General & Company News
- Expion Health: Navigating Shifting Market Expectations: Enhancing OON Claim Repricing Fairness and Transparency
- Expion Health Announces Strategic Partnership with HUB International
- Young Consulting Rebrands to Connexure: Embracing Connectivity and Innovation in the Stop Loss Insurance Market
- HealthWare Systems and WLT Forge Partnership to Empower TPA Members with Innovative Solutions
- HCAA Announces Registration Now Open for TPA Summit
- HCAA's Episode #29: Examining Population Health Management: Part One
- 6 Degrees Health Announces April Fireside Chat Featuring Ryan Work: 'Health Care Policy & the Political Landscape'
- 90 Degree Benefits Invites You To Join Their Upcoming Webinar: Exploring Unique Plans – Group Medical with Embedded Dental
- Nova Healthcare Administrators Receives Bronze in 2024 Stevie® Awards for Sales & Customer Service
- Nova Healthcare Administrators Honored Among Best Companies to Work for in New York for the 7th Consecutive Year
- The Phia Group Announces Webinar: Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!
- Research and Markets Release Global Insurance Third Party Administrators Market 2024-2028
- BRM Specialty Markets Welcomes Silvana Herbert as Director of Underwriting
- Vālenz® Health Welcomes Srinivas Achukola as New Chief Information Officer
- Medical Stop-Loss Providers Ranked by 2022 Annual Premium - Over $31.5 Billion
- ICD-10 stop-loss Trigger Diagnosis Tools
- The Value of Self-Funding
- An Introduction to Self-Funding: What, Who & How
Job News
Clicking a job listing below will open a webpage with job summary, details and links to additional information (when available). Initial publish date is shown right of listing. Listings are generally published for 1 month. This format helps reduce this Newsletter under the size limits of most email applications.
- Tokio Marine HCC - Stop Loss Group Open Positions (4/22)
- 90 Degree Benefits Seeks Billing and Enrollment Associate and Stop Loss Marketing Analyst (4/22)
- Vālenz® Health Seeks Patient Scheduling Agent & Case Management Nurse to Join Growing Team (4/22)
- Prudential Seeks Vice President, Medical Stop Loss (4/8)
- TruScripts Seeks Proposal and Content Marketing Writer (4/8)
- Risk Strategies Seeks Health Claims Stop Loss Auditor (4/1)
- The Phia Group Open Positions (4/1)
- Skyward Seeks Claims Auditor - Accident & Health and Assistant Underwriter - Medical Stop Loss (3/25)
- Coverys Seeks Senior Underwriter (3/25)
- CGS Health Group Seeks VP & General Manager (3/18)
General & Company News
Expion Health: Navigating Shifting Market Expectations: Enhancing OON Claim Repricing Fairness and Transparency
MyHealthGuide Source: Expion Health, 4/12/2024
In the changing landscape out-of-network (OON) medical claims, health plans and TPAs face the dual challenge of managing costs while ensuring fairness and transparency. A recent New York Times article spotlighting practices by certain industry players has intensified concerns regarding the management of OON claims. Such revelations underscore the importance of adopting business practices that not only meet but anticipate market expectations. Three key areas for plans to focus on are: fair repricing, balance billing support, and new models for repricing.
1. Balancing Cost Containment with Fairness in Repricing
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While it is essential to protect plans from exorbitant or erroneous charges, relying solely on simplistic or fixed pricing models and employing overly aggressive discount strategies can have negative consequences, such as tarnished reputations, increased financial burdens for members, and inflated administrative fees. Expion Health’s approach to claim repricing deviates significantly from the aggressive cost minimization tactics discussed in the article. We employ a balanced strategy through our ExpionIQ Intelligent Allowable pricing engine, which integrates a robust array of data points including FAIR Health, RAND Study data, UCR rates, geographical factors, clinical outcomes, historical data, and the potential for provider abrasion and member impact. This comprehensive approach ensures that reimbursements are not only fair but are also more likely to be accepted by healthcare providers, reducing conflict and the risk of balance bills for members.
