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TABLE OF CONTENTS
Global Excel Management Acquires Olympus Managed Health Care
MyHealthGuide Source: Global Excel Management Inc., 6/30/2015, www.globalexcel.com
Global Excel Management Inc. is pleased to announce our recent acquisition of Olympus Managed Health Care Inc., and its associated companies, Olympus Healthcare Solutions México SA, ChoiceNet International México SA and Healthcare Concierge Services Inc.
With this acquisition, Global Excel reinforces its position as the leading supplier of cost containment, claims management and medical assistance services in the industry. Both organizations feel that the synergies experienced with this fusion will bring benefits on domestic and international levels.
According to Steven W. Jacobson, Chairman, CEO and Founder of Olympus, "In the process of planning strategic position we considered a sale of the company. The only way we would consider a sale was upon the condition that the buyer would need to be in a position and have the ability to continue, not only the aggressive growth, but also sustain the values we had created. Ironically it was in a key competitor that we found the capacity and drive that would satisfy these significant conditions. The combination of our network management, our strength in the destination and expat markets and our position as market leader in Latin America market along with Global Excel’s history of experience in complementary skills and markets, made it evident they were an ideal purchaser. I am confident and pleased that we have been acquired by a company who will ensure the legacy of Olympus continues for its clients and employees."
Reg Allatt, CEO of Global Excel, adds, "Olympus was a very natural fit for Global Excel. Each organization has strengths which will complement each other perfectly. The response from clients and employees from each group has been overwhelmingly positive. We were very pleased that Olympus, CNI and HCS trusted our reputation for being client oriented, innovative and performance focused. We’re very confident that together we’ll be able to provide significant added value to existing and new clients. More importantly, we found that the core values in Olympus were the same as ours, and that included a very strong focus on our respective employees. In the future, Global Excel will continue to concentrate on our corporate objective of both horizontal and vertical expansion, both through profitable organic growth and qualified targeted acquisitions."
"Over the next few months the goal of both management teams will be to continue providing the highest level of service to our respective clients. We’ll be focusing on identifying those synergies which will bring added value to existing clients and allow both Olympus and Global Excel to extend their service offering to new markets and clients. We look forward to a long and mutually beneficial relationship with our new colleagues at Olympus, CNI and HCS.
If you have any questions or comments, please don’t hesitate to contact us, " says David O’Connor, President, Global Excel Management Inc.
About Global Excel Management Inc.
Global Excel is a full-service cost containment, claims management and medical assistance company located in Canada. It offers a complete range of services to over 300 international, Canadian and U.S. domestic clients located in more than 40 countries around the world. Global Excel manages approximately 105,000 inpatient, outpatient and non-medical cases per year and processes in excess of $850 million in healthcare claims annually. Contact John Spears, VP Business Development and Marketing, at email@example.com and visit www.globalexcel.com.
About Olympus Managed Health Care Inc.
Olympus Managed Health Care Inc. is the leading independent provider of health care claims administration and cost containment services. Since its inception in 1994, Olympus has focused exclusively on facilitating access to health care on behalf of its health care clientele. Olympus' products and services focus on bringing value to the payer, medical provider, and health care consumer. Olympus is an ISO 9001:2008 Certified Company, has over 60 clients located in 90 countries, and will process approximately $415 million in healthcare claims annually.
Educational Foundation Presents Self-Insurance Executive Summit in London
with Special Lloyd's Tour - Sept 14-16
The host hotel for the SIEF Self-Insurance Executive Summit is Apex City of London Hotel. Hotel reservations must be made directly with the hotel. The SIEF group rate is £255.00 Single. Rate includes full English breakfast and 20% VAT. Early reservations are strongly advised. The room block for the special group rate ends July 15, 2015. Reservations made after July 15, 2015 will be made on space and rate availability basis only.
The Self-Insurance Educational Foundation (SIEF) is affiliated with the Self-Insurance Institute of America, Inc. (SIIA).
Call 800-851-7789 and visit www.siia.org.
EBMS Seeks Director of Account Management for Billings, MT Office
MyHealthGuide Source: EBMS, 6/24/2015, www.ebms.com
EBMS is an industry leader providing administrative services to corporate employee benefit plans throughout the United States. We are currently seeking a Director of Account Management to oversee the strategic and operational direction of the Account Management team. Key responsibilities include coaching staff in achieving revenue growth targets and client retention goals while ensuring a high quality customer experience. The ideal candidate will demonstrate a high level of expertise in leadership and third party administration to deliver a high level of service, quality performance and production.
Ideal candidate must have a Bachelor's degree in a related field with a minimum of eight years of experience in management and third party administration account management experience. The position requires travel up to 50% of the time. Qualified, interested candidates are encouraged to apply online at www.ebms.com.
