MyHealthGuide Newsletter
News for the Self-Funded Community
5/23/2016

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.comClick here if Newsletter stops arriving.

TABLE OF CONTENTS

General & Company News

People News

Job News

Market Trends, Studies, Books & Opinions

Legislative & Regulatory News

Medical News

Recurring Resources

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures


General & Company News



Healthx and CieloStar Partner To Launch Enrollment Solution to Reduces Costs and Streamlines Operations

MyHealthGuide Source: CieloStar, 4/26/2016, www.cielostar.com and www.healthx.com

INDIANAPOLIS -- Healthx, Inc., the leader in cloud-based digital engagement solutions for healthcare payers and other stakeholders, and CieloStar, a leading nationwide healthcare benefits distribution and payment technology company, announced a partnership to offer CieloStar's enrollment capabilities on the Healthx member engagement platform. Healthx officials state this is part of a larger integrated partner solution strategy to bring more robust, comprehensive solutions to its customers.

The Healthx Enrollment Solution is pre-integrated on the Healthx platform. TPAs and commercial health plans that purchase this solution can expect to see significant cost reductions while streamlining operations, according to Sean Downs, CEO of Healthx.  "Managing eligibility and the entire benefits administration process can be an administrative nightmare when dealing with medical claims, flexible spending accounts, COBRA and other offerings. This is now simplified with a seamless system that ties these benefits together in a unified tool to manage employee benefits from hire to separation."

Downs said employees and members will also value the solution. "Trying to navigate through multiple benefits systems and programs can be downright confusing for the member," said Downs. "We simplify this by automating the benefit administration process into a single platform with all the tools the member needs, such as their payer medical plans, COBRA, flexible spending account, health spending account, and so on. It can be a real challenge, but by unifying these functions into a single-source tool, we're making healthcare easier for the member."

CieloStar says the partnership is a natural fit with their capabilities. "The demands on payers to increase member engagement while reducing costs and improving the overall health of their members are increasing every day, and Healthx is literally a pioneer in unifying information for payers, members and providers," said William Mehus, chairman and CEO of CieloStar. "The objective of unifying systems into a seamless experience is at the core of our capabilities, and we're excited to partner with a like-minded organization."

This partnership marks the first in several new offerings Healthx is planning to roll out this year. "CieloStar fits perfectly into our integrated partner solutions strategy," said Downs. "We recognize that TPAs and commercial health plans need to provide more robust self-service tools for their members to manage their own healthcare. To that end, we have set a course to partner with some of the most innovative engagement providers and wrap these capabilities into one very powerful solution to empower people to improve their own healthcare while making our customers more efficient and competitive." Downs concluded, "We are very excited about our relationship with CieloStar, and to share more offerings in the coming months, which will be a game changer in member engagement."

About Healthx, Inc.

Healthx provides the healthcare industry's leading digital engagement platform connecting our payer customers to their consumer, provider, employer and broker constituents. As an innovator in cloud-based technology, Healthx supports over 170 payers representing 20 million members and 600,000 providers. Our engagement expertise enables us to guide customers to achieve their business objectives by driving online portal and mobile app utilization and producing measurable ROI. The platform can integrate with over 150 third party applications, customized into a seamless user experience across the consumer engagement ecosystem including shop and enroll, managing benefits, cost transparency, payment processing, wellness, health education and other specialty content. Healthx is a proven and trusted partner, led by healthcare and technology experts passionate about delivering engagement solutions that drive outcomes. Contact Ron Wozny, Vice President of Marketing, at 317-550-3244, rwozny@healthx.com and  www.healthx.com and follow Healthx on Twitter, LinkedIn and Facebook.

About CieloStar

CieloStar has been helping employers and employees nationwide navigate the ever-changing world of benefits since 1988. The company's expanding suite of products and services includes web-enabled and mobile high-tech, high-touch, integrated EDI and SaaS based solutions, sophisticated decision support and benefits administration technology, private exchanges, enrollment solutions, health and wellness tools, consolidated billing systems with auto reconciliation, and an automated marketing, enrollment, rating, quoting, underwriting, onboarding and eligibility management solution for the self-funded marketplace. CieloStar, headquartered in Minneapolis, Minn., is privately-held and employee-owned. Visit www.cielostar.com for more information.  Contact Paul Walther, President, at 612-436-2721, Paul.Walther@cielostar.com and visit www.cielostar.com.

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People News



Companion Life Announces Austin Scott as Director of Marketing in the Specialty Markets

MyHealthGuide Source: Companion Life, 5/20/2016, www.CompanionLife.com

Companion Life is pleased to announce that Austin Scott, Director of Marketing in the Specialty Markets division since 2010, has been promoted to Assistant Vice President of Sales and Marketing. In his new position Scott will continue to be responsible for managing current client relationships as well as helping Companion Life in its growth strategy across all product lines.

"Austin has done a great job over the last 6 years in helping Specialty Markets grow and diversify our portfolio," said Phil Gardham, Chief Operating Officer of Companion Life. "This promotion is well deserved and his new role going forward will be key to Companion Life's continued success."

Scott, a native of Columbia, has helped diversify the specialty markets product portfolio as well as manage some of Companion's key client relationships. Before coming to Companion Life, Scott was in sales at a reinsurance intermediary company where he began his career in the insurance industry.

About Companion Life

Headquartered in Columbia, S.C., Companion Life has specialized in employee benefits since 1971. The company markets life, dental, disability, accident and specialty health plans including medical stop loss, limited benefit health plans and group supplemental retiree prescription drug plans, as well as other insurance programs through a network of independent agents and brokers, general agents and managing general underwriters. Companion Life is licensed in 49 states and the District of Columbia. It holds an A.M. Best Rating of A+ (Superior).  Visit www.CompanionLife.com.

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Lucent Health Hires Lorrie Lacko as Senior Account Executive

MyHealthGuide Source: Lucent Health, 5/17/2016, www.lucenthealth.com

Nashville TN -- Lucent Health,  the leading Healthcare Risk Management, Administration and Advisory Services company, announced the hiring of Lorrie Lacko as a Senior Account Executive. Effective immediately Lorrie will lead the relationship management, delivery of services and ongoing support of strategic accounts within the Texas region and across the nation. Before joining Lucent Health, Lorrie was an Account Executive at MHBT and Director of Employee Benefits with TexCap Concord Insurance Services where she led account teams in consistently delivering innovative and high-care services.

Lorrie's background includes an impressive 20 year career in employee benefits. She has a tremendous success record from dedicating her career to serving the complex healthcare needs of employers and aligning each client's unique needs with the best-fit solutions that drive down the cost of healthcare.

"Lorrie has built strong and lasting relationships with industry leaders in Healthcare including, insurance providers, claims & risk managers, underwriters, and related service partners; she will consistently provide the most competitive and high-value service options to Lucent Health clients," said Clay Timmons, Senior Vice President of Sales for Lucent Health.

Lorrie will be based out of Lucent Health's Irving Texas office. She resides near Irving with her husband and teenage children.

About Lucent Health

Lucent Health, based in Nashville, dramatically reduced employer healthcare risks and costs while improving employee access to innovative healthcare services. Lucent Health developed the most advanced risk-reduction solution for self-funded healthcare groups and continues to lead the industry revolution with its innovative e2 MEC/MVP, reference based pricing and captive services while serving over 140,000 members and processing $600 million in claim value annually. Follow Lucent Health on Twitter, LinkedIn and Facebook. Subscribe to the latest Lucent Health news. Contact Mark Stephen Ware, Senior Vice President, Corporate Marketing, Branding and Strategic Alliances, at marketing@lucenthealth.com and visit www.lucenthealth.com.