2. Providing Proactive Support for Members Facing Balance Bills
Fifty-six percent of Americans are unable to cover an emergency expense of $1,000 from their savings1, and 51% want professional assistance to resolve balance bills2. Ensuring fair payments to providers is critical in reducing the incidence of balance bills, but it is equally important to offer support to members when such bills arise. Understanding the stress and financial burden balance bills can impose, Expion Health offers proactive, concierge-level support for members who might face such charges. We inform members of the potential for receiving a balance bill and provide options through our ExpionME app. Members can choose to handle the bill independently or enlist the help of our expert negotiators, who are equipped to resolve these matters efficiently and equitably. Additionally, ExpionIQ’s dashboards provide health plans and TPAs with valuable out-of-network insights to understand the impact on members and help inform decisions such as allowable schedules and how to optimize reimbursement strategies.
3. Exploring Innovative Solutions to Enhance Control and Reduce Fees
Employers and groups are increasingly vigilant about how their funds are utilized, pushing health plans and TPAs to justify their operational efficiencies and financial stewardship – forcing the adoption of a more fiduciary-like role. Forward-thinking plans and TPAs who proactively adapt will secure a competitive edge. In response, this year we introduced a groundbreaking Software as a Service (SaaS) option for our ExpoinIQ Intelligent Allowable pricing engine. This innovative tool enhances in-house pricing capabilities, offering unprecedented insights and control over the repricing process. Our volume-based pricing model presents a cost-effective alternative to traditional contingency-based models, aligning more closely with the financial and ethical interests of your business and your groups.
Conclusion
As market expectations shift towards greater transparency and fairness, it’s crucial for health plans and TPAs to adapt and align with these evolving standards. Expion Health is at the forefront, offering solutions that ensure compliance, enhance trust, and maintain the delicate balance between cost efficiency and fair reimbursement. By partnering with us, your business is not just keeping pace with industry changes—it's leading the way.
Sources
1. BankRate Emergency Savings Report 2023
2. Expion Health Balance Billing Survey 2022
About Expion Health
Expion Health, pioneers in healthcare cost containment innovation, combines the power of technology and multiple pricing pathways to unlock significant savings across pharmacy and medical claims. Leveraging 30+ years of experience to drive cost savings for health plans, PBMs, TPAs, and self-insured employers, Expion uses the most accurate and current data to address complex factors driving healthcare costs. At the heart of Expion Health's innovative solutions is the ExpionIQ platform, which brings together artificial intelligence, automation, and advanced analytics to create powerful solutions for unlocking savings opportunities while ensuring compliance with complex regulations. Email info@expionhealth.com and visit expionhealth.com and LinkedIn.
Expion Health Announces Strategic Partnership with HUB International
MyHealthGuide Source: Expion Health, 4/11/2024
Expion Health is pleased to announce our strategic partnership with HUB International, which was launched at HUB’s Clinical and Pharmacy Conference. As a preferred partner, Expion Health will provide expertise in medical bill review, independent reviews, and actionable insights for strategic pharmaceutical initiatives, complemented our powerful, award-winning ExpionIQ analytics.
Nick Stone, SVP, Medical Cost Containment Sales, commented on the partnership, stating, "We are thrilled to join forces with HUB International. This collaboration extends the reach of our pioneering cost management solutions, creating a greater impact in the health insurance space. By leveraging our expertise and innovative approaches, we are well-positioned to enhance healthcare cost management, providing significant benefits to HUB's extensive client base."
Together, Expion Health and HUB International are committed to transforming the impact of healthcare costs by implementing strategic solutions that promise substantial reductions for clients.