EBMS is an EEO/AA/M/F/Vet/Disability Employer
EBMS is one of the nation's premier industry leaders in health risk management and third party administration of self-funded health benefit plans, designing strategies to transform the health and wellbeing of individuals, organizations and communities. Throughout the past 33 years, EBMS has thrived and excelled within the very challenging landscape of change in the healthcare marketplace. In contrast to insurance companies, ASO carriers, and other third party administrators, EBMS creates unique solutions that can be tailored to meet the specific needs of our clients, including your organization, allowing for greater flexibility and customization. Visit www.ebms.com.
Beating Medical Trend - Managed Care vs Reference Based Pricing
MyHealthGuide Source: Bill Rusteberg, 7/2015, RiskManagers.us White Paper
Medical inflation continues to rise. Facing rate increases year after year, plan sponsors, with their financial backs to the wall, have historically resorted to cost shifting. These continued failed attempts to control costs have driven some to seek alternate means to restore pricing sanity to health care. To many, the cost of health insurance can mean the difference between profit and loss.
Understanding the cost of health care is directly related to what we agree to pay; more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time. Secretive contracts between health care givers and third party intermediaries contain provisions that guarantee continuous and systematic cost increases. Shared savings side agreements and other schemes found in the health industry economic chain help fuel raging health insurance costs.
Known as medical trend, cost increases have proven to be consistent and predictable. The expected rise in the cost of medical services over time is expressed as an annual percentage increase and is an important element in underwriting future risk. Medical trend is a dominant cost driver in rate making. The annual compounding effect can double or triple health care costs over time.
"For managed care plans, the medical care inflation part of trend is a function of the changes in provider reimbursement rates that are negotiated. To the extent that such negotiations entail factors such as outliers and provider bonuses, the trend rate may be materially more than simply the weighted average increase in fees." Kevin Gabriel, MBA, FSA, MAAA, Chief Actuary of Sierra Berkshire Associates, Inc.
Moving away from managed care contracts, more and more employers are embracing a myriad of reference based pricing models. These models can vary in scope and reach; however all share certain common characteristics in conformance with prudent business practices. Price transparency and claim benchmarking are key elements.
In 2007 -- 2008 we approached several of our clients to suggest something different to control costs. The concept was simple. Eschew managed care contracts in lieu of claim benchmarking off multiple data points such as Medicare reimbursement rates. Removing managed care contracts, i.e, PPO, and paying providers quickly, fairly and directly had an immediate impact on claim costs.
After 15 months we performed a study by running 100% of claims back through the prior PPO network reimbursement rates. This exercise proved a net savings of 43% above and beyond the PPO discounts we would have otherwise experienced. Instead of doing the same thing year after year, our client did something different and it worked.
It has been seven years since our first client exited the managed care world. Subsequently more clients have embarked on the same journey, most with equally good results. None have returned to the world of managed care.
Skeptics may ask "How have your clients fared over time? Have they won the battle against medical trend?" The answer may be found by reviewing the experience of four of our clients who have been on a reference based pricing model for five years or more.
Our study is based on actual paid, mature medical claims through succeeding plan years starting in the first year on reference based pricing benchmarked off the prior year under a managed care plan. All claims above stop loss levels have been excluded.
This abbreviated analysis does not recognize changing demographics and plan changes. For example the leveraging effect of higher deductibles will increase trend factors. Of particular importance it should be noted that plan changes occurred in each case through improved benefits supported by prior year claim savings. This study includes medical claims only.
One must understand that medical trend is just one of the factors used to calculate renewal rates for health plans and stop loss insurance. Each year carriers set their own trend level based on various factors, including the current health care inflation rate, analysts’ forecasts and their own experiences. However, our clients are self-funded and thus bear most risk with actual trend directly affecting costs without the benefit of pooling to any significant degree.
"Over the past several years, trend rates have consistently run 8-10% nationally, though certain regions have seen significantly higher or lower figures. Prescription drug trends (which are a component of this) have been more volatile. In the early 2000’s these trends were above 15%. They then fell back to single digit levels. But they have now returned to the teens," said Gabriel.
In comparing our client’s experience with average medical trend, we relied upon Heffernan Benefit Advisory Services -- 2013 Trend Report; Historical Trend Factors. Based on this report, we are using 9.615% as average annual medical only trend factor.
Political Subdivision -- 400 Employee Lives
This case has been on RBP for 7 years. They experienced poor claim years in 2010 and 2012. In 2012, for example, there were 14 large claims that approached or exceeded $125,000. Medical PEPM for 2014 and 2015 (to date) is less than 2008. Benefits have been improved; no deductible or co-insurance features with all benefits subject to co-pays only. Funding increase over seven years has been 15.6% or 2.23% per year.
Public School District -- 900 Employee Lives
This case has demonstrated a consistent downward claim trend. Current PEPM (2015) is less than 2008-2009. No benefit reductions. Some benefit improvements. Plan funding has remained essentially static for the past five years.
