registration: www.conf-reg.com/webreg/RegGate.wbr?ZW13057
June 10-12, 2013
2013 Annual International Conference presented by
Self-Insurance Institute of America (SIIA)Newport Beach, CA.
www.SIIA.org
July 10-12, 2013
2013 TPA University presented by Health Care
Administrators Association (HCAA). HCAA's annual TPAU provides
in-depth discussion and analysis of key industry issues.
Glenn McLellan, McLellan Consulting Services (MCS),
conducts the
three-day annual event offers a comprehensive view of trends and
issues within third party administration. Sessions are some of the
most informative in the industry and our networking opportunities
are unmatched. Disney's Grand Californian Resort & Spa. Anaheim, CA.
Information and registration:
www.hcaa.org/tpa/index.html
July 22-24, 2013
2013 Health & Business Symposium: The New Frontier of Healthcare
presented by EBMS, Inc.
To succeed in the post-PPACA era, join
EBMS clients, benefit consultants and industry experts as nationally known
physicians and innovators, Dr. Jason Hwang and Dr. Keith Smith share new
business models meant to change the landscape of healthcare. National
thought leaders Adam Russo, Larry Thompson and Brad Cleveland will be on
hand, along with a host of EBMS and industry professionals, to share
trailblazing strategies that every self-funded health plan and their
business partners can employ to "bend the trend" and achieve better overall
health for their workforce. Continuing education credits available.
Billings, Montana. Contact Alice Agiello at
800.777.3575 ext. 1234 and ajagiello@ebms.com.
Information and registration: www.EBMSevents.com.
July 23-25, 2013
MCIA 8th Annual Conference presented by Montana Captive
Insurance Association, Inc.. Features key captive regulators,
captive owners and leading service providers addressing a variety of
timely educational topics. Lodge at Whitefish Lake, Whitefish,
MT. Information:
mcia@mtcaptives.org and
www.mtcaptives.org
September 18-20, 2013
SPBA Fall Meeting (members only). Fairmont,
Dallas, TX. Society of Professional Benefit Administrators
(SPBA). www.SPBATPA.org
October 21-23, 2013
National Educational Conference & Expo presented by Self-Insurance
Institute of America. Chicago Sheraton Hotel. Chicago, IL. Contact
Justin Miller at 800-851-7789,
jmiller@siia.org and visit
www.SIIA.org.
December 5-6, 2013
IHC FORUM West in Las Vegas! presented by IHC FORUM. Red Rock
Resort & Spa. Information and registration:
www.theihccforum.com/2013-forum-west/
February 4-6, 2014
2014 Executive Forum presented by Heath Care Administrators Association (HCAA). Encore at Wynn Las Vegas. Las Vegas, NV. www.HCAA.org.
March 24-26, 2014
Self-Insured Health Plan Forum presented by Self-Insurance Institute of America (SIIA). Charleston, SC. www.SIIA.org.
April 16-18, 2014
SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org
April 23-24, 2014
Legislative Conference presented by Self-Insurance Institute of America (SIIA). Washington, DC. www.SIIA.org.
October 5-8, 2014
National Conference presented by Self-Insurance Institute of America (SIIA). , J.W. Marriott Desert Ridge, Phoenix, AZ. www.SIIA.org.
October 15-17, 2014
SPBA Fall Meeting (members only). Nashville, TN. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org
Editorial Notes, Disclaimers & Disclosures
- Articles are edited for length and clarity.
- Articles are selected based on relevance and diversity.
- No content in this Newsletter should be construed as legal advice. All legal questions should be directed to your own personal or corporate legal resource.
- Internet links are tested at the time of publication. However, links change or expire often.
- Articles do not necessarily reflect views held by the Publisher.
- Disclosure: Owner of MyHealthGuide also has ownership interest in CareHere, LLC® and LabInsight®
Ernie Clevenger
President & Publisher
MyHealthGuide, LLC
Clevenger@MyHealthGuide.com