MyHealthGuide Newsletter
News for the Self-Funded Community
1/30/2012
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
The Phia Group Announces the Development of its Plan Language Service Center
NorthWind Provides Coverage for IRO Reversals
Fairmont Specialty and Kindred Travel Launch "Reverse" Evacuation Program
One Call Medical's Subsidiary Express Dental Holdings Moves to New, Larger Location
Market Trends, Studies, Books & Opinions
Beating the Spread: Understanding and Eliminating Spread Pricing in Pharmacy Benefit Plans
Health Plans Seeking the Cost Savings of Generic Drugs Must Still Remain Vigilant for Overcharges
Legal, Legislative & Regulatory News
Is Plaintiff an ERISA "Participant" Following Separation from Employment?
When Overeating, Calories, Not Protein, Contribute to Increase in Body Fat
Editorial Notes, Disclaimers & Disclosures
The Phia Group Announces the Development of its Plan Language Service Center
MyHealthGuide Source: The Phia Group, 1/25/2012, www.PhiaGroup.com
Braintree, MA -- To ensure that all self funded benefit plans maximize benefits while minimizing costs, The Phia Group is proud to announce its new "Plan Language Service Center."
The Phia Group's Senior Vice President and General Counsel, Ron E. Peck, advised that, "It is a fact that the greatest advantage of being self-funded is plan design. All of the plan's rights, obligations, and rules are set forth in its plan document. That is why a benefit plan's rights are only as good as its plan language." The Employee Retirement Income Security Act of 1974 ("ERISA") merely permits the enforcement of the plan document. If the document is ambiguous or silent as it relates to any issue, the benefits of ERISA are nullified.
When a plan sponsor seeks to obtain updated language, there has been an industry trend towards offering template plan documents as the only option. These "one size fits all" documents are sold to TPAs and employers, who would then "fill in the blanks." According to Mr. Peck, "it's basically like a health insurance version of Mad Libs... only unlike Mad Libs, sometimes the end result isn't funny at all." The issue is that many benefit plan sponsors consider self-funding to be a viable option because they can customize their plan document to reflect their needs and values. Being forced to use a preset document eliminates that benefit.
"Rather than only offer a template," says The Phia Group's CEO, Adam V. Russo, "we are also happy to revise existing provisions, add new language to functional documents, and ensure that each plan has a unique document customized to meet their unique needs. We offer an amazing plan document template for plans that are just getting started, or plans that want to scrap their current document and start fresh... but we also wanted to make sure we had a suite of services for use by plan sponsors that would rather do something different." The end result? "By focusing on plan language updates, revisions, and modernization -- rather than cookie-cutter templates -- benefit plans continue to utilize a document that they are familiar with, but also which features up-to-date provisions."
Mr. Russo added, "In addition to fixing plan documents from a compliance standpoint, we also add specialized provisions we've developed to deal with the types of issues our consulting team regularly handle, including language dealing with stop loss, PPO networks, fiduciary duties, and other complex matters most other plan document templates ignore."
To learn more about The Phia Group's suite of plan document services, and find out how The Phia Group is "Setting the Industry Standard for Plan Language™," please contact The Phia Group's Director of Client Services, Andrew Milesky, at 781-535-5636 or via amilesky@phiagroup.com.
About The Phia Group
The Phia Group's mission is to reduce the cost of health care through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward thinking methodology, The Phia Group boasts an all encompassing cost containment scheme for the ever-changing health care industry. Visit www.PhiaGroup.com.
NorthWind Provides Coverage for IRO Reversals
MyHealthGuide Source: NorthWind, LLC, 1/27/2012, www.northwindllc.com
NorthWind, LLC is pleased to announce that it will provide coverage for claim denial reversals under the IRO provisions of PPACA. Accordingly, NorthWind will consider appropriate claims that have been denied by the Administrator, which are later overturned by an IRO panel.
"It is important to provide products that reduce uncertainty for our self-insured clients" said Doug Thomas, NorthWind's President. "As our clients face new challenges under PPACA, we will continue to innovate our offerings, providing them the necessary tools for managing risk."
About NorthWind
NorthWind, LLC is a full service managing general underwriter of various specialty insurance products. Since its 1997 inception, NorthWind has written over $250 million of premium for insurance companies rated "Excellent" by AM Best across 40 states. In addition to its underwriting services, the company provides specialty brokerage services in both the employee benefit and property/casualty spaces. Visit www.northwindllc.com.
GTESS ClaimPRECISE™ Solution Helps TPAs and Health Plans Respond to Market Demands, Regulatory Updates
MyHealthGuide Source: GTESS Corporation, 1/23/2012, www.gtess.com
Richardson, TX -- GTESS Corporation, a provider of claims pre-adjudication technology and services for the healthcare industry, announced that its ClaimPRECISE™ solution with multiple deployment options is helping customers respond to healthcare reform and industry challenges while saving up to 50% on claims processing costs. ClaimPRECISE is the complete integration of GTESS technologies including several product enhancements that have been released over the past 18 months.
GTESS clients have responded favorably to its advanced technology and services: the company achieved a 99%+ client retention rate over the past three years, including eight long-term renewals over the last six months. GTESS also received a 99.75% satisfaction level on its most recent client satisfaction survey.
"At GTESS, we are committed to continually innovating value-based solutions that address market needs, drive operational efficiencies and help our clients grow their businesses," said Donna Taylor, GTESS EVP & COO. "Our client satisfaction and renewal rates underscore the fact that our automated and flexible solutions make a positive financial impact to their bottom lines."
Last spring, GTESS introduced its breakthrough Advanced Claim Validation technology, which facilitates data verification through automated problem diagnosis and resolution recommendations, and expanded its delivery options, giving clients the flexibility to insource, outsource or combine insourcing and outsourcing to facilitate pre-adjudication claims processing management. The delivery options also feature redaction, helping clients remain compliant by removing Personally Identifiable Information (PII) from digital claim files and images.
About GTESS
ClaimPRECISE™, drives automation and straight-through processing, allowing healthcare payers to accelerate their initiatives to achieve lower transaction costs, improve payment accuracy and move toward real-time transaction processing. Our patent-pending technology yields superior quality, lower costs and guaranteed compliance. Using technology instead of human labor and offering multiple deployment options, ClaimPRECISE solutions are customized to adapt to client specific business requirements and improves performance without additional capital investment.
GTESS is a Dallas, Texas-based provider of claims pre-adjudication technology and services for advancing the efficiency, accuracy and speed of healthcare transactions. We provide technology that allows our clients to achieve their goals for increased automation, speed and lower costs of claims processing. GTESS serves health plans, benefit administrators and networks, and our team of healthcare-experienced professionals delivers industry-leading service levels and guaranteed high-quality results every day. Contact Vincent Vallejo, Vice President, Sales Operations, at (972) 792-5529, vvallejo@gtess.com and visit www.gtess.com.