Medical Industry -- 280 Employee Lives
Plan year 2012-2013 experienced an outlier year with several large claims and 34 pregnancies. Current medical PEPM is 16% higher than under managed care plan in 2008-2009, representing a 2.66% increase per year (sans outliers). This illustrates that higher utilization and outlier claims will result in increasing cost which would occur under either managed care or RBP model. However, RBP trend factor continues below industry benchmarks.
Retail Business -- 818 Employee Lives
This case has consistently been well below medical trend. Current medical PEPM is significantly lower than plan year 2008-2009. This case has not raised plan contributions in seven years.
Managed care has failed. Medical costs continue to soar. Providers are charging more and we continue to agree to blindly pay up through secretive contracts negotiated by vested interests. Medical trend has, and continues to be, consistently at double digits or close to it.
Cost plus insurance / reference based pricing is a proven method to maintain and even improve comprehensive coverage while at the same time keeping costs reasonable, predictable and consistent. Industry sources estimate reference based pricing plans represent 10% market share and rising. An east coast hedge fund, seeking opportunities in reference based pricing models, predicts reference based pricing will gain 60% market share within the next five years.
"What moves things is innovation. But it's not easy to innovate in stagnant, hyper-regulated, captured sectors" - Max Borders ( www.fee.org ) Cost shifting under the Affordable Care Act will continue to fail to control costs.
Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market.
Plan sponsors can reasonably expect to reduce their health care costs below medical trend without benefit reductions or cost shifting of any kind.
Self-funded Health Plans: A New Challenge for Hospitals
About the Author
Emily M. Scott is a partner in Hirschler Fleischer’s Richmond office. Her
commercial litigation practice focuses primarily on assisting healthcare
providers with contract matters, business torts, employment disputes, and
hospital staffing issues, including credentialing, peer review and bylaw
compliance. She can be reached at 804.771.9593 or
Supreme Court Will Rule
Whether ERISA Preemption Shields a Self-funded Health Plan from Vermont's
Requirements to Report Health Claims Data
Alfred Gobeille, chairman of the Green Mountain Care Board (the state agency
that takes care of the health care database’s responsibilities), filed a
writ of certiorari in August 2014 to overturn the appeals court’s ruling.
Liberty Mutual filed a brief in opposition, to which Gobeille replied in
Trauma, PTSD May Raise
Women's Odds of Heart Attack, Stroke
The study reviewed data from 49,978
women who took part in the Nurses' Health Study II. Trauma exposure and PTSD
symptoms were assessed using the Brief Trauma Questionnaire and a PTSD
Researchers advise that while this study found an association
between trauma and a higher risk of stroke and heart attack, it wasn't
designed to prove a cause-and-effect relationship. It's possible that other
factors may explain the increased risk.
Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/4/2015)
MyHealthGuide 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 more.
Other stop-loss leaders include the following list. However, we await reader response providing stop-loss premium volume (and additional carriers) so that each could be added to the table above.
Stop-loss Premium Volume is not the Whole Story
Industry executives question the purpose of a chart reporting only stop-loss premium without additional information such as:
Reader response and correction is encouraged. Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com.
The Value of Self-Funding
MyHealthGuide Source: The Self-Insurance Educational Foundation, Inc. (SIEF), 2014, www.SIEFOnline.org The Self-Insurance Educational Foundation, Inc. (SIEF has published The Value of Self-Funding.
Self-funding is an important contributor to the financial and physical health of America's wellness future. Self-funding is more than processing claims and receiving premiums, it provides quality coverage and proactive healthcare management for employers of all sizes and industries.
About the SIEF
The Self-Insurance Educational Foundation, Inc. (SIEF) is a 501(c)(3) non-profit organization affiliated with the Self-Insurance Institute of America, Inc. (SIIA). The foundation's mission is to raise the awareness and understanding of self-insurance among the business community, policy-makers, consumers, the media and other interested parties. Visit www.SIEFOnline.org.
July 15-17, 2015
MCIA Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA). Features key captive regulators, captive owners and leading service providers addressing a variety of timely educational topics. The conference also serves as the premier networking event for those doing captive insurance business (or would like to) in the growing Montana captive domicile. Lodge at Whitefish Lake in Whitefish, MT. Sponsors: Shane Byars at 866/388-6242, or via e-mail at firstname.lastname@example.org. Contact email@example.com and visit www.mtcaptives.org
September 14-16, 2015
September 14-16, 2015
September 28-30, 2015
October 18-20, 2015
The health care sessions are part of a larger educational program that includes nearly 40 general and breakout sessions related to the broader self-insurance marketplace. This top-notch educational program will be supplemented by the industry's largest exhibit hall and incredible networking opportunities throughout the event. Marriott Marquis, Washington, DC. Call 800-851-7789 and visit www.SIIA.org.
February 9-11, 2016
March 30-April 1, 2016
July 13-15, 2016
October 17-19, 2016
February 8-10, 2017
March 15-17, 2017
September 13-15, 2017