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INETICO Appoints Ray Longo as Sales Executive, Eastern US, and April Tomberlin as Marketing and Sales Coordinator

MyHealthGuide Source:  INETICO, 5/18/2016, www.Inetico.com

Tampa, FL -- INETICO Care and Claims Management is pleased to announce that Ray Longo, Sales Executive and April Tomberlin, Marketing and Sales Support Manager have joined the firm to further expand INETICO's portfolio of regional and national accounts.

Raymond Longo has over twenty years of healthcare experience in sales and operations, including medical benefits, insurance, TPA, employee assistance programs, work life, wellness, human resources solutions, and behavioral health. Ray works as a strategic partner to understand the needs of clients, brokers, and consultants to develop and implement innovative, engaging, and effective solutions.

Ray said, "I am excited to be a part of the Inetico team. Inetico's innovative healthcare products and solutions are a game changer in the market place. I am proud to advocate the great solutions which help plan members to control costs and improve their health."

April Tomberlin joins the INETICO team as Marketing and Sales Support Manager, with 20+ years in the financial services and healthcare industry. April most recently worked with Florida Hospital West Region, a division of the Adventist Health System, supporting the marketing department. In addition to her healthcare experience, she also has knowledge of the financial services industry. During her tenure with OMNI Tax & Financial Advisors, she coordinated marketing efforts to enhance the firm's high net-worth client relationships and develop new client relationships. She is a Lee University Alumni, and a proud mother of two children.

April said, "It is an honor to have the opportunity to work at INETICO and be a part of an entrepreneurial company that is innovative and has integrated solutions. I am excited to collaborate with a passionate group of people that are conscious of the financial wellness of healthcare plans, and strive each day to be accountable, insightful, and interactive with clients and partners.

Linda Ludwick, COO of INETICO, said, "We are excited to continue our expansion in the market place and amplify our Innovative platform! Ray and April are both dynamic people and will be great team additions."

About INETICO

Established in 2004, INETICO provides healthcare cost containment services to self-funded, fully insured and various health care entities across all of the United States. INETICO has developed its products and people with a mission: INETICO is committed to strengthening the fiscal health of the Plan while improving the clinical health of the Plan Members.  Contact Linda Ludwick, Chief Operations Officer, at 877-601-2200, LLudwick@Inetico.com and visit www.Inetico.com.

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BridgeHealth Announces Mark Stadler as CEO and Jeff Waggoner as COO

MyHealthGuide Source: BridgeHealth Medical, Inc., 5/18/2016, www.BridgeHealth.com

DENVER, CO -- Representatives of BridgeHealth Medical, Inc. ("BridgeHealth"), the country's leader in lower cost, high-quality, bundled surgical case rate benefit plans, announce a new executive management team to lead the company as it continues to grow and expand its operations and services.

Mark_Stadler   Mark_Stadler
Mark Stadler
Chief Executive Officer
  Jeff Waggoner
Chief Operations Officer

On June 1, 2016, Mark Stadler will join BridgeHealth as Chief Executive Officer (CEO) and will be responsible for the strategic direction of the organization. Jeff Waggoner will become President and Chief Operations Officer (COO). Together, they will be responsible for the overall management and growth of the company.

BridgeHealth is a bundled medical services benefit management company that offers a suite of products for self-insured group health plans to improve the quality and outcomes of surgery, reduce costs, and positively affect the rate of unnecessary surgery. In 2015, BridgeHealth was named No. 812 on the prestigious Inc. 5000 list as one of the fastest growing private companies in America, with three-year sales growth of 546 percent.

"We are excited to continue BridgeHealth's rapid growth under the leadership of such a talented executive team," said David Calone, chairman of the Board of Directors for BridgeHealth. "This management team has the experience to help BridgeHealth reach an even larger base of organizations offering self-insured health plans, while at the same time expanding our top-rated provider network. Our company has grown so quickly because we are committed to delivering high-quality outcomes at lower costs," Calone said.

Stadler, who comes to BridgeHealth from HealthSmart Holdings, Inc., where he served as Chief Marketing Officer, said he is excited to join the BridgeHealth family. "This company is truly unique, offering clients real-cost savings and excellent medical care," he said. "Creating a network of the most qualified providers across the country helps our members receive the best clinical outcomes at a lower cost, while eliminating complicated billing procedures. With the help of some of the most strategic thinkers in the business, I look forward to guiding BridgeHealth on its continued path of success."

During his nearly 40-year career, Stadler has served in multiple executive positions that include Senior Vice President for the U.S. Markets for Great-West Healthcare, Chief Growth Officer for Optum Health, and Chief Sales Officer for American Enterprise Group. Additionally, he has an extensive background in health care consulting, where he spent nearly 18 years with Mercer Human Resource Consulting.

Waggoner, who recently served as interim Chief Executive Officer of BridgeHealth, said, "BridgeHealth is a leader in the health benefits industry, and because of the value delivered to sponsors, members, and providers through our high-quality, lower-cost bundled medical service offerings, and facilitated process, the company continues to grow at a rapid pace," he said. "This is a testament to our employees, plan sponsors, plan members, and providers. I am committed to working with Mark to oversee the continued success of BridgeHealth today and in the future."

Waggoner brings nearly 30 years of experience in the structuring and development of high-performance organizations to create technology and market disruptive solutions in the defense, aerospace, telecommunications, health insurance, financial services, media and advertising, and health care fields. He brings expertise in scaling organizations at all stages from pre-Angel concept to Fortune 10, managing sustainable rapid growth in a wide variety of functional managerial and senior executive roles.

About BridgeHealth

Founded in 2007, BridgeHealth is a bundled medical services benefit management company that offers a suite of products for self-insured group health plans to improve quality and outcomes of surgery, reduce costs and positively affect the rate of unnecessary surgery. Through decision support, a high-quality narrow network, care coordination and other strategies, clients get real savings in cost and high-quality outcomes while providing an outstanding patient experience through a facilitated process. Clients achieve very quantifiable results for themselves and their employee/plan members in a manner that integrates with their full suite of health plan benefits. BridgeHealth is headquartered in Denver, Colo., with offices in Chicago, Ill. Contac Susan Lavenski at 304-545-8006, media@bridgehealth.com and visit www.BridgeHealth.com.

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Foundation for Complex Healthcare Solutions Announces Todd Hancock as Newest Board Member

MyHealthGuide Source: Foundation for Complex Healthcare Solutions, 5/16/2016, www.foundation-chs.org
 
INDIANAPOLIS -- Todd Hancock was announced as the newest board member of the Foundation for Complex Healthcare Solutions.

Mr. Hancock is the President of International Medical Group. IMG is a leader in the global medical and travel insurance market. Headquartered in Indianapolis, IMG also has offices in the United Kingdom and Dubai. Being responsible for the administration of IMG's global insurance operations Mr. Hancock has been a core leader for the company.

Mr. Hancock over the years has demonstrated his skills and his efficiency by managing the operational integrity of numerous reputable insurance and multicultural healthcare organizations across several continents. With a focus at each continent on global health and benefits plan design, cross-cultural employee development, and the optimization of high performance and organizations.

Doug Stratton, the Foundations Chairman of the Board, stated, "It has been a pleasure to getting to know Todd. His leadership qualities and passion for finding innovative solutions for complex healthcare conditions, makes him a perfect fit for our Board."

Todd Hancock added, "I am excited to be a part of an organization that is working to change the dynamic of healthcare by providing individualized care and prevention models that achieve better outcomes."