About Expion Health
Expion Health, pioneers in healthcare cost containment innovation, combines the power of technology and multiple pricing pathways to unlock significant savings across pharmacy and medical claims. Leveraging 30+ years of experience to drive cost savings for health plans, PBMs, TPAs, and self-insured employers, Expion uses the most accurate and current data to address complex factors driving healthcare costs. At the heart of Expion Health's innovative solutions is the ExpionIQ platform, which brings together artificial intelligence, automation, and advanced analytics to create powerful solutions for unlocking savings opportunities while ensuring compliance with complex regulations. Visit expionhealth.com, LinkedIn, and contact us at info@expionhealth.com.
Young Consulting Rebrands to Connexure: Embracing Connectivity and Innovation in the Stop Loss Insurance Market
MyHealthGuide Source: Connexure 4/21/2024
Atlanta, GA - Young Consulting, a leading vertical SaaS company in the stop loss market, proudly announces its rebranding to Connexure. This strategic rebranding reflects the company's commitment to embracing connectivity, innovation, and enhanced service offerings in the evolving landscape of stop loss insurance solutions.
At Connexure, we unite the self-funded medical ecosystem through integrated technologies, processes, and data insights. Our mission is to foster connections, drive innovation, and empower our clients to navigate the complexities of the stop loss insurance market with confidence and clarity.
"This rebranding represents a pivotal moment for our company as we continue to evolve and innovate in the stop loss ecosystem," said Mark Larsen, CEO of Connexure. "Connexure embodies our core values of curiosity, courage, collaboration, and exceptionalism. We are dedicated to unifying the self-funded medical ecosystem and delivering value-added solutions to our clients."
With their suite of solutions, carriers can underwrite and administer policies, brokers can shop coverage, and third-party administrators (TPAs) can submit and track claims for reimbursement, all while knowing their systems are connected and in sync with their industry counterparts. "Connexure aims to further leverage its platform to create a customer centric seamless experience for the overall ecosystem of carriers, brokers, and TPAs. With a dominant presence serving the carrier market, we are in the perfect position to create this win-win for the overall network," said Mahesh Bhirangi, COO of Connexure.
"We believe in the transformative potential of connectivity to drive positive change in the stop loss insurance market," added David Young, Founder of Connexure. "Through Connexure, we are committed to fostering a dynamic network of industry stakeholders to promote innovation, collaboration, and mutual success."
About Connexure
Connexure is dedicated to providing exceptional service, expertise, and support to its clients as it transitions to its new brand identity. The company's team of experienced professionals is poised to continue delivering innovative solutions and personalized service to meet the evolving needs of clients in the stop loss insurance market. Visit connexure.co.
HealthWare Systems and WLT Forge Partnership to Empower TPA Members with Innovative Solutions
MyHealthGuide Source: WLT, 4/17/2024
Elgin, IL -- HealthWare Systems, a leading provider of healthcare technology solu ons for over 26 years, announces the expansion of its services to benefit WLT's TPA (Third Party Administrator) partners. With multiple business units dedicated to providing innova ve solutions and services, HealthWare Systems aims to enhance opera onal efficiency and effec veness for WLT’s TPA partners.
HealthWare offers a comprehensive suite of solu ons and services tailored to meet the diverse needs of WLT’s TPA partners. These include:
- Workflow Opmization: Streamlining processes and improving efficiency through innovative workflow solutions.
- Document Interpretation: Utilizing advanced technology to interpret and process documents accurately and efficiently.
- Electronic Forms: Implementing electronic forms to enhance data capture and streamline administrative processes.
- Member/Provider Engagement: Enhancing communication and interac on between members, providers, and TPAs.
- Robotic Process Automa on (RPA): Automating repetive tasks and processes to increase productivity and reduce manual effort.
"Our collaboration with HealthWare Systems, alongside its subsidiaries Naviquis and CyberPro, signifies a leap forward in leveraging advanced technologies to tackle the complexities of modern healthcare,” said Shelley Van Etten, President & CEO of WLT Soware Enterprises, Inc. “HealthWare Systems' AI-powered workflow automation solutions, coupled with Naviquis' expertise in payment integrity, and CyberPro's robust security services, present an unparalleled opportunity to transform healthcare operations. Together, we are poised to deliver comprehensive solu ons that streamline processes, ensure payment accuracy, and fortify data security. This partnership embodies our shared commitment to innovation and excellence in addressing the evolving needs of the healthcare industry."