Fairmont Specialty and Kindred Travel Launch "Reverse" Evacuation Program
MyHealthGuide Source: Fairmont Specialty, 1/25/2012, www.FairmontSpecialty.com and www.kindredtravel.com
Eatontown, NJ -- The accident & health division of Fairmont Specialty, part of Crum & Forster group, is pleased to announce the launch of a new and unique emergency travel program with Kindred Travel.
Kindred Travel is a unique service that has been set up to assist in getting individuals and families to their loved ones as quickly as possible in the event of a medical emergency. This program was developed in response to the high costs and intricacies associated with last minute travel. Through their background in the financial and insurance industries, founders Jeremy Coll and James Hill created the Kindred Travel Membership program to be the premium service for emergency flights and accommodations around the world. The program has had great success in Europe and is the first of its kind in the United States. Kindred Travel Membership may be offered on both a group and individual basis.
About Kindred Travel
Kindred Travel was founded in 2011 by Jeremy Coll and James Hill, who had both experienced firsthand the costs and problems when you need to travel at short notice. Through their background in the financial and insurance industries they created the Kindred Travel Membership Program, to be the premium service for emergency flights and accommodation. Kindred Travel Membership was developed by Kindred Travel LLC and utilizes the assistance services of On Call International. Contact Jeremy Coll, Partner, at 00 44 1491 352008, jcoll@kindredtravel.com and visit www.kindredtravel.com.
About Fairmont Specialty, part of Crum & Forster group
Fairmont Specialty is part of Crum & Forster group, a national commercial property and casualty group of insurance companies wholly owned by Fairfax Financial Holdings Limited. Crum & Forster offers a broad range of commercial property and casualty insurance products, including standard and specialty casualty lines, and excess & surplus lines, as well as excellent claims and loss control services. The Accident & Health division of Fairmont Specialty offers a unique variety of insurance and reinsurance products, some of which are underwritten in-house and others though select strategic partnerships. The Crum & Forster group of companies has an A (Excellent) rating from A.M. Best (2011). Contact Lauren Woods, Sr Marketing Associate at 732-676-9833, lwoods@fairmontspecialty.com and visit www.FairmontSpecialty.com.
Dossia Joins Forces With PatientPAL to Provide Individuals With Tools
Necessary to Put Them at the Center of Their Health and Care
MyHealthGuide Source: Dossi, 1/27/2012, www.dossia.org
and www.PatientPAL.org
CAMBRIDGE, MA -- Dossia, a leading health management system
provider, announced a strategic alliance with patient advocacy service
provider PatientPAL to offer an effective solution to improve the quality of
care and overall healthcare experience of users. The joint solution will
allow individuals to better navigate the healthcare system and provide users
with services that will enable them to make better health and healthcare
decisions, leading to higher value care and lower out-of-pocket expenses.
The PatientPAL solution will now be available to Dossia users through the
Marketplace in the Dossia Health Manager.
The capabilities that the PatientPAL solution now provides to Dossia users
include:
- Assist members with securing second opinions and schedule with hard-to-access physicians
- Assist in resolving error in claim denials or billing issues
- Steer patients from unnecessary ER and into engagement with PCP
- Enable users to pursue a healthy lifestyle, prevent disease, manage chronic conditions, reducing need for excessive cost/care
- Identify and suggest high value procedures and providers upcoming appointments
- Refer patients to appropriate specialists
- Arrange for emergency transportation (including medical air transport), home health care, delivery of medical equipment, etc.
"As high-deductible health plans and purchases of customized healthcare services become more prevalent, it is imperative for individuals to be armed with the types of services offered jointly by Dossia and PatientPAL so they can identify and demand higher quality care," said Dossia CEO Mike Critelli. "Dossia is very pleased to be working with PatientPAL to bring these necessary services to Dossia users."
Patient PAL is focused on providing clients and their family members with expedited access to health care services. The Patient PAL service model prides itself on assisting its members in navigating through the complex health care system and will cooperate with the provider network and the client to ascertain the most beneficial outcome possible on behalf of the patient. With many health care issues that arise unexpectedly, the Patient PAL advantage makes dealing with chronic health conditions, emergencies, major surgeries, catastrophic health events, and a myriad of other health care related issues, much less stressful for patients and their families. As is Dossia's aim, Patient PAL desires to empower the patient while "Compassion is our Focus, Prompt Service is our Standard, and the Patient Always Comes First."
"Patient PAL users now have the benefit of Dossia's revolutionary technology based Health Management System that has taken years to develop by some of the nation's leading Fortune 100 companies. The advancement of the Dossia program will only enhance the effect of the Patient PAL service model and will bring an added and indispensable value to our own population base," affirmed President and CEO of Patient PAL, Jack G. London. "We are excited about the opportunity that this association brings to our current members and members to be."
The Dossia Health Management System was launched in the summer of 2011 and
included a wide variety of new capabilities. Dossia's intelligent platform
is able to suggest tools and content based on the information that enters a
user's record. Dossia further augments the value of these solutions by
adding a layer of game and social dynamics, incentives and messaging in
order to foster sustained user engagement, behavior change and value to
employers. Additionally, Dossia currently offers an extensive ecosystem of
third party applications that address all aspects of a user's health and
healthcare.
About Dossia
Dossia is a non-profit organization consisting of several large U.S. employers who have united under a common vision: to empower their employees to make smarter more informed decisions about their healthcare. Through Dossia, they will leverage their combined influence to break down barriers to health information, which will help drive consumer-initiated change. The Dossia Founders group includes AT&T, Applied Materials, BP America, Cardinal Health, Intel, NantWorks, Pitney Bowes, sanofi-aventis, Vanguard Health Systems and Walmart. Contact Shelley Harrison at 617-621-7677, shelley.harrison@dossia.org and visit www.dossia.org.
About PatientPAL
Patient PAL™ has developed relationships with Centers of Excellence from a national perspective of favorable outcomes for the most complex healthcare maladies known. PatientPAL.org was created and, as a result of fortunate opportunities and nationwide recognition, it has been established as one of the leading advocacy firms in the United States with assistance provided for over 1.8 million covered lives to date. Patient PAL™ adheres to the maxim of, "The Patient Always Comes First" as it offers patient advocacy services to individuals to help navigate through the complex health care system. Contact Rebecca Sherer at 702-737-7555, RebeccaS@PatientPAL.org and visit www.PatientPAL.org.
WPC Services Strengthens Security and Compliance Offerings in Wake of HITECH Preparations and Surging Data Breaches
MyHealthGuide Source: WPC Services, 1/16/2012, www.wpc-services.com
BRENTWOOD, TN -- WPC Services, a full-service healthcare technology and business process consulting organization in Brentwood, Tenn., announced that it is broadening the scope of its security consulting approach and offerings. The expanded security practice will meet healthcare organizations' burgeoning demands for greater safeguarding of data and enhanced protection of business associates and patients against the exponential risk of data breaches, identity theft and fraud.
"We're seeing an unprecedented need to provide broad and powerful security solutions to protect healthcare organizations from a variety of threats," said WPC Services Chief Security Officer Brad Hutson. "Because of changing regulatory rules stipulating higher penalties for HIPAA violations, damage from any breach to a covered entity now has much greater impact. Losing millions of dollars due to a data security compromise can wipe out profit margins and damage reputations for years to come."
WPC Services' expanded security solutions incorporate an all-inclusive business approach in its assessment of HITECH and HIPAA security compliance efforts. WPC's Security Development Lifecycle (SDL) analyzes the processes, people and technology that access sensitive data and mitigates the risk of mobile e-health data compromises.
Additionally, WPC's security team has deep experience with federal and state government agencies. Leading the growing security leadership practice is Hutson, Stephen Sideris, data security lead, and Brian Weston, quality assurance lead. The team's certifications include Certified Information Systems Security Professional (CISSP), Certified Information Systems Auditor (CISA), Certified Ethical Hacker (CEH), Certified Cyber Security Analyst (CCSA), Capability Maturity Model Integration (CMMI), and Information Technology Infrastructure Library version 3 (ITILv3). Collectively, WPC brings more than 50 years of experience at large multinational companies and small businesses specializing in database, application and infrastructure security to protect sensitive data.
Meaningful Use and new payment models continue to spur active digitizing of clinical and financial data and processes that are generating an abundance of electronic protected health information (ePHI). HIPAA 5010 data processing requirements and the transition to ICD-10 codes are equally having an impact on ePHI management. As well, HITECH entails stringent security protocols along with increased enforcement of HIPAA Privacy and Security Rules and Breach Notification standards.
"Though patient data has long been a target for cyber criminals, activists and other malicious activities, the consequences are now greater than ever," said Hutson. "This period of tremendous change in our industry demands intense scrutiny of how and where ePHI is developed, handled, monitored, accessed and used."
"WPC was the original contractor to CMS for HIPAA transaction compliance so security and compliance is in our DNA. By focusing exclusively on healthcare, WPC leverages unparalleled industry experience and expertise ensuring a security offering that covers the many people, processes and technologies challenges in healthcare," said Eric Mueller, president, WPC Services. "Our goal is to help our clients confront and overcome rapidly evolving healthcare security challenges while improving business operations."
About WPC Services
WPC Services is a full-service healthcare technology and business process consulting organization in Brentwood, Tenn. The subsidiary is a growing extension of Seattle-based Washington Publishing Company (WPC), the founding publisher of HIPAA implementation guides and code sets. Anchored by its 35-plus year heritage, WPC Services provides technical, business process and compliance expertise. Its comprehensive solutions empower healthcare organizations to optimize operational performance and effectively manage complex business and technology change. Domain experts specialize in: application development, integration and interoperability, data analysis, trending and reporting, HIPAA compliance and readiness, ICD-10 readiness assessment and attestation, health I.T. training, electronic medical records adoption, health information exchange, payment reform, Accountable Care Organization qualifications, and more. Visit www.wpc-services.com.
Flexible Benefit Service
Introduces FSA and HRA Enhancements As More Employers Prepare for HSAs and
HRAs
MyHealthGuide Source: Flexible Benefit Service Corporation,
1/24/2012,
www.flexiblebenefit.com
ROSEMONT, Ill -- Flexible Benefit Service Corporation (Flex)
announced they are introducing enhanced Flexible Spending Account
(FSA) and Health Reimbursement Arrangement (HRA) products, which are now
supported by a more robust benefits administration and reimbursement
platform.
The FSA and HRA platform enhancement comes as many employers are evaluating
their benefit options in an upcoming world of changes that health care
reform will bring. According to a recent study by McKinsey & Company, 45 to
50 percent of employers will definitely or probably pursue alternatives to
employer sponsored insurance in the years after 2014. Among these options is
offering their coverage through a defined-contribution model, such as an FSA
or HRA.
"Flex has been a long-time advocate for consumer-driven strategies and
tax-advantaged programs because they create cost-effective health care plans
for employers of all sizes," says John DiVito president of Flex
"Our enhanced FSA and HRA platform streamlines the employer and participant
experience and offers cutting edge reimbursement solutions."
The FSA and HRA platform enhancements apply to FlexFSA®, FlexHRA® and
Flex125® Cafeteria Plans. Key features that the enhanced FSA and HRA
platform will bring to employers and their participants include:
- Integrated, informational web portal for employer and participant account access
- Weekly and daily reimbursement options
- Multiple funding options
- Online claims submission with automated e-mail status alerts
- Paperless communication options
- Enhanced reporting capabilities
- Free debit cards with all Health Care FSAs
- And, more!
About Flexible Benefit Service Corporation
Flexible Benefit Service Corporation (Flex), headquartered in Rosemont,
Ill., is a leader in the health insurance and benefits administration
markets. Since 1988, it has offered cost-effective healthcare solutions
integrated with unparalleled expertise, service and technology to health
insurance Producers, Employers and Employees. Their two primary divisions
include the Flex General Agency and Flex Plans. The General Agency offers
health insurance Producers free access to leading health, Medicare and
ancillary/voluntary insurance carriers, products, resources and more. The
Flex Plans division serves Employers and Employees through its in-house
portfolio of benefits administration products that are designed to add
cost-effective value to any employee benefits package. Through its
comprehensive understanding of the health insurance and benefits
administration markets, Flex presents a cutting edge perspective on finding
solutions for the rising cost of health care. Contact Nick Severino
at 888-353-9178,
nseverino@flexiblebenefit.com and visit
www.flexiblebenefit.com.
American Health Receives URAC Health Utilization Management, Case Management and Disease Management Accreditation
MyHealthGuide Source: American Health Holding, Inc., 1/24/2012, www.AmericanHealthHolding.com
Worthington, OH -- American Health Holding, Inc. announced that it has been awarded Health Utilization Management, Case Management and Disease Management Accreditation from URAC, a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry.
"American Health is thrilled to receive URAC accreditation again," said Paul Lavin, President & CEO of American Health. "It is an honor to be recognized by URAC, an independent accrediting body that is well-respected in the industry. We will continue to uphold the rigorous standards of quality and efficiency in order to provide outstanding service to our clients."
American Health is a single-source provider of medical management services that support millions of members across the health care continuum. The organization, which received its first URAC accreditation in 1994, has been helping clients to maximize cost savings while ensuring the quality and appropriateness of care for more than 19 years. American Health's flexible, customized programs support integrated solutions for clients and assist in creating healthy outcomes for members.
American Health's Utilization Management, Case Management and Disease Management services are integrated through the company's proprietary system, iSuite, and are delivered by a team of highly qualified clinical staff with the training and tools to impact quality and cost.
The company's Utilization Management program uses evidence-based medical necessity criteria to certify treatments and direct providers towards the most cost-effective, quality treatment available. Utilization Management's robust triggers generate automatic referrals to American Health's Case Management program, through which the company's experienced Case Managers function as advocates, facilitators and educators. Case Managers are Registered Nurses or licensed social workers who ensure that members receive quality care and, when appropriate, make smooth transitions from inpatient settings to alternative care and home care.
About American Health Holding, Inc.
American Health Holding is a single-source provider of medical management services that supports millions of members across the health care continuum. The multi-URAC accredited organization has been helping clients to maximize cost savings while ensuring the quality and appropriateness of care since 1993. American Health provides a level of flexibility that supports integrated solutions for creating healthy outcomes. Contact Anne Klie, Director of Marketing, at (614) 818-3222, aklie@ahhinc.com and visit www.AmericanHealthHolding.com.
MultiPlan Selects Cloud-Based Solution To Provide Automatic PO Generation Upon Approval and Mobile Device Integration
MyHealthGuide Source: BP Logi via PRNewswire, 1/24/2012, www.bplogix.com
SAN DIEGO -- BP Logix, a developer of BPM software that accelerates time-to-value, announced that MultiPlan, provider of a comprehensive suite of transaction-based healthcare cost management services, has selected Process Director/Cloud Edition to centralize its capital expenditure (CapEx) and Major Expenditure Request (MER) processes. The selection of Process Director was made by executives in both Finance and IT, making the decision to acquire the product both a business and an IT decision.
Founded in 1980, MultiPlan is the nation's leading comprehensive provider of healthcare cost management solutions. The company provides a single gateway to a host of primary, complementary and out-of-network strategies for managing the financial risks associated with healthcare claims. MultiPlan delivers its transaction-based services to insurers/health plans, third party administrators, self-funded employers, HMOs and other entities that pay medical bills in the commercial healthcare, government, workers compensation and auto markets. The company processes more than 100 million medical claims annually. MultiPlan is owned by BC Partners, a leading international private equity firm, and Silver Lake, the world's largest private investor in technology.
Initially, MultiPlan expected to replace its proprietary Capital Expenditure (CapEx) application with an eProcurement solution but eventually realized that what was needed was software that embraced the business processes underlying the capital and major expenditures, along with an electronic approval process, and the ability to integrate with MultiPlan's ERP and other packaged applications.
The IT and Finance departments at MultiPlan recognized the need to automate and provide more visibility into the company's Capital Expenditure and Major Expenditure processes, as well as a need to integrate with its financial management software. Lisa Campbell Chau, Contract Manager for IT and Beth Kaplan, Senior Operations Analyst with MultiPlan's Finance department, along with the combined IT/Finance project team, identified the criteria for a tool that would incorporate workflow, business logic, and reporting and would be available as both an on-premise and hosted solution.
Delivering on the promise of rapid deployment and cost savings, while also providing process improvements and automation, MultiPlan entered into a Proof of Concept with Process Director/ Cloud Edition. Over the course of 6 months, Campbell Chau and Kaplan, along with the project team, worked collaboratively to ensure that the technology they selected would address both Finance and IT's concerns. Based on the success of the POC, MultiPlan selected Process Director to automate and manage its CapEx and MER process.
Process Director/Cloud Edition enables business users to review historical and current data related to business processes, understand the implication of activities in running processes and to instantly implement corrective action to overcome a pending problem, if one is present. Process Director/Cloud Edition fuses traditional workflow automation with the BP Logix Process Timeline™. As a result, it enables process builders to specify dependencies and conditions, determine the planned duration of a process, and define the order for all activities within the process.
About BP Logix
BP Logix is the first software company to introduce the dimension of Time into business process management. BP Logix Process Director provides the infrastructure and business intelligence that enables business users to anticipate and predict potential problems in recurring business processes. The system 'learns' how running processes behave, anticipates the impact of changing conditions and adjusts processes accordingly. BP Logix offers an on-premise and hosted model, providing users with the advanced capabilities they need to define, model, automate and track their business processes, resulting in greater efficiency across the organization. Customers include Abbott Labs, DuPont, IDEX, Johnson & Johnson, Leo Burnett USA, NEC Labs, NORESCO, Starwood Hotels and Resorts, the National Eye Institute and the National Institute of Mental Health. Call 877-627-5871 and visit www.bplogix.com.
One Call Medical's Subsidiary Express Dental Holdings Moves to New, Larger Location
MyHealthGuide Source: One Call Medical, Inc. (OCM), 1/26/2012, www.onecallmedical.com
Tampa, FL -- Express Dental Holdings, LLC (EDH), the first and only national dental referral management company to address the specific needs of the workers' compensation, auto, and liability industries and a subsidiary of One Call Medical, Inc. (OCM), has moved to a new, larger location in Tampa. This move strategically positions EDH for future growth and expansion, and enables it to better respond to an increasing demand for dental and specialty referral management services nationwide.
Traditionally, the workers' compensation, auto, and liability industries have lacked convenient access to dental and specialty providers. As a result, adjusters and nurse case managers spent countless hours trying to locate dental and specialty providers who could treat specialized injuries and were equipped to service these lines of insurance. In this way, EDH has helped to fill a critical need in the insurance industry, helping to manage and coordinate referrals for dental, hearing, eye, and other hard-to-find medical specialists.
OCM CEO Don Duford commented on the value of EDH services: "EDH is a strategic component within our portfolio of specialty claims services, offering a unique and comprehensive dental and specialty referral management solution. The new location will support the company's aggressive plans for growth and its ability to serve as a trusted partner to claims professionals, who need assistance in locating and scheduling appointments with quality dental and specialty providers. Its referral management service has enabled clients to achieve greater savings, increased efficiency, and superior outcomes."
EDH President Chris Toepke has observed a growing demand for his company's clinical expertise: "Dental and other specialized injuries are less common than other types of claims. As a result, payers find these claims present unique challenges, complications, and costs--and require clinical expertise and care coordination. From our new office, we'll be able to continue to broaden and deepen our clinical knowledge and oversight to handle various types and levels of claims complexity. In addition, we plan to integrate the latest data and telephony technology to ensure continued service excellence."
The new EDH office is located in the Colonial Place I building, 4350 West Cypress Street, Suite 1000 in Tampa, Florida and covers over 14,454 square feet.
About One Call Medical, Inc.
One Call Medical, Inc. (OCM) is the nation's trusted partner, delivering a suite of easy-to-use, efficient and cost-effective specialty services that help claim professionals achieve superior outcomes. We provide the experience and reliability that optimizes each claim, setting the standard in innovation, customer service, and dependability.
When the management of every claim makes the difference to your bottom line, you can depend on OCM to provide easy, fast, and effective solutions. Through OCM's specialty diagnostic, transportation, translation, interpretation, and dental network services, our customers benefit from access to fully credentialed providers, prompt scheduling of services, and improved care. Contact Bill Colacurcio at 973-316-3718, Bill_colacurcio@onecallmedical.com and visit www.onecallmedical.com.
Willis Re Appoints John Cavanagh as CEO
MyHealthGuide Source: Willis Group Holdings (NYSE: WSH), 1/19/2012, www.willis.com
London, UK, January 19, 2012 – Willis Group Holdings, the global insurance broker, announced the appointment of John Cavanagh as CEO Willis Re, the reinsurance broking arm of Willis Group. Effective immediately, Cavanagh succeeds Steve Hearn, who was appointed Chairman and CEO Willis Global last December. In his new role, Cavanagh joins Peter Hearn, Chairman Willis Re, and Paddy Jago, President of Willis Re on the Willis Re Executive team, in addition to becoming a member of the Willis Executive Committee.
John Cavanagh has been an Executive Vice President and Managing Director of Willis Re since 2009, when he joined Willis from International Specialty reinsurance broker RK Carvill, of which Cavanagh was joint CEO. Previously responsible for production and marketing of large specialty reinsurance accounts, and a member of the Willis Re Global Production Board, Cavanagh brings to the role of CEO 36 years of experience in the London insurance market.
Prior to his 21 years at the Carvill Group, Cavanagh was Deputy Managing Director of Minet Re and a Director of the North American reinsurance division at Willis Faber and Dumas.
As a pioneer in the Capital Markets space, Cavanagh was instrumental in the delivery of the first ever Insurance-Linked Securities (ILS) transaction at Lloyd’s and acted as advisor on the first ever Casualty ILS. He was also a founder of the Carvill Hurricane Index, an innovative product which described the potential for damage from Atlantic hurricanes, and is used as a basis for the trading of commoditised catastrophe instruments on the Chicago Mercantile Exchange.
About Willis Re
One of the world's leading reinsurance brokers, Willis Re is known for its world-class Analytics capabilities, which it combines with its Capital Markets and Reinsurance expertise in a seamless, integrated offering that helps clients increase the value of their businesses. Willis Re serves the risk management and risk transfer needs of a diverse, global client base that includes all of the world's top insurance and reinsurance carriers as well as national catastrophe schemes in many countries around the world. The broker's global team of experts offers services and advice that help clients make better reinsurance decisions, access worldwide capital markets and negotiate optimum terms. Visit www.willisre.com.
About Willis
Willis Group Holdings plc is a leading global insurance broker. Through its subsidiaries, Willis develops and delivers professional insurance, reinsurance, risk management, financial and human resource consulting and actuarial services to corporations, public entities and institutions around the world. Willis has more than 400 offices in nearly 120 countries, with a global team of approximately 17,000 employees serving clients in virtually every part of the world. Visit www.willis.com.
Market Trends, Studies, Books & Opinions
Beating the Spread: Understanding and Eliminating Spread Pricing in Pharmacy Benefit Plans
MyHealthGuide Source: Employee Benefit News, 1/23/2012, EBN Recorded Interview
Scott Haas, CLU, RHU, VP- Integrated Healthcare Metrics and Terrance Killilea, VP of IHM-Clinical and Fiscal Integration, Wells Fargo Insurance Services, talk with EBN Associate Editor Lisa Gillespie about the pervasive issue of spread pricing -- a little-understood pharmacy benefit manager practice that pays a pharmacy a minor amount for a prescription, but charges the employer and policyholder a much higher price for that same drug.
This higher amount is reflected in both the copay and billing to the employer. In an ever-increasing consumer-driven health plan market, the cost is passed on to the employee completely. Killilea and Haas go over why this is a problem, and what employers can do about it.
About Wells Fargo Insurance Services
Wells Fargo Insurance Services USA, Inc., headquartered in Chicago, Ill., is the fifth largest insurance brokerage firm in the world, according to Business Insurance magazine, and the largest bank-affiliated insurance brokerage firm in the United States. We provide insurance brokerage and administrative services, as well as a wide range of financial and consulting services to thousands of satisfied customers. Today, we have 200* offices across the nation with more than 7,000* professionals who place more than $15.5 billion* in risk premiums. Visit https://wfis.wellsfargo.com.
Health Plans Seeking the Cost Savings of Generic Drugs Must Still Remain
Vigilant for Overcharges
MyHealthGuide Source:
Todd Leeuwenburgh, Editor,
Employer Health Benefits, Thompson Publishing Group,
1/25/2012,
Blog Entry
The good news: Important drugs are going generic -- a savings opportunity for
employer-sponsored health plans, which should do what's reasonable and
what's allowed to switch employees over to generics. The bad news: Health
plans may still have to ensure they are getting the maximum cost savings. A
case in point: Several health plans are suing one of the nation's largest
pharmacy chains, alleging that it colluded with a generic drug maker in
order to rip off insurers and self-insured plans.
The lesson for employer-sponsored health plans may be: Learn about your new
generic opportunities … but watch your back.
Good News First
More and more brand-name drugs are going generic. For example, Pfizer's
cholesterol drug Lipitor is now available in generic form: Watson
Pharmaceuticals Inc., and Ranbaxy Laboratories Ltd. are manufacturing
generic Lipitor.
Here's CNN's list of important drugs going generic.
- Lipitor, a cholesterol drug, goes generic in November 2011
- Solodyn, for bacterial infections, also in November 2011
- Zyprexa, used to treat schizophrenia, October 2011
- Lexapro, for depression, March 2012
- Provigil, which treats sleep problems, April 2012
- Plavix, an antiplatelet drug which can prevent blood clots, May 2012
- Singulair, an asthma drug, August 2012
It's important for plan sponsors make a pitch to employees to make those
switches when possible.
As this post reminds us, generics cost only 20% to
30% of what brand-name drugs do.
Now the Hard Part
Medicaid programs lost a combined $329 million in 2009 by failing to switch
over to cheaper generics and opting instead to pay higher rates, Alex Brill
of the American Enterprise Institute stated in
their 2011 report. And worse,
Plans might have to worry about unscrupulous entities trying to take
advantage of weak plan pursuit of generic alternatives, as illustrated in
United Food and Commercial Workers Unions and Employers Midwest Health
Benefits Fund v. Walgreen Co., which alleges fraudulent dispensing of
brand-name drugs by Walgreens, a company that owns and runs 7,000 pharmacies
in 49 states.
"Walgreen's and Par engaged in at least two widespread schemes to overcharge
insurance companies, self-insured employers and union health and welfare
funds," the United Food & Commercial Workers Unions & Employers Midwest
Health Benefits Fund said.
Employer plans appear vulnerable to at least two forms of pharmacy fraud,
according to the
U.S. Health and Human Services Department's Office of
Inspector General:
- collecting brand name prices for dispensing generics; and
- "dispensing fees."
Legal, Legislative & Regulatory News
Is Plaintiff an ERISA
"Participant" Following Separation from Employment?
MyHealthGuide Source: Roy F. Harmon, ERISA lawyer, Harmon & Major, P.A.,
1/27/2012, HealthPlanLaw
Article
Case:
Leeson v. Transamerica Disability Income Plan, 2012 U.S. App. LEXIS 1248
(9th Cir. Wash. Jan. 23, 2012),
Court's
Opinion
Author Mr. Harmon summarizes, "ERISA 'participant' status is not a jurisdictional
issue."
Whether a plaintiff is a "participant" has posed one of the great metaphysical questions in ERISA benefits litigation. It is usually clear that the person was once a participant -- but following separation from employment, are they still? The question can present itself in the form of another ERISA imponderable -- that of standing (see, e.g., The Continuing Controversy Over Standing To Sue Under ERISA).
EExcerpt from the above Leeson case:
- Whether Leeson is a participant for purposes of ERISA is a substantive
element of his claim, not a prerequisite for subject matter jurisdiction. As
the Supreme Court has instructed, "when Congress does not rank a statutory
limitation on coverage as jurisdictional, courts should treat the
restriction as nonjurisdictional in character." Arbaugh v. Y & H Corp., 546
U.S. 500, 516, 126 S. Ct. 1235, 163 L. Ed. 2d 1097 (2006).
- To the extent our prior cases--including Curtis--hold otherwise, they have "no precedential effect" because they are precisely the type [*4] of "drive-by jurisdictional rulings" the Supreme Court has since rejected. Id. at 511 (quoting Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 91, 118 S. Ct. 1003, 140 L. Ed. 2d 210 (1998)). We therefore vacate the dismissal and remand for further proceedings.
In this recent Ninth Circuit opinion, the Court, taking its cue from the
Supreme Court decision in Arbaugh, took a relatively mundane approach to the
issue. Whether a plaintiff is a participant or not is not jurisdictional,
but rather just another aspect of the proof of his or her case.
Granting that some of its prior jurisprudence conflicted with this ruling,
the Ninth Circuit disavowed those prior cases, dismissively characterizing
them as "drive-by jurisdictional rulings". (The blame for introducing this
bizarre metaphor apparently belongs to Justice Scalia. See, Steel Co. v.
Citizens for a Better Env't, 523 U.S. 83 (U.S. 1998)).
The Defendant's case is presented well in this excerpt:
- Transamerica filed a Federal Rule of Civil Procedure 12(h)(3) motion to dismiss for lack of subject matter jurisdiction on the ground that Leeson did not qualify as a plan participant, and therefore lacked statutory standing to sue under ERISA. In support of its argument, Transamerica explained that after the remand, its newly retained counsel located relevant plan documents8 that governed Leeson's eligibility for benefits. Under these LTD plan documents, Transamerica argued that Leeson was not a plan participant because he was on an unpaid leave of absence when he applied for benefits.
The Court rejects this argument for three reasons.
- First, the only limitation to invoking federal court jurisdiction under §
1132(a)(1)(B) relates to the categories of individuals entitled to initiate
a civil action in state or federal court. Franchise Tax Bd., 463 U.S. at 21.
As explained above, participants are among those parties authorized to bring
suit under ERISA. 29 U.S.C. § 1132(a)(1)(B). Like Title VII's employee numerosity requirement, the definition of
"participant" "appears in a separate provision that ‘does not speak in
jurisdictional terms or refer in any way to the jurisdiction of the district
courts.'" Arbaugh, 546 U.S. at
515 (quoting Zipes, 455 U.S. at 394). Section 1002(7) serves to identify
those plaintiffs who may be entitled to relief, not to limit the authority
of federal courts to adjudicate claims under ERISA.
Second, nothing in the jurisdiction-conferring provision requires that a plaintiff must assert anything more than a colorable claim that he or she is a participant in order to assert a claim under ERISA. Our earlier cases imported an additional requirement--that a plaintiff must also actually prove that he or she is a participant to obtain access to federal court. In light of Arbaugh, however, "we are reluctant to infer such a restriction where Congress has not made it explicit." Payne, 653 F.3d at 870.
Finally, we can discern no other reason for importing § 1002(7)'s definitions into ERISA's jurisdiction-conferring provisions. To conclude otherwise would contravene clearly established precedent. Bell, 327 U.S. at 685 (explaining that "the right of the petitioners to recover under their complaint will be sustained if the Constitution and laws of the United States are given one construction and will be defeated if they are given another."). If the district court concludes that Leeson is a plan participant, he may be entitled to relief. If, on the other hand, the district court concludes that Leeson is not a plan participant, his claim fails. See 29 U.S.C. § 1132(a)(1)(B). Because Leeson's ERISA claim rises and falls on the district court's determination of participant status, the construction of the term "participant" involves a merits-based determination, even if it results in a dismissal. As a result, he has a "right" to bring suit in federal court. Bell, 327 U.S. at 685.
This approach serves judicial economy and assures that the claimant has a
day in court. It is a good decision.
Note: It is probably worth noting how these matters should be addressed
procedurally. The Court explained this aspect of its ruling as follows:
- [We] conclude that the district court erroneously dismissed Leeson's case
for lack of subject matter jurisdiction. HN24Go to the description of this
Headnote. By asserting a colorable claim that he is a plan participant,
Leeson has satisfied the threshold for establishing federal court subject
matter jurisdiction. The issue of participant status goes to the merits of
his claim and not to the subject matter jurisdiction of the district court.
In this context, the district court should not have attempted to resolve the issue of participant status when ruling on Transamerica's motion to dismiss under Rule 12(h)(3). Rather, because Leeson's participant status relates to the merits of his claim, the district court should have addressed it at the summary judgment stage or at trial.
When Overeating, Calories, Not Protein, Contribute to Increase in Body Fat
MyHealthGuide Source: Journal of the American Medical Association, 1/4/2012,
JAMA Article
People consuming the low-protein diet had less
weight gain compared to those consuming normal and high protein diets, and
calories alone, and not protein appeared to contribute to an increase in
body fat, according to a study published in the Journal of the American
Medical Association.
George A. Bray, M.D., of the Pennington Biomedical Research Center, Baton
Rouge, La., and colleagues conducted a study to determine whether the level
of dietary protein differentially affected body composition, weight gain, or
energy expenditure under tightly controlled conditions.
The randomized
controlled trial included 25 U.S. healthy, weight-stable male and female
volunteers, ages 18 to 35 years, with a body mass index between 19 and 30.
The first participant was admitted to the inpatient metabolic unit in June
2005 and the last in October 2007. After consuming a weight-stabilizing diet
for 13 to 25 days, participants were randomized to receive diets containing
5% of energy from protein (low protein), 15% (normal protein), or 25% (high
protein), which they were overfed during the last 8 weeks of their 10- to
12-week stay in the inpatient metabolic unit. Compared with energy intake
during the weight stabilization period, the protein diets provided
approximately 40% more energy intake, which corresponds to 954 calories a
day.
Study findings
- All participants in the study gained weight and there were no differences by sex.
- The rate of weight gain in the low protein diet group was significantly less than in the other 2 groups (6.97 lbs. [3.16 kg] vs. 13.3 lbs [6.05 kg] for the normal protein diet group and 14.4 lbs [6.51 kg] in the high protein diet group).
- Protein did contribute to changes in energy expenditure and lean body mass.
- Body fat increased similarly in all 3 protein diet groups and represented 50% to more than 90% of the excess stored calories.
- Resting energy expenditure, total energy expenditure, and body protein did not increase during overfeeding with the low protein diet.
"In summary, weight gain when eating a low protein diet (5% of energy from protein) was blunted compared with weight gain when eating a normal protein diet (15% of energy from protein) with the same number of extra calories.
Calories alone, however, contributed to the increase in body fat. In
contrast, protein contributed to the changes in energy expenditure and lean
body mass, but not to the increase in body fat.
IIn an accompanying editorial,
Zhaoping Li, M.D., Ph.D., and David Heber,
M.D., Ph.D., of the University of California, Los Angeles, write that the
results of this study "informs primary care physicians and policy makers
about the benefits of protein in weight management."
"The results suggest that overeating low protein diets may increase fat
deposition leading to loss of lean body mass despite lesser increases in
body weight. Policy makers and primary care physicians need to understand
the role of the Western diet in promoting overweight and obesity. Because
this diet increases the risks of over-nutrition through fat deposition beyond
that detected by body mass index, the method used to assess the current
obesity epidemic and the magnitude of the obesity epidemic may have been
underestimated. Clinicians should consider assessing a patient's overall
fatness rather than simply measuring body weight or body mass index and
concentrate on the potential complications of excess fat accumulation. The
goals for obesity treatment should involve fat reduction rather than simply
weight loss, along with a better understanding of nutrition science."
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 estimates.
| Stop Loss Premium Ranking Compiled by MyHealthGuide Newsletter
Reader response and correction is
encouraged. |
|||||
| Stop Loss Provider | Associated Carriers / MGUs | Annual Stop Loss Premium (Millions) |
Source | Source Date | |
| 1. | HCC Life Insurance Company | Perico Life | $785 | Craig Kelbel, President & CEO | 7/4/2011 |
| 2. | Sun Life Financial | $768 | Mick Young, Employer Benefits Group, Sun Financial | 12/31/2010 | |
| 3. | Symetra | Block - $386 AUL - $120 MRM - $190 |
$696 | Symetra Press release, Mike McLean, President Medical Risk Managers, Inc. |
6/21/2011 |
| 4. | Highmark Casualty Insurance Company | HM Insurance Group | $650 | Dan Lebish, President & CEO, (at SIIA Stop Loss Executive Forum) | 10/14/2010 |
| 5. | ING | ING Employee Benefits | $560 | Mary Sullivan, Head of Stop Loss, ING Employee Benefits | 7/1/2011 |
| 6. | Independence Holding Company | Standard Security Life Insurance
Company of New York, Madison National Life, Independence American Insurance Company |
$280 | MyHealthGuide Estimate | 7/1/2011 |
| 7. | Companion Life | $225 | Philip Gardham, Vice President, Specialty Markets | 8/16/2011 | |
| 8. | Zurich North America | $130 | Tracey Brennan, Zurich North America | 7/22/2011 | |
| 9. | National Union Fire Insurance Company of Pittsburgh | Chartis, Accident & Health Corporate Benefits | $114 | Charmaine Chachula, Director of Marketing | 7/6/2011 |
| 10. | Munich Re Stop Loss | AAIC, TransAmerica | $110 | Paul Fallisi, President | 7/12/2011 |
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
- American Fidelity Assurance Company
- American National Life Insurance Company of Texas
- BEST Re
- Blue Cross Blue Shield (various regions)
- Gerber Life Insurance Company
- ING
- Lloyd's of London
- Nationwide Life Insurance Company
- Pan American Life
- QBE Insurance Company
- Trustmark Insurance Company
- ULLICO
- 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
- Capital size of the insurance company
- Reinsurance purchased and from whom
- Length in the business
- 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.
January 31 - February 1, 2012
21th Annual National Health Benefits Conference & Expo
presented by HBCE. On-site clinics, Health Reform, Benefits to
Businesses, Kidcare and You. Sheraton Sand Key Resort, Clearwater Beach, FL.
www.Hwww.HBCE.com
January 31 - February 1, 2012 February 7-9, 2012 Features: Network with Senior-Level HR, Benefits & Health Strategy Executives from
Employers,
Brokers, and TPAs. Special discounted employer rate of only $195 (discount
code BMQ922). Information and registration:
Peter Grant and
www.worldcongress.com/selffunding.
February 14-16, 2012 Transaction information http://forums.x12.org/
and
Registration and information.
February 27-29, 2012-
A Hybrid Conference, Internet Event and Training Tool
March 4-7, 2012
March 7-9, 2012
April 11-13, 2012
April 16-18, 2012
April 18, 2012
March 19- 21, 2012 -
A Hybrid Conference and Internet Event
March 26-28, 2012 -
A Hybrid Conference and Internet Event
April 25-27, 2012
May 15-17, 2012
Hyatt Regency San Antonio located on the
city's famous Riverwalk. San Antonio, Texas. Contact
Justin Miller at jmiller@siia.org
or
(800) 851-7789 for information
on limited sponsorship opportunities.
Information
and registration. www.SIIA.org
June 5-7, 2012
Biltmore Hotel, Coral Gables, Florida.
Contact Justin Miller at
800-851-7789, jmiller@siia.org. Information:
www.SIIA.org/2012International
June 6-8, 2012-
A Hybrid Conference and Internet Event
June 13-15, 2012
July 11-13, 2012
July 24-26,
2012
October 1-3, 2012
October 3-5, 2012
October 14-17, 2012
April 10-12, 2013
September 18-20, 2013
Editorial Notes,
Disclaimers & Disclosures
9th Annual National Workers' Comp Insurance ExecuSummit
presented by
ExecuSummit, LLC. Mohegan Sun Hotel & Convention Center, Uncasville, CT.
Contact
Joanne Fazzino, 845-306-1340 x 704,
jfazzino@execusummmit.com.
Registration and Information: www.summit-02.com.
2012 HCAA Executive Forum presented by Health Care Administrators
Association.
Aria Resort and Casino.
Las Vegas NV. Information and registration:
www.hcaa.org/ef/ef_Home.html
February 7-8, 2012
Self-Funding and Alternative Models for Health Benefit Financing presented
by World Congress Executive Forum. Keynote speakers include:
WEDI Winter Forum presented by
Workgroup for Electronic Data Interface.
Fairfax Marriott at Fair Oaks.
Fairfax, Virginia.
ASC X12 recently announced a public review period for the 006020 Type 3
Technical Reports for public comments deadline of March 7, 2012.
This program will provide attendees an overall view of the outcome from the
claims attachments hearing as well provide multi-stakeholder leadership and
guidance to the healthcare industry on how to use and leverage the
industry's collective technology, knowledge, expertise and information
resources to implement claims attachments.
February 27-29, 2012-
A Hybrid Conference and Internet Event
Twelfth Population Health and Care Coordination Colloquium
presented by Harvard Health Policy Review, Health Affairs, Accountable Care
News, Medical Home News, and Population Health Journal.
The Leading Forum on Innovations in Population Health, Chronic Care and
Disease Management.
Co-located with Medical Home Summit.
Philadelphia Marriott Downtown.
Philadelphia, PA. www.PopulationHealthColloquium.com
Fourth National Medical home Summit presented by presented by
Harvard Health Policy Review, Health Affairs, Accountable Care News, Medical
Home News, and Population Health Journal.
The Leading Forum on Developing and Implementing Patient- and
Family-Centered Medical Homes.
Philadelphia Marriott Downtown
Philadelphia, PA. www.MedicalHomeSummit.com
Society of Actuaries "ReFocus Conference. Las Vegas. www.soa.org
26th Annual Legislative/Regulatory Conference presented by the
Self-Insurance Institute of America (SIIA).
Washington Marriott at Metro Center,
Washington, DC. www.SIIA.org
The IHC FORUM East (formerly Consumer-Directed HealthCare Forum).
Theme is "The Journey to HealthCare Consumerism". 500 attendees
expected. Cobb Galleria Centre, Atlanta, GA.
www.theihccforum.com
TPA & MGU/Excess Insurer Executive Forum presented by the
Self-Insurance Institute of America (SIIA).
Charleston Place Hotel
Charleston, South Carolina. www.SIIA.org.
The 2012 Canadian Reinsurance Conference presented by CRC Council.
Metro Toronto Convention Centre in Toronto, South Building
(same venue as 2011). www.crconline.ca
Seventh National Pay for Performance Summit presented by Integrated Healthcare Association, Harvard Health Policy Review and Health Affairs.
The Leading Forum on Pay for Performance, Transparency and Value Driven
Healthcare.
Hyatt Regency Century Plaza Hotel
Los Angeles, CA. www.PFPSummit.com
Twentieth National HIPAA Summit presented by Harvard Health Policy Review and Health Affairs.
The Leading Forum on Healthcare EDI, Privacy, Confidentiality, Data Security
and HIPAA Compliance.
Renaissance Hotel.
Washington, DC. www.HIPAASummit.com
SPBA Spring Meeting (members only), Washington, DC.
Capital Hilton Hotel. Society of Professional Benefit Administrators
(SPBA). wwww.SPBATPA.org
Self-Insured Workers' Compensation Executive Forum presented by the
Self-Insurance Institute of America (SIIA).
2012 International Conference presented by Self-Insurance Institute
of America (SIIA). Industry's top experts share their knowledge on
helping companies with international risk.
Agenda includes:
Third National Accountable Care Organization (ACO) Summit presented
by Engelberg Center for Health Reform at the Brookings Institution
and Dartmouth Institute for Health Policy and Clinical Practice, Harvard Health Policy Review and Health Affairs.
The Leading Forum on the Accountable Care Organizations (ACOs) and Related
Delivery System and Payment Reform.
Grand Hyatt.
Washington, DC. www.ACOSummit.com
Society of Actuaries Spring Health Meeting. New Orleans. www.soa.org
2012 HCAA TPA University presented by Health Care Administrators
Association.
Swissotel Chicago, IL. Information and registration:
www.hcaa.org/tpa/index.html
MCIA 7th Annual Conference presented by Montana Captive Insurance
Association, Inc. (MCIA). Lodge at Whitefish Lake in
Whitefish, MT. Attendees will include
captive owners, captive managers and key regulators. Information:
www.mtcaptives.org
32nd Annual National Educational Conference & Expo presented by
the Self-Insurance Institute of America (SIIA).
JW Marriott Indianapolis.
Indianapolis, Indiana. www.SIIA.org
SPBA Fall Meeting (members only), Las Vegas, NV.
Bally's Las Vegas. Society of Professional Benefit Administrators
(SPBA). www.SPBATPA.org
Society of Actuaries Annual Meeting. Washington DC.
www.soa.org
SPBA Spring Meeting (members only),
Capital Hilton,
Washington DC. Society of Professional Benefit Administrators
(SPBA). www.SPBATPA.org
SPBA Fall Meeting (members only). Fairmont,
Dallas, TX. Society of Professional Benefit Administrators
(SPBA). www.SPBATPA.org
Ernie Clevenger
President & Publisher
MyHealthGuide, LLC
Clevenger@MyHealthGuide.com