About the Foundation for Complex Healthcare Solutions

The Foundation is a not-for-profit 501(c)3 organization with the purpose of developing and supporting innovative healthcare programs for individuals with chronic, complex, and complicated conditions living in the State of Indiana. The Foundation works with self-funded employers, provider organizations, research organizations, other non for profits and commercial payers in Indiana to support the care of individuals who can benefit from Foundation programs and to research alternative methods of health and wellness approaches. All programs result in quality study outcomes. Contact Eric Banter, COO, at 765-730-4954, eric.banter@foundation-chs.org and visit www.foundation-chs.org.

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Job News


HIIG Accident & Health Has an Immediate Opening for Senior Stop Loss Underwriter

MyHealthGuide Source: HIIG Accident & Health, 5/17/2016, www.hiig.com

Join HIIG Accident & Health's growing team! Be a part of a rapidly expanding company that values your expertise and contributions.

This position is responsible for determining acceptability of insurance risks and appropriate premium rates for large, complex stop loss renewals / prospect employer groups in accordance with underwriting guidelines and authority limits.

The role can be located in any of the following regional offices: Malvern, PA, Indianapolis, IN, Wakefield, MA, Atlanta, GA, Dallas, TX, Scottsdale, AZ

Essential Duties and Responsibilities

  • Relies on experience and judgment to review risk, set pricing, negotiate, and accomplish goals.
  • Independently provides detailed explanations to sales regarding conditions and requirements of quotes, rating decisions and underwriting guidelines.
  • Analyzes stop loss claims experience; combines with manual in accordance with credibility factors to determine appropriate rate levels for new business and renewal accounts using a variety of pricing and funding methods.
  • Reviews plan design and calculates rates for requested or recommended plan changes.
  • Composes, prepares, and generates correspondence, proposals, and other reports as needed or required.
  • Develops and communicates new business or renewal rate recommendations and decisions in accordance with level of underwriting authority.
  • Processes sold accounts and/or confirmed renewals following established procedures.
  • Manages new business or renewal accounts to balance profitability and growth.
  • Monitors performance of assigned book of business and initiates actions to improve performance when needed.
  • Develops and maintains relationships with clients, producers, and sales representatives to support Company's production goals and persistency.
  • Provides competitive feedback on rates, products, pricing and marketing strategies.
  • Makes presentations to peers, producers, and leadership as necessary.
  • Acts as a mentor to lower level underwriters by answering questions, reviewing accounts that exceed their authority level, and offering recommendations.
  • Manages projects as assigned.
  • Carries out stop loss training on simpler concepts as assigned.
  • Other duties as assigned.

Essential Requirements for Education and/or Experience

  • Bachelor's Degree and 5 years of related experience and/or training; or equivalent combination of education and experience.
  • 5-7 years of progressively complex medical stop loss underwriting experience.

Specialized Knowledge/Beneficial Skills and Experience

  • Professional certifications (HIAA, CEBS, etc.) beneficial.
  • Strong understanding of stop loss industry concepts, practices and procedures.
  • Proficient in Microsoft Office Suite (Outlook, Word, Excel ).
  • Excellent written and verbal communication and presentation skills.
  • Strong analytical skills and the ability to pay attention to details.
  • Ability to carry out assignments within parameters of instructions given, prescribed routines and standard accepted underwriting practices.

HIIG A&H offers

  1. A competitive base salary with performance based commissions
  2. Leadership development through individualized support and mentoring
  3. Medical benefits, STD/LTD, Life, Dental, Vision, 401k, PTO
  4. Background check including drug screen

Interested candidates should email their resume to HR@hiig.com and/or jsweeney@hiig.com

About HIIG

HIIG is a Houston based, fast expanding insurance group that provides creative solutions for our clients' specialized needs. HIIG writes business throughout the USA and Internationally through its underwriting divisions that include Accident & Health, Construction, Energy, Professional, Transactional Property, and other Specialty business. Visit www.hiig.com and www.hiigah.com.

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OneBeacon Insurance Group Seeks HMO Reinsurance and Provider Excess of Loss
Underwriting Consultant


MyHealthGuide Source: OneBeacon Insurance Group, 5/18/2016, www.onebeacon.com

Description

The Underwriting Consultant will develop and execute strategic initiatives that contribute to the growth and profitability for a book of business in an assigned territory. This includes the selection and rejection of new and renewal business for the most complex, specialty accounts within the highest underwriting authority levels.

Focus is typically on new business production and large account management. Viewed as a senior resource and may act as a technical expert for a particular line of business. Position can sit in any OneBeacon office or remote.

Responsibilities

  1. Maximizes opportunities for underwriting profitable new and renewal business, as appropriate based on market conditions, by leveraging business relationships, product knowledge and underwriting acumen. Develops and maintains an active target account list tracking prospects and account rounding and/or missed opportunities. Manages financial performance of all assigned products in assigned territory including: accident year loss ratio, premium plans (including new business, retention, and rate/exposure increases), and commission targets.
  2. Underwrites a book of business. Manages underwriting quality and book management. Executes underwriting strategy, including portfolio management, self-audits of new and renewal business and well documented approvals of underwriting edits. Ensures compliance with standards and assigned underwriting authorities.
  3. Demonstrates a strong understanding of exposures and key coverage issues. Makes underwriting decisions to accept, decline, or modify risks within the highest production underwriter authority levels. Implements underwriting decisions in compliance with state laws.
  4. Develops superior working relationships with producers to successfully promote achievement of mutual growth and profitability goals and to supply the appropriate products and services. From a sales perspective, has the ability to identify gaps in coverage and/or services, understands where OneBeacon can make a difference based on those gaps and uses that information to help retain or obtain a customer. Works closely with and establishes strong business partnerships with other OneBeacon departments, including claims, actuary, and risk control staff in an effort to better service producers and accounts.
  5. Regularly travels to key producers/accounts and remains highly visible in the marketplace. Anticipates the needs of the agency plant, analyzes trends, and implements proactive strategies that best position the business. Understands and communicates the OneBeacon underwriting appetite and generates qualified business in support of that  appetite. Monitors agency action plans and participates in agency planning and marketing meetings to best position the business for the future.
  6. Gathers and analyzes competitor information and producer specific reports on assigned producers' new business flow, retention, profitability and potential, to support territorial rate reviews. Works with other underwriting staff to determine and make recommendations for marketing, pricing, products and systems.

Requirements

  • Expert knowledge of HMO Reinsurance and Provider Excess of Loss technical underwriting, pricing, and coverage issues. Must be a proven self-starter with strong multi-tasking and relationship management skills. Must have superior negotiation, marketing and sales skills.
  • Must maintain strong professional knowledge of legislative issues, industry trends and marketplace issues for the line of business within the territory. Must be able to work in a fast pace and rapidly changing environment.
  • Must be able to act as coach and mentor to junior members of the department. Must possess a high and extensive level of technical knowledge and skills including product and industry.

Education and Experience

  • Bachelor's degree or equivalent experience.
  • 7-10 years of progressively more complex, specialty lines underwriting experience.
  • Professional insurance designation is preferred (AICPCU, RPLU).

To apply, please visit www.onebeacon.com/careers - Refer to Job #411BR

About OneBeacon

OneBeacon Insurance Group is a specialty company that focuses on the unique risks faced by certain industry groups that we believe would benefit from specialized expertise, tailored products and an intense commitment to service.

At OneBeacon, we believe that specialized expertise matters. Through our underwriting companies, we offer a broad range of specialty insurance products and services sold through independent agencies, regional and national brokers, wholesalers and managing general agencies. Each OneBeacon business is managed by an experienced team of specialty insurance professionals focused on a specific customer group or industry segment they know well. Visit www.onebeacon.com.