Steve Gruner, President of HealthWare Systems, expressed enthusiasm about the partnership with WLT and its TPA partners, stating, "We are extremely excited to work with WLT and its TPA partners. We look forward to offering new services and solutions via our automation platform, our payment integrity solutions, and our cybersecurity services.”
In response to the escala ng cybersecurity threats facing the healthcare industry, HealthWare Systems' cybersecurity unit offers cuting-edge solutions to protect digital assets and mi gate risks. Through access to experienced Chief Information Security Officers (CISO) and Chief Technology Officers (CTO) on a fractional basis, HealthWare Systems empowers TPA partners to strengthen their cybersecurity posture and navigate the ever evolving threat landscape with confidence.
The expansion of HealthWare Systems' services comes at a critical time for the healthcare industry, particularly considering the recent cyber-atacks that have impacted organizations across the sector. By providing innovave solutions and robust cybersecurity measures, HealthWare Systems is commited to supporting the success and resilience of WLT’s TPA partners.
About WLT
WLT Soware Enterprises, Inc., is a leading provider of advanced benefits administra on and claims adjudica on systems for Insurance Companies, Government Employee Plans, TPAs and Self-Administered Groups. With corporate offices in Clearwater, FL, WLT’s core systems include MediClaims and CompClaims. Core system capabili es encompass a range of benefit and claim types, from full Medical, Dental, Vision, and Prescrip on Drug, to FSA, HSA, HRA, COBRA, Disability, and HMO Capita on, to Work Comp claims. Visit wltsoftware.com.
About HealthWare Systems
HealthWare Systems is a leading provider of fully integrated, customizable workflow solutions and Revenue Cycle Management software. We specialize in applying robotic process automation (RPA) to healthcare processes to improve both the patient experience and the revenue cycle. Our ActiveWARE suite of products manages prearrival, financial assistance, early out, collections, denial management, claims follow-up, and more, and is proven to maximize productivity and profitability so that healthcare teams have more time and resources to spend on quality care. Visit healthwaresystems.com.
HCAA Announces Registration Now Open for TPA Summit
MyHealthGuide Source: The Healthcare Administrators Association (HCAA), 4/17/2024
HCAA TPA Summit
Date: July 15-17, 2024
Location: Hyatt Regency St. Louis at the Arch, St. Louis, MO
Reserve your seat today and receive the best early-bird rate
Information and Registration
Join your self-funding industry colleagues for three days of networking and thought-provoking discussions. Together, we'll collaborate and educate on ways our industry can continue fostering a transparent self-funding marketplace!
Our TPA Summit is once again jam-packed with engaging speakers analyzing the issues most important to TPAs and the self-funding industry, including:
- How to leverage actionable insights enabled in the new price transparent healthcare marketplace
- The impact of the 2024 election on healthcare policy
- A primer on digital transformation and it's impact on TPA organizations
- A deep dive into the TPA customer
- Humanizing and revolutionizing customer service
- And much, much more!
About HCAA
The Healthcare Administrators Association (HCAA) is the nation’s most prominent nonprofit membership trade association supporting the education, networking, resource and advocacy needs of benefit administrators (TPAs), stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, plan sponsors and health care consultants. For over 40 years, HCAA has taken a leadership role in transforming the self-funding industry, and increasing the importance of self-funding as an important alternative in the health care delivery systems of our country. Visit hcaa.org.
HCAA's Episode #29: Examining Population Health Management: Part One
MyHealthGuide Source: The Health Care Administrators Association (HCAA), 4/17/2024
Join in on the conversation with host Ramesh Kumar, CEO and Co-Founder of zakipoint Health, as he interviews key self-funding experts and dives deep into impactful topics and perspectives surrounding the self-funding industry.