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Tokio Marine HCC Seeks Vice President Marketing and Senior Underwriter in Southeast Regional Office

MyHealthGuide Source: Tokio Marine HCC, 5/13/2016, www.tmhcc.com/life

Tokio Marine HCC -- Stop Loss Group, a leading provider of medical stop loss insurance, has the following open positions:

Senior Underwriter -- Southeast Regional Office -- Kennesaw, Georgia

As a Senior Underwriter for the Southeast Region, you'll establish and maintain producer relationships while making underwriting recommendations and decisions to protect the financial assets of the company. The geographic territory of the region includes Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia.

Qualified candidates will possess a four-year degree, and 5-7 years previous experience and success in health insurance underwriting, and excellent analytical, organizational, and communication skills.

Vice President, Marketing -- Southeast Regional Office -- Kennesaw, Georgia

As the Vice President of Marketing for the Southeast Region, you'll establish and maintain producer relationships while making underwriting recommendations and decisions to protect the financial assets of the company. The geographic territory of the region includes Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia.

Qualified candidates will possess a four-year degree, and 8 years previous experience and success in health insurance marketing, and excellent analytical, organizational, and communication skills.

Interested individuals should email a current resume to hr@hcclife.com.

About Tokio Marine HCC -- Stop Loss Group

For more than 35 years, HCC Life Insurance Company, operating as Tokio Marine HCC -- Stop Loss Group, has been leading the way in medical stop loss insurance for employers and plans who self-fund their benefit plans. Rated A+ (Superior) by A.M. Best Company, Tokio Marine HCC -- Stop Loss Group is backed by the financial stability of its parent company, Tokio Marine HCC.

About Tokio Marine HCC

Tokio Marine HCC -- Stop Loss Group delivers competitive coverage through exceptional customer service. Our team of underwriters, claim specialists, actuaries and medical professionals provides personal service and professional expertise to a network of producers and third party administrators (TPAs) across the United States. Visit www.tmhcc.com/life.

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Lucent Health Seeks Vice President of Underwriting/Sales Support

MyHealthGuide Source: Lucent Health, 5/13/2016, www.lucenthealth.com

Lucent Health Seeks Vice President of Underwriting/Sales Support with location in Nashville, TN or Dallas, TX

Position Overview

The Vice President, Underwriting/Sales Support manages all aspects of sales and proposal support for Lucent's self-funded solutions including stop-loss partnerships, staff management, proposal development, and adherence to underwriting standards.

Essential Job Functions

  • Manage all aspects of sales and proposal support for Lucent's self-funded solutions
  • Manage stop-loss partnerships
  • Assure competitive stop-loss pricing for clients and prospects
  • Assure timely delivery of competitive proposals to brokers and distribution partners
  • Assist company to meet and exceed growth and profitability goals
  • Ensure adherence to Underwriting standards, compliance, and internal audit requirements
  • Maintain operational process and workflows
  • Develop organizational and operational metrics to contribute information and analysis for strategic plans and reviews

Qualifications & Skills

  • Bachelor's Degree required
  • MUST HAVE 5 or more years of experience managing a sales support team
  • MUST HAVE 10 or more years of stop-loss underwriting experience
  • Experience with developing and implementing sales strategies
  • Ability to effectively negotiate sales contracts and proposals
  • Detail oriented, organized and able to meet tight deadlines
  • Strong understanding and experience utilizing Sales Force (SFDC)

How to Apply

Interested persons may apply on LinkedIn at https://www.linkedin.com/jobs/view/132369591 or email their MS Word resumes to Alex Arnet, alex.arnet@lucenthealth.com.

About Lucent Health

Lucent Health, based in Nashville, empowers US employers by dramatically reducing healthcare risks and costs while improving employee access to innovative healthcare services. Lucent Health developed the most advanced risk-reduction solution for self-funded healthcare groups and continues to lead the industry revolution with its advanced referenced based pricing, e2 MEC/MVP, and captive solutions while serving over 140,00 members and processing $600 million in transactions annually. Follow us on Twitter, LinkedIn and Facebook. Subscribe to the latest Lucent Health news.  Visit www.lucenthealth.com.

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Market Trends, Studies, Books & Opinions


The OPEC of Healthcare

MyHealthGuide Source: Mike Dendy, MBA, MHA, Vice Chairman and CEO of Advanced Medical Pricing Solutions, Inc., 5/21/2016

Healthcare costs for employers continue to skyrocket. According to the Kaiser Family Foundation, family premiums are up from approximately $10,500 in 2005 to over $17,000 in 2015. This increase occurred in spite of hundreds of new companies and services being created to contain healthcare spending over the last 10 years with ObamaCare blended in for good measure as well.

Hardly a day goes buy that I don't hear someone touting "a breakthrough" that will assist employers in keeping cost trends in check and some even dare to suggest maintaining "flat" cost levels. The problem with the host of utilization management, wellness, on-line provider options etc. is that they are all working around the periphery of the healthcare cycle and thus have no real opportunity to truly assist an employer in reducing healthcare costs. If you are thinking that the PPOs have the answer, think again, since PPOs came into existence about 25 years ago healthcare costs are up by nearly 4x (Kaiser). According to the Peter G. Peterson Foundation, US per capita spending on healthcare is more than twice the average of other developed countries. PPOs are a big part of the problem by the way as their models are only intended to perpetuate their middle-man cost escalating and opacity inducing existence.

So, what is the problem and how does an employer truly start to reign in healthcare spending? The problem is easy and here is the breakdown:

The Problem

  • Hospitals: Makes Own Pricing, Unregulated Utilities
  • Physicians: Greater Utilization = More Income
  • Insurance Concerns: Higher The Cost, Greater The Profit (Even W/Fixed Margins)
  • Brokers: Mostly, Higher The Cost Greater Their Income
  • Pharmacy: Unabated Greed, No governors On Price Or Profits
  • Ancillary Services: Greater The Turmoil, The Greater The Need
  • Employee/Members: Have little to no financial interest in their purchase decisions

Who Loses? Employers, Employees and General Public
Is there a breaking Point?


In the aggregate, these healthcare players are healthcare's OPEC.

 Like the oil producing cartels that for many years controlled the cost of the world's energy in unencumbered fashion, there is absolutely no catalyst for healthcare providers to reduce their costs or for an employers covered members to be concerned whatsoever with their spending. I know of no CEO or company that is willing to raise their hand and ask that fees or salary paid to them be reduced so that they can provide their crucial services at a more affordable level.

 OPEC laughed at the US and the rest of the world when we complained that $120 per barrel oil was choking the life out of business and the public in general around the world. Rather, they built ski mountains in their deserts out of the rest of the world's money and threatened to drive oil prices even higher.

Until it ended. OPEC's strangle-hold on the world ended when other countries, led by the U.S. and Canada started finding alternative ways to produce oil themselves (fracking) and started to initiate aggressive efforts in alternative energy. Note if you will that just a few months ago, the OPEC countries were willingly and aggressively pumping oil and selling all that they could for less than $30 per barrel. Since it only costs the OPEC countries about $10 per barrel to extract oil, there is still a significant margin in the pricing of oil at $30 per barrel.

  • Like OPEC's weakening, a similar metamorphosis is available for healthcare costs but such will require an external catalyst in the form of employer righteous indignation with a bit of help from the government.

Let's start with hospitals.

A well run hospital can make money from Medicare payment schedules. The problem is that most hospitals are not financially well managed and have no reason to be when they can pretty much charge for services at will. Through commercial payer sources (the PPOs), hospitals around the country are collecting on average about 260% of what Medicare would pay for the same procedures.

Look at that number, 260%, closely, a hospital can make a profit on Medicare yet they are collecting 2.6 times that amount from commercial (employer) payers. While there are some markets where the average commercial payment is below the 260% of Medicare number, there are many more where that number is significantly greater going as high as 1,000% of Medicare at times. It is stunning to think that an area of cost for many companies that represents as much as 15-20% of the total cost of a business is spent in such a clouded and non-transparent way. Providers and the large health insurance companies have hidden this incredibly crucial data from employers for the last 25 years and continue to do so. An employer not having transparency into this information is beyond preposterous.

So, where does the excess money go within a hospital, many claim to be financially insolvent at some level. According to a study first reported in Health Affairs September 2014 edition, U.S. hospitals have administrative costs that are significantly greater than their counterparts in other countries.

  • Administrative costs account for 25% of total US Hospital expenses according to the study.
  • The US has the highest administrative expense of all countries studied and US hospital expenses are twice those of Canada and Scotland.
  • The Netherlands had the second highest administrative expense ratio coming in at 20%.

The article continues that were US Hospital expenses reduced to the level of those of Canada, US hospitals would have saved $158 billion in 2011. In a well-vetted interview with CBS News 60-Minutes, the CEO of the University of Pittsburgh Medical Center admitted to having a base salary of $8,000,000 annually. I also understand from well-informed sources that Sutter Medical Center in California has over 30 executives on staff that are paid more than $1,000,000 annually. Seems a bit much when hospitals are protected like utilities yet have the ability to set their own pricing levels to support poor management and potentially overpaid executives. For what it's worth, the study reported no apparent link between higher administrative costs and better quality care.

Physicians

Physicians are much less of an issue but still need to be considered. "Managed care" supposedly took care of physician cost escalations by creating reasonable and customary tables for every possible physician directed procedure. In many cases, managed care and Medicare and Medicaid don't pay physicians enough for procedures to allow them to adequately cover their costs and make a reasonable profit. So, the logical answer for the physicians who can't be paid enough on a single visit to cover their costs is to just increase utilization via second and third visits many of which are absolutely unnecessary.

It is ironic to consider the fact that an average physician's salary in the US ranges from $174,000 to $413,000 according to a recent study published by Medscape when comparing to the pay level of at least some hospital executives. Another issue that should raise the ire of employer/payers is the fact that hospitals are buying physician practices hand over fist to first control referral patterns and second become a new profit center. These purchases are almost always accompanied by significant increases in the pricing of the physicians' services.

Health Insurance Companies

Health insurance and administrative services are mostly a commodity and thus must be price sensitive. The large insurers seek to maintain a steady margin of somewhere between 4% and 8% but of course, as the cost of insurance goes up their revenues go up even with a fixed margin. So, as the cost of medical service payments to providers goes up, the insurance company's profits go up in lockstep.

We have already reviewed the fact that the PPOs negotiated rates often pay 2x to 4x what Medicare would pay. So for an insurer/PPO to push providers for more reasonable reimbursements of a smaller margin over Medicare would mean they would be negotiating their own revenues downward as well.

  • In another note of irony, employers entrust their health-plans and share fiduciary responsibility with large health insurers that, as we have shown, have the absolute opposite financial objective as the employer. How can an administrative service only (ASO) provider that owns a PPO, which intentionally overpays to perpetuate their own existence, operate to protect an employer's plan assets?

Remember that these same organizations hide the data necessary for an employer to understand and then act upon this illusion of partnership and cost management.

Brokers

Most quality brokers are now working off of a very transparent fee basis and don't have their incomes tied to an employers' overall spend. However, I recently visited with an employer in Texas that has about 300 employees and a broker that is paid over $300,000 annually on their account. I hear of such egregious over compensation occasionally and wonder if the employer does not know what their broker is being paid or does not care. I would suggest that it is a breach of an employer's fiduciary responsibility to their plan members to make gross overpayments to brokers (or anyone else for that matter) as healthcare funding is typically co-mingled funding from both the employer administrative cost and employee/members health spend.

Pharmacy

Pharmacy costs are beyond outrageous due to greed and government negligence. Seemingly due to effective pharmacy lobbying efforts, the U.S. government has not instituted favored nations pricing caps similar to other developed nations. That one item could save 8-10% of overall healthcare spend in our current economy and would appear to be a relatively simple adjustment to the paradigm that does not affect access to services and could significantly improve quality of services provided.

Cost Containment and Wellness

Due to the inadequacies of cost containment on all the above mentioned elements of healthcare, employers are forced to employ multiple services that work around the periphery of healthcare to try and reign in costs as best they can. Programs are expensive, fragmented add-ons to the health plan, and some are just unnecessary which adds to the cost burden for employers. For example, many health plans employ wellness services which encourage annual health assessments, wellness checks, and promote health and wellness overall. While the services are valid, they tweak the overall cost structure vs. making fundamental strides to change the approach to healthcare delivery and financing.

Finally, we have to consider the role we play in these overcharges as employed consumers of healthcare. For the most part, an employer covered member of a group healthcare plan can purchase all the healthcare they care to consume, whenever and wherever they care to consume it with absolutely no concern for the cost of those services. Somehow, we have allowed ourselves to believe that such is a birthright and anything less is penal and unfair. Consider this within the context of data provided by the government on multiple levels and private reports as well that show that oftentimes had a member consumer just altered their purchase patterns by walking a couple of blocks down the street, they could have reduced by half or more the cost of that service. Were that same consumer spending their own money for a service, they would consider it reprehensible to have not vetted the best value for their money. Until this paradox is addressed, employers will be forever saddled with significant overpayments on group healthcare plans.

Defined Contribution Healthcare Plans are the only Answer

An employer can spend all the time they want utilizing peripheral options for controlling healthcare spending but, until they address how they allow their members to purchase healthcare, nothing is going to change the cost curve for the better.

  • The solution for employers is incredibly simple, just budget what a health plan will pay for a service and push the consumer to make financially reasonable choices. This is not as ridiculous as it sounds.

CALPERS did exactly that with a handful of services for their California based employees. They announced what they were willing to pay for commonplace events like knee or hip replacements and asked providers to raise their hands if such were not sufficient. The handful of hospitals who initially would not accept the CALPERS payment levels quickly changed their minds and acquiesced when they saw the volume of business they were losing. Eliminating the "healthcare payment fairy" from the purchase equation would force the buyers of services and the sellers of services to meet on neutral ground and find common value.

Insurance is intended to indemnify against loss that we can't afford. That concept can stay in place while allowing U.S. healthcare costs to come under control through appropriate use of defined contribution healthcare programs. The step beyond the CALPERS model noted above is for an employer to determine a financial ratio payable for all healthcare services within their own sponsored plans. In a well managed plan, payments to providers take into account unique overhead (such as for teaching hospitals) and geography. A quality plan would seek to be fair to both the provider and the payer of healthcare services and the data to make that determination is readily available.

  • Assume for example that 70% of hospitals in the country would agree to provide the services of a standard baby delivery for $16,000 (the same service is delivered in Europe for about $3,000 by the way), why would we allow payment to a hospital of $20k, $30k, or even $50k, just because a member chose, without any consideration for cost, to have their baby at one of the more expensive hospitals.

If that same employee were traveling on behalf of the employer a budget would be provided as to what would be reimbursed relative to airline, hotel, and food/ beverage charges during the sponsored trip. Few employers would be accepting of that employee flying first class, staying at The Ritz Carlton, or eating caviar and lobster constantly during the trip. Rather, a reasonable budget would be provided taking into account that while hotels are more expensive in New York than in Omaha there are plenty to choose from and at multiple levels of expense. Controlling travel expenses are a critical cost management item for most company's yet those same companies take no interest whatsoever in trying to control their healthcare expenditures in a similar way even though the bottom line effect would be significantly greater for doing so.

There is more than amble data available to allow an employer to provide a well-vetted defined contribution healthcare plan for their members. Hundreds of employers are now providing such an option for their group healthcare plans through Reference Based Reimbursement or Cost Plus programs and those employers are being rewarded with cost reductions to their overall healthcare spend of 20% to 40% annually. Those savings accrue to both the employer and their employee/members alike of course ultimately increasing take home pay and the profitability and sustainability of the organization. The defined contribution options are also superior to the newly manufactured narrow network program concoctions of the large insurance companies in that they allow members to utilize any provider of their choice rather than have a very limited provider, HMO, type of option.

The cost of healthcare in the US is financially choking our businesses and our employees the same way high oil and gasoline prices choked us all just a few years ago. Like with oil, the answer to reducing healthcare costs without affecting healthcare services, quality, and outcomes is immediately available to employers once they dutifully consider the option of defined contribution as their delivery model.

About the Author

Mike Dendy is the Vice Chairman and CEO of Advanced Medical Pricing Solutions, Inc., one of America's premier healthcare cost management companies. Mike is the former Chairman/CEO of HPS Paradigm Administrators a Third Party Administrative services company managing group healthcare benefit plans for commercial and government agencies. Mike has a Master of Business Administration and a Master of Healthcare Administration degree as well as dual undergraduate degrees in Journalism and Social Psychology and has served employers as a healthcare consultant for the past 26 years.

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Legislative & Regulatory News


Final ADA Wellness Rules: 5 Important Changes for Employer Wellness Programs

MyHealthGuide Source: Lindsey Surratt, 5/19/2016, Healthcare Reform Digest Article

On Monday, May 16, the Equal Employment Opportunity Commission (EEOC) released its final rule to amend regulations under Title I of the Americans with Disabilities Act (ADA). This final rule provides guidance about the extent to which employers may pay incentives or provide rewards to encourage employees to participate in a wellness program that involves a disability-related inquiry (like a health risks assessment (HRA) or a medical examination (like a biometric screening)).

The final rule is effective prospectively as of the first day of the first plan year beginning on or after January 1, 2017, for the health plan used to determine the wellness program incentives.

In April 2015, the EEOC published a Notice of Proposed Rulemaking, giving industry stakeholders their first look at how the EEOC might address the ADA's voluntary requirement for wellness programs, and whether that guidance would be consistent with HIPAA's wellness regulations and incentive limits. The final rule made few changes to the big-ticket items addressed in the Notice of Proposed Rulemaking.

Keep in mind that the final rule applies to "employee health programs" in other words, all wellness programs that include disability-related inquiries or medical examinations, regardless of whether the wellness program is connected to an existing group health plan. Not all wellness programs include disability-related inquiries or medical examinations. For example, lunch-and-learn programs or seminars on nutrition or weight loss, or activity-based programs that require employees to exercise or walk, may be exempt from the final rule depending on the program's design.

5 important changes for wellness programs

  • No Gateway Plans: The EEOC is aware of a trend in the marketplace used by some employers to base eligibility for a particular plan or cost-sharing structure on the completion of an HRA or participation in a biometric screening. The EEOC made clear that the ADA prohibits "the outright denial of access to a benefit available by virtue of employment" and concluded that such plan designs discriminate against the employee in violation of 42 U.S.C. 12112(d)(4). Employers that currently utilize gateway plans should prepare to align their wellness program structure with the requirements of the final rule.
  • New Notice Requirement: For a wellness program to be considered voluntary, employers must meet certain conditions. One of these conditions is a new notice requirement. Employees participating in wellness programs that involve disability-related inquiries or medical examinations must be given a notice that describes
    • (a) the type of information to be collected,
    • (b) the purpose for which the information will be used,
    • (c) the restrictions on disclosure of the information,
    • (d) any employer representatives or other parties with whom the information will be shared, and
    • (e) the methods used to ensure the information will not be improperly disclosed.
    • To the extent employers already provide communication pieces to employees that include the required information, an employer may continue to do so. If the required information is not provided in existing communications, the employer must revise current communications or develop a new communication that addresses the required information. The EEOC plans to publish a sample notice on its website in the next 30 days.
  • Incentive Limitations -- Not Tobacco Related: The final rule retains the 30% cap on incentives from the Notice of Proposed Rulemaking, but clarifies how the limitation must be calculated. The limitation is based on the cost of self-only coverage. The calculation methods in the final rule address four scenarios:
    • (1) incentives provided to employees when participation in the wellness program is limited to employees enrolled in the plan;
    • (2) incentives provided to employees when the employer offers only one group health plan and participation in the wellness program is offered to all employees regardless of enrollment;
    • (3) incentives provided to employees when the employer offers only one group health plan and participation in the wellness program is offered to all employees regardless of enrollment; and
    • (4) incentives provided to employees when the employer does not offer a group health plan. Employers with wellness programs that involve an HRA or biometric screening are encouraged to consult with legal counsel or their benefits adviser to determine which calculation method applies and whether the incentive or penalty currently offered is consistent.
  • Incentive Limitations -- Tobacco Related: The 30% incentive limitation referenced above applies to programs that offer both a non-tobacco related incentive and a tobacco related incentive. This is a significant difference between the HIPAA nondiscrimination regulations for wellness programs and the EEOC final rule.
    • Under HIPAA, employers may provide an incentive of up to 50% of the cost of coverage for participation in a program designed to prevent or reduce tobacco use.
    • However, under the EEOC final rule, such a program would be subject to a total incentive cap of up to 30% of the cost of self-only coverage.
    • This limitation applies if the program involves a medical examination, like a cotinine test administered as part of a biometric screening or on a stand-alone basis.
    • A wellness program that merely asks an employee whether or not they use tobacco is not subject to the lower 30% limitation, as the EEOC clarifies that such a program does not involve a disability-related inquiry or medical examination. Employers with programs designed to prevent or reduce tobacco use should evaluate the design of the tobacco component of their to determine the appropriate incentive limitation.
  • Confidentiality: The final rule reiterates the ADA's confidentiality protections for medical records. Generally, wellness programs that are connected to a group health plan or wellness programs that meet the definition of a group health plan are subject to HIPAA's privacy and security protections.
    • The EEOC's interpretive guidance states that it is likely wellness programs that must comply with HIPAA's Privacy Rule will also be compliant with the ADA's confidentiality protections.
    • However, for wellness programs that are not subject the HIPAA, the EEOC's final rule clarifies the confidentiality protections that apply to such a program. Under these protections, employers offering wellness programs subject to this final rule are only permitted to receive information collected as part of the wellness program in aggregate form that does not disclose, and is not reasonably likely to disclose, the identity of specific individuals except as necessary to administer the plan or as permitted by the regulations.
    • The ADA's confidentiality protections also prohibit employers from requiring an employee to waive the ADA's confidentiality protections, or agree to the sale, transfer, or other disclosure of their medical information as a condition for participating in the wellness program or receiving an incentive for participation.
    • The publication of this final rule, together with Phase 2 of the HIPAA Audit Program, indicate a renewed focus on compliance with the confidentiality, privacy, and security measures designed to protect employee medical records and other health information.

So what does this mean for employer wellness programs?

  • Employers with wellness programs involving health risks assessments, medical questionnaires, or biometric screenings should familiarize themselves with the requirements under the rule.
  • Employers with calendar year plans are encouraged to act quickly to work with their legal counsel and benefits consultant, as the work necessary to renew the plan and handle both Form W-2 and Form 1094-C and 1095-C reporting by the end of January 2017 will make for a busy third and fourth quarter of 2016.

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Reactions to New EEOC Wellness Program Changes from Senator, Business, Lawyers and Others

MyHealthGuide Source: Senator Lamar Alexander (R) Tennessee, 5/16/2016 and Jayne O'Donnell, 5/16/2016, USA TODAY and Thomas Reuters Practical Law

WASHINGTON, DC -- The Senate health and labor committee chairman today said the Equal Employment Opportunity Commission's (EEOC) final rules on workplace wellness programs released "will make it harder for employees to choose healthy lifestyles and to save money."

"Wellness programs are the only part of ObamaCare that everyone agreed on--everyone except the EEOC," said Sen. Lamar Alexander (R-Tenn.). "Congress was clear in its support of workplace wellness programs in the health care law--just about the only provision in the law with bipartisan support--and the Departments of Health and Human Services, Labor, and Treasury were clear in their regulations implementing the law. It seems the EEOC is the only one missing the mark."

"The EEOC is taking away authority that Congress gave the administration and overruling the actions of the Departments of Health and Human Services, Labor and Treasury," Alexander said. "Today's rules contradict the law and continue the confusion the agency has caused, so Congress will need to act to help employees seeking to improve their health, while bringing down their insurance costs."

Alexander said he will push his bicameral legislation, The Preserving Employee Wellness Programs Act, to reaffirm existing law. He said he is considering introducing resolutions of disapproval under the Congressional Review Act to overturn the rules by a majority vote in the Senate and the House of Representatives.

Bryce Williams, CEO of HealthMine, a data analytics company for wellness plans, doesn't think the new rules will discourage wellness programs and instead thinks they could now become more common among smaller companies.

The rule requires enough disclosures to address concerns and is "measured and appropriate" given the large investment employers are making in workers' health, he says.

An employer's wellness program has to be designed to improve an employee's health or prevent disease.

Companies should meet the rules if they help workers understand health risks, says Seth Perretta, co-chair of Groom Law Group's health practice group. Problems could arise if an employer makes a financial incentive payable if an employee achieves a certain health goal, such as a lower body mass index, without providing more ways to help the employee meet those goals, he says.

The Affordable Care Act clearly makes these plans legal by saying financial incentives could be worth 30 to 50% of health insurance costs, says James Gelfand, senior vice president for health policy at the ERISA Industry Committee.

Megan Garcia, who works at JFK Hospital in Edison, N.J., says she wouldn't have known husband Michael had severe hypothyroidism if he hadn't been pushed to get a blood screening test under the program. After treatment, he feels much better, lost 20 pounds and avoided what his doctor said could have turned into cancer within four years.

TPAs Impacted

Thomas Reuters Practical Law says, HHS expressly declined to exclude TPA services from the final regulations. As a result, regarding an insurer that receives federal financial assistance and is principally engaged in providing health insurance but also provides TPA services, the insurer's TPA services are subject to Section 1557 in addition to its health insurance functions.

HHS acknowledged commenters' concerns that a TPA that administers a self-insured plan could be held liable for benefit plan design features that are discriminatory under Section 1557, but over which the TPA has no control. In this situation, HHS will assess whether responsibility for an alleged discriminatory decision or action rests with the TPA or the employer. If the TPA is responsible, HHS will process the complaint against the TPA.

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Medical News


Therapy that Uses Patient DNA to Guide Drug Selection Seems Superior to Standard Chemo

MyHealthGuide Source: Maria Schwaederle, Pharm.D., Center for Personalized Cancer Therapy, University of California, San Diego School of Medicine, et al., 5/19/2016, National Institute of Health HealthDay Article

"Precision" cancer treatment that's guided by genetic clues from the patient's own tumor appears to outperform traditional chemotherapy, a new research review finds.

Researchers analyzed 346 phase 1 clinical trials published between 2011 and 2013 involving 13,200 patients.  Those trials included 58 treatment arms that employed precision medicine, using tumor data to select patients for treatment, and 293 that did not. 

Study findings

  • Patients given precision -- or personalized -- treatment experienced a tumor shrinkage rate six times that attained by regular chemotherapy.
  • Achieved tumor shrinkage rates of about 31 percent, compared to about 5 percent in those that did not match a person's cancer to the drug being tested.
  • Patients in precision medicine arms also had nearly twice the progression-free survival -- time spent on medication before their cancer resumed progression -- with an average of 5.7 months compared with 2.9 months.
  • Basing therapy on a patient's DNA indicators outperformed use of protein indicators, 42 percent to 22.4 percent.

Researcher Maria Schwaederle will present these results at the American Society of Clinical Oncology's annual meeting in Chicago scheduled June 2016. But until they're published in a peer-reviewed medical journal, data and conclusions presented at meetings are usually considered preliminary.

About DNA Mapping

Precision medicine aims to treat cancer by targeting the unique DNA mutations that allow tumors to grow and spread, according to the U.S. National Cancer Institute.

Drugs developed under this approach might help the immune system better find and destroy cancer cells; block cancer-cell division; stop signals that form new tumor-feeding blood vessels; or order the cancer cells to commit suicide, the cancer institute says.

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Recurring Resources



Medical Stop-Loss Providers Ranked by Annual Premium Survey (last updated 4/16/2016)

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.
Stop-loss Premium Ranking
Compiled by MyHealthGuide Newsletter
Reader response and update is encouraged.
Sources will be cited. Please send updates / changes to Info@MyHealthGuide.com
  Stop-loss Provider Years Providing Stop Loss Associated Carriers / MGUs Annual stop-loss Premium
(Millions)
Capital/Equity
(Millions)
1 CIGNA     $2,701
2015
 
  Source - CIGNA Financial Supplement 2015, P.5 12/31/2015
2 Sun Life Financial     $1,034
2014
 
  Source - Sun Life 2/12/2015 Management Discussion of "13% stop loss growth over 2013" of 2013 premium of $915.2M provided by Scott Beliveau, Sun Financial 4/28/2014
3 Tokio Marine HCC
>35 Years Tokio Marine HCC Life
(A.M. Best Rated: A+)
$907
2015
$29,700 as part of Tokio Marine Group
  Source - Ketrice Williams, 5/6/2016
4 Voya Employee Benefits > 35 Years ReliaStar Life
(A.M. Best Rated: A)
$807
2015
$396
12/31/2015
  Source - Joe Keller, Lead Financial Analyst, Voya Employee Benefits, 3/28/2016
5 HM Insurance Group >30 Years HM Insurance Group
(A.M. Best Rated: A-)
$751.4
2015
$588
12/31/2015
  Source - Matt Rhenish, President & COO, 2/19/2016
6 Symetra >36 Years Symetra Life Insurance Company
(A.M. Best Rated: A)
(Block - $495M
MRM - $233M)
$728
2014
$3,360.6
12/31/2014
  Source - Symetra 4Q 2014 Financial Supplement;
Tom Doran, President, Medical Risk Managers, Inc., 2/9/2015
7 Companion Life > 20 Years   $440
10/8/2014
 
  Source - Philip Gardham, Vice President, Specialty Markets, 10/8/2014
8 Swiss Re Corporate Solutions >40 Years Standard Security life Insurance Company of New York, Westport Insurance Corporation and Independence American Insurance Company $324
3/31/2016
 
  Source - Swiss Re Corporate Solutions Accounting Department
9 National Union Fire Insurance Company of Pittsburgh >35 Years AIG Benefit Solutions $253
2/1/2016
 
  Source - Jeff Gavlick, FSA, FCA, VP, Stop Loss Products, AIG Benefit Solutions, 2/1/2016
10 Zurich North America     $150  
  Source - Joseph Byers, Zurich North America, 4/6/2015
11 Munich Re Stop Loss, Inc.   American Alternative Insurance Company (AAIC),
TransAmerica
$147
2015
 
  Source - Travis Micucci, the Chief Executive Officer of Munich Re Stop Loss, Inc., 11/09/2015
12 United States Fire Insurance Company 15   $120
2015
$1,200
  Source - Lauren Woods, VP Marketing Fairmont Specialty, 1/4/2016
13 The Union Labor Life Insurance Company  (ULLICO) >25 Years ULLICO
(A.M. Best Rated: B++)
$104
12/2014
 
  Source - Victor Moran, Second Vice President, Actuarial Operations.  3/6/2015
14 Gerber Life Insurance Company   Gerber Life Insurance Company $35
2016
$6,800
  Source - Gerber Life Insurance Company Stop Loss Director Job Description.  4/11/2016
15
Markel Insurance Company <5 Years Markel Insurance Company
(A.M. Best Rated: A-)
$3 $3,388
12/31/2011
  Source - Mark Nichols, Managing Director.  7/20/2012

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
  • Berkley Accident and Health
  • BEST Re 
  • Blue Cross Blue Shield (various regions)
  • International Insurance Agency Services, LLC (IIS)
  • 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?
  • % age of risk retained vs. ceded
  • Average stop-loss claim processing turn-around time
  • % age 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.  

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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.

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Video Highlighting Captive Solutions for Mid-market Companies

MyHealthGuide Source: The Self-Insurance Educational Foundation (SIEF), 5/11/2016, www.siefonline.org

The Self-Insurance Educational Foundation (SIEF) announced that it has released a new video highlighting captive insurance solutions for mid-market companies, including stop-loss captive programs, enterprise risk captives, and property & casualty group captives. Please click here to access the video.

The video can be accessed through the Foundation's web site at www.siefonline.org or by clicking here.  The video includes a separate video focused on self-insured group health plans. Both videos can be private labeled by individual companies interested in using them for their own purposes. Contact Justin Miller at jmiller@siia.org or 800-851-7789 for more information about private labeling.

About 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). Its 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.

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ICD-10 Readiness Tools

MyHealthGuide Source:  Industry Study Group (ISG), 9/19/2015

In the early 2000s a group of industry professionals collectively known as the Industry Study Group ("ISG") created a Standard Disclosure Notification form and a standardized list of ICD-9 diagnosis codes, known as the Trigger list. On October 1, 2015, our industry transitions to the new ICD-10 coding system. The ISG has once again undertaken the development of a new Trigger list based on the ICD-10 diagnosis codes. Please find links to the ISG White Paper on the process and to the new ICD-10-CM Trigger list

  • The new ICD-10-CM Trigger list is endorsed by SIIA and HCAA and supported by SPBA.  
  • Below are useful links for members of the self-funded community including TPAs, stop-loss carriers, MGUs, and others.

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    Upcoming Conferences


    May 23-26, 2016
    WEDI 25th Annual National Conference presented by Workgroup for Electronic Data Interchange.  This forum is designed to facilitate the groundwork underlying the future of healthcare information exchange. WEDI provides multi-stakeholder leadership and guidance to the nation's healthcare system on how to use and leverage the industry's collective technology, knowledge, expertise and information resources to improve the administrative efficiency, quality and cost effectiveness of healthcare information. Grand America Hotel, Salt Lake City.  Information and Registration

    May 24-25, 2016
    Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance Institute of America. The educational program weaves together a collection of compelling topics including "big data" applications for claims management, how wellness programs can help control workers' comp costs, alternatives to statutory workers' comp, medical "over-diagnosis," SIG tax updates, and developments contributing to the erosion of exclusive remedy.  Rounding out the program, a variety of hot topics will be addressed as part of an "Out Front Ideas" session, and also during a separate "Battle of the Bloggers" session, featuring several of the leading workers' compensation industry commenters. These sessions promise to spark lively discussions that you will not want to miss.
    Scottsdale, AZ. www.SIIA.org

    May 25-26, 2016
    12th Annual Canadian Captives and Corporate Insurance Summit presented by Captive Insurance. Sheraton Centre, Toronto, ON. Event for current and prospective captive owners, captive managers and other professionals working in risk management and corporate insurance. Information and registration: www.captivesinsurance.com/attending/download-brochure/

    June 13, 2016
    Predict Suite Subscribers Workshop, an interactive forum for subscribers to the Predict Suite of on-line diagnosis, RX, and implant management tools, presented by Advanced Medical Strategies at Mohegan Sun, Uncasville, CT. Contact Adria L. Garneau, CEBS, agarneau@mdstrat.com and visit www.mdstrat.com.

    June 13-15, 2016
    AMS Claims Symposium, a 2-day educational seminar for medical excess, underwriting, and medical management professionals, presented by Advanced Medical Strategies. Join top-industry experts at Mohegan Sun, Uncasville, CT, for this unparalleled educational opportunity. Contact Adria L. Garneau, CEBS, agarneau@mdstrat.com and visit www.mdstrat.com.

    July 13-15, 2016
    TPA University 2016 presented by  Health Care Administrators Association (HCAA). Renaissance Dallas, Dallas, TX. www.HCAA.org

    July 19-21, 2016
    MCIA Eleventh Annual Conference presented by The Montana Captive Insurance Association, Inc. (MCIA). This year's program will feature 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, Montana. (www.lodgeatwhitefishlake.com). Block of reserved rooms released on May 18, 2016. Contact Shane Byars at 866/388-6242, or sbyars@mtcaptives.org.  Visit www.mtcaptives.org.

    June 23-24, 2016
    Medicare Secondary Payer Master Class presented by Healthcare Conferences.  San Diego, CA. Self-insured identities must be able to manage the complexity of medical and pharmacy claims while handling Section 111 reporting, conditional payments, and settlements that follow. Join us to get all of your questions answered and ensure you have a handle on the complexities of MSP!  Information and Registration: Call 704-341-2445, email wbetts@frallc.com and visit https://healthcare-conferences.com/conference.aspx?ccode=H378 

    September 25-27, 2016
    36th Annual National Educational Conference & Expo presented by Self-Insurance Institute of America. Austin, TX. www.SIIA.org 

    October 17-19, 2016
    SPBA Fall Meeting (members only). Minneapolis, MN. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

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    January 30-February 1, 2017
    26th Annual National Health Benefits Conference & Expo.   Real-world education with numerous sessions focusing on case study evaluations and addressing many of today's hottest topics and issues from the latest ACA regulations to wellness program trends. To assist you in continuing your education, we are also pleased to provide CE credit for numerous designations including PHR/SPHR/GPHR, CIMA, CPA, CHES/MCHES, CEBS CPE and more! And because we understand that education goes beyond the classroom, this three-day program is designed to give attendees numerous opportunities to network with peers, speakers and exhibitors. ​Clearwater, FL.  Registration and information: https://www.hbce.com/Pages/Default.aspx 

    February 8-10, 2017
    Executive Forum 2017
    presented by Health Care Administrators Association (HCAA). Bellagio, Las Vegas, NC. www.HCAA.org  

    March 15-17, 2017
    SPBA Spring Meeting (members only). Washington, DC. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

    September 13-15, 2017
    SPBA Fall Meeting (members only). Cincinnati, OH. Society of Professional Benefit Administrators (SPBA). www.SPBATPA.org

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    Editorial Notes, Disclaimers & Disclosures


    • Articles are edited for length and clarity.
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    Clevenger Ernie Clevenger
    President & Publisher
    MyHealthGuide, LLC
    Clevenger@MyHealthGuide.com