Episode #29: Examining Population Health Management: Part One
On this episode of Voices of Self Funding, Ramesh interviewed Fred Goldstein, co-host of PopHealth Week, a weekly radio show that engages thought leaders, disruptive companies, and health systems in the field of Population Health Management.
This is the first of a two-part podcast that was recorded in front of a live audience at HCAA's Executive Forum and examined GLP-1, weight loss, gene therapies, reinsurance, and outcomes based contracts. The discussion also focused on population health and the use of data, access to primary care, maternity and musculoskeletal care, and more.
About HCAA
The Health Care Administrators Association is the nation’s most prominent nonprofit membership trade association supporting the education, networking, resource and advocacy needs of benefit administrators (TPAs), stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, plan sponsors and health care consultants. For over 40 years, HCAA has taken a leadership role in transforming the self-funding industry, and increasing the importance of self-funding as an important alternative in the health care delivery systems of our country. Visit hcaa.org.
6 Degrees Health Announces April Fireside Chat Featuring Ryan Work: 'Health Care Policy & the Political Landscape'
MyHealthGuide Source: 6 Degrees Health, 4/17/2024
6 Degrees Health is excited to announce its upcoming Fireside Chat event featuring Ryan Work. Titled "Health Care Policy & the Political Landscape," this virtual event will explore the intersection of healthcare policy and the current political climate.
In this Fireside Chat, Ryan Work, a renowned expert in healthcare policy, will provide attendees with invaluable updates on recent developments in health policy. From discussing the implications of these policies to dissecting the current political landscape, Work will offer valuable insights into what to expect in 2024 and beyond.
Fireside Chat: Health Care Policy & the Political Landscape (Webinar)
Date: Wednesday, April 24th, 2024
Time: 11:00 am PT
Location: Virtual, Click Here to Register
Key Speaker
Ryan Work
President & CEO
Surety & Fidelity Association of America (SFAA)
About Ryan Work
Ryan Work is the President & CEO of the Surety & Fidelity Association of America (SFAA), a nonprofit, nonpartisan trade association representing all segments of the surety and fidelity industry. Under his leadership, SFAA is undertaking critical advocacy, outreach and educational initiatives on behalf of member companies.
Before joining SFAA, Mr. Work was Senior Vice President of Government Relations at the Self-Insurance Institute of America (SIIA), where he led advocacy and political activities on self-insurance, stop-loss, and captive insurance issues. Prior to SIIA, he was Senior Director of Government and Regulatory Policy for S&P Global, representing brands including Standard & Poor’s, Platts, J.D. Power, and BusinessWeek.
Mr. Work has served in several senior staff positions within the U.S. Congress, including as Legislative Director for Cathy McMorris Rodgers (WA), current Chair of the House Energy & Commerce Committee. He previously served as Chief of Staff to Rep. Katherine Harris (FL) and in various staff roles with the U.S. House Committee on Ways & Means and the Office of the Speaker of the House.
Mr. Work is a graduate of Penn State University, where he holds degrees in Political Science, Spanish and International Relations.
About 6 Degrees Health
6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy.Visit 6degreeshealth.com
Heath Potter, Chief Growth Officer, 6 Degrees Health, can be reached at heathpotter@6degreeshealth.com (503) 640-9933 Ext. 1102, and (971) 762-1406 direct.
90 Degree Benefits Invites You To Join Their Upcoming Webinar: Exploring Unique Plans – Group Medical with Embedded Dental
MyHealthGuide Source: 90 Degree Benefits, 4/19/2024
Webinar: Exploring Unique Plans – Group Medical with Embedded Dental
Date: May 8 at Noon EST
Register Now.
90 Degree Benefits is all about embracing new and unique plan options. That includes some that you may not have heard of like our Group Medical with Embedded Dental (GMED) solution! Join hosts Tyler Fletcher, and Tom Davenport from our Georgia office, as they sit down with our partner and Managing Director at OnePlan, Steve Schultz to discuss the ins and outs of GMED on May 8 at Noon EST.
Until then, here are some interesting points about the plan:
- Major Medical: Self-Funded w/ Stop-Loss Protection (Level-Funded & Traditional Options)
- Predictive Risk Underwriting Tools
- Group Questionnaire Only (15-150 covered lives)
- 100% Surplus Returned
- Cigna, PHCS, First Health, Regional Networks
- Dental: EMBEDDED in the Major Medical Plan (Stop-Loss Protection)
- 80%-100% Coverage, No Annual Limits, No-Cost Preventative Visits
- Dental Claims Track Towards the Major Medical Deductible & OOP Max
- ONE CARD for both Medical & Dental Coverage
90 Degree Benefits is a leading Third-Party Administrator serving over 525,000 members nationwide. Our mission is to health employers Make the Right Turn™ for their business through strategically tailored benefit offers. We design health plans and administer benefits that meet each employer’s unique health and operational needs, both now and for the road ahead. Visit 90degreebenefits.com.
Nova Healthcare Administrators Receives Bronze in 2024 Stevie® Awards for Sales & Customer Service
MyHealthGuide Source: Nova Healthcare Administrators, 4/15/2024
Buffalo, NY – Nova Healthcare Administrators, Inc. received a Bronze Stevie® Award for Sales & Customer Service in the Contact Center of the Year Category. Finalists were honored during the 18th annual Stevie® Awards for Sales & Customer Service awards presentation on Friday, April 12 in Las Vegas, NV.
More than 2,300 nominations from organizations of all sizes and in virtually every industry, in 47 nations and territories, were evaluated in this year’s competition. Finalists were determined by the average scores of more than 200 professionals worldwide, working in seven specialized judging committees. Entries were considered in more than 90 categories for customer service and contact center achievements, including Contact Center of the Year, Award for Innovation in Customer Service, and Customer Service Department of the Year.
Nova provides comprehensive self-funded health plan administration along with flexible solutions, including medical, dental, vision, reimbursement and COBRA accounts, medical management and private-labeled services. Our contact center team is headquartered in Buffalo, NY, with approximately 180 associates, including around 30 associates in customer service roles, serving more than 500 clients with more than 300,000 members across the country. Nova’s customer service team was recognized for our focus on employee culture and retention, which is reflected in our high level of service delivery, with consistently low average speed of answer rates, high audit scores and client satisfaction ratings of above 90%.
More than 400 professionals from around the world attended the awards event in Las Vegas. Two leaders from Nova’s customer service team, Ashley Franczyk and Manny Garcia, both operations supervisors, accepted the award on behalf of Nova.
“We’re so humbled and thrilled to receive the Bronze Stevie Award. As a supervisor in our customer service area, receiving this award is not just a validation of our team's hard work, but a testament to our unwavering commitment to excellence,” said Franczyk. “This recognition highlights the importance of prioritizing culture, which directly translates into the exceptional level of service delivery we consistently aim to provide. When we prioritize our employees, they, in turn, prioritize our customers, resulting in outstanding outcomes for all involved.”
“I want to extend a heartfelt thank you to all our care navigators,” added Garcia. “Their dedication to providing caring, accurate, and empathetic service to clients and members is the cornerstone of our success. It's their commitment to going above and beyond that truly sets us apart and ensures that every interaction with our customers is not just satisfactory, but exceptional. We’re so thrilled to be a part of this amazing team.”
“The high scores given to the winning nominations in this year’s competition are evidence of the high levels of achievement portrayed in them,” said Stevie Awards president Maggie Miller. “We join with the judges and all members of the Stevie Awards community in congratulating and celebrating the winners for their accomplishments.”
Details about the Stevie Awards for Sales & Customer Service and the list of winners in all categories are available at stevieawards.com/sales/2024-stevie-award-winners.
About Nova
Founded in 1982 and headquartered in Buffalo, NY, Nova is one of the largest third-party administrators of self-funded employee benefit programs in the nation, providing the health care solutions our clients need in the way they need them. And we go far beyond the basics. We are creative problem solvers who build custom solutions. Nova provides a customizable, comprehensive array of services, including medical, dental, vision, COBRA, reimbursement account administration, and private-labeled solutions. Nova also offers award-winning, in-house, integrated medical management programs. We are the stewards of our clients’ benefit plans, offering best-in-class partnerships, customized solutions, and personalized service. Conmtact Breann Petro and visit novahealthcare.com,
About The Stevie Awards
Stevie Awards are conferred in nine programs: the Asia-Pacific Stevie Awards, the German Stevie Awards, the Middle East & North Africa Stevie Awards, The American Business Awards®, The International Business Awards®, the Stevie Awards for Great Employers, the Stevie Awards for Women in Business, the Stevie Awards for Sales & Customer Service, and the new Stevie Awards for Technology Excellence. Stevie Awards competitions receive more than 12,000 entries each year from organizations in more than 70 nations. Honoring organizations of all types and sizes and the people behind them, the Stevies recognize outstanding performances in the workplace worldwide. Visit stevieawards.com.
Nova Healthcare Administrators Honored Among Best Companies to Work for in New York for the 7th Consecutive Year
MyHealthGuide Source: Nova Healthcare Administrators, 4/22/2024
Buffalo, NY – Nova Healthcare Administrators, Inc. was recently named one of the 2024 Best Companies to Work for in New York for the seventh year in a row. Nova ranked 13th among 27 finalists in the medium size company category.
This statewide survey and awards program is designed to identify and honor the best places of employment in New York, benefiting the state's economy, its workforce and businesses. Winners were honored at an awards ceremony on April 18 in Albany, where rankings were also announced.
“Achieving this honor for the seventh consecutive year is a remarkable feat,” said Nova’s President James Walleshauser. “It speaks volumes about the sustained efforts and commitment of our team. At the heart of our success is a vibrant and positive work culture that fosters innovation, collaboration, and associate engagement. This recognition is not just about perks and benefits but a testament to the collective effort in creating an environment where everyone feels valued, empowered, and motivated.”
Whether meeting a client deadline or getting together for a Nova Navigators hike at a local park, Nova associates work hard and have fun. A variety of associate-led groups, including a Diversity Council, Renovations wellness committee and Nova in the Neighborhood volunteer and giving committee offer the opportunity to connect with one another, grow and make an impact on the company and community.
The annual Best Companies awards program is presented by the New York State Society for Human Resource Management (NYS-SHRM), Best Companies Group and BridgeTower Media/ Rochester Business Journal. Companies from across the state entered the two-part survey process to determine the Best Companies to Work for in New York. The first part consisted of evaluating each nominated company’s workplace policies, practices, and demographics. The second part consisted of an employee survey to measure the employee experience. The combined scores determined the top companies and the final rankings.
For more information on the Best Companies to Work for in New York program, visit bestcompaniesgroup.com/best-companies-to-work-for-in-new-york.
About Nova
Founded in 1982 and headquartered in Buffalo, NY, Nova is one of the largest third-party administrators of self-funded employee benefit programs in the nation, providing the health care solutions our clients need in the way they need them. And we go far beyond the basics. We are creative problem solvers who build custom solutions. Nova provides a customizable, comprehensive array of services, including medical, dental, vision, COBRA, reimbursement account administration, and private-labeled solutions. Nova also offers award-winning, in-house, integrated medical management programs. We are the stewards of our clients’ benefit plans, offering best-in-class partnerships, customized solutions, and personalized service. Visit novahealthcare.com.
The Phia Group Announces Webinar: Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!
MyHealthGuide Source: The Phia Group, 4/18/2024
Webinar: Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!
Description: On Dec. 27, 2020, the No Surprises Act (NSA) was signed into law, with an eye towards protecting patients against so-called “surprise” balance bills. The law leaned heavily on “good faith” negotiations between payers and providers, as well as “objective” decision making via independent dispute resolution. Three years later, The Brookings Institution reported that you are paying nearly four-times what Medicare pays (an average of 390%) and are spending at least 50% MORE than an average PPO network. The bottom line? Providers are winning and you are paying MORE now than you did before the NSA’s passage.
The Phia Group can help you formalize a process that ensures timely triaging of disputes, insert an objective third party for correspondence with providers and IDR, utilize intelligent out-of-network pricing methodologies, implement multifaceted benchmarking for objective yet aggressive defense, and utilize a tiered program to ensure continuous advocacy on behalf of your plan. Want to join the winning team? Then join The Phia Group for another priceless (and free) webinar on Thursday, April 25, at 1:00 PM EDT. Webinar Link.
About The Phia Group
The Phia Group, LLC, headquartered in Canton, Massachusetts, is a leading provider of health care cost containment solutions. With offices across the United States, The Phia Group offers comprehensive claims recovery, plan document, and consulting services designed to contain health care costs and protect plan assets. By delivering industry-leading consultation and cost containment solutions, The Phia Group empowers plans to achieve their goals. Visit phiagroup.com.
Research and Markets Release Global Insurance Third Party Administrators Market 2024-2028
MyHealthGuide Source: Research and Markets, 4/13/2024
The insurance third party administrators market is forecasted to grow by USD 119.02 Billion during 2023-2028, accelerating at a CAGR of 6.79% during the forecast period. The report on the insurance third party administrators market provides a holistic analysis, market size and forecast, trends, growth drivers, and challenges, as well as vendor analysis covering around 25 vendors.
The report offers an up-to-date analysis regarding the current market scenario, the latest trends and drivers, and the overall market environment. The market is driven by rising demand for specialized services in insurance industry, growing complexity of insurance regulations, and regulatory compliance requirements in the insurance industry.
Global Insurance Third Party Administrators Market 2024-2028
Cost: Single User: $2,500, Enterprise License: $4,000
Information and Order
This study identifies the technological advancements in insurance TPAS as one of the prime reasons driving the insurance third party administrators market growth during the next few years. Also, integration of multichannel communication in the insurance TPAS and rising mergers and acquisitions among the vendors in the market will lead to sizable demand in the market.
People News
BRM Specialty Markets Welcomes Silvana Herbert as Director of Underwriting
MyHealthGuide Source: BRM Specialty Markets, 4/14/2024
Philadelphia, PA - BRM Specialty Markets is extremely excited to announce Silvana Herbert as Director of Underwriting for BRM.
Silvana Herbert
Director of Underwriting
BRM
With over a decade of stop-loss experience, Silvana brings extensive knowledge of the stop loss industry from her work at TPAs, brokers and carriers. She previously worked as a client consultant, managing plan cost containment and plan design for self-funded clients. Most recently, Silvana worked as a Sr. Underwriter at a carrier, managing a premium block of 10M+. Silvana is a graduate of Gwynedd Mercy University with a degree in Applied Psychology.
Silvana commented “I am honored and excited to be a part of the BRM team. I share a passion for community and inclusion that BRM offers to all of their clients and staff and happy to be a part of the history of their continued growth and success.”
Roman McDonald, CEO of BRM, added: “We are very lucky to have Silvana as part of our BRM family. She brings a wealth of knowledge and experience to the team, and her expertise will be key as we continue our expansion strategies and product diversification in 2024.”
About BRM
BRM is a minority-owned comprehensive Managing General Underwriter (MGU) that offers an array of medical stop loss products and services to support the vast growing needs of the ESL marketplace. They offer a unique perspective from the broker/consultant lens and aim to make the placement of stop-loss a seamless process that results in satisfied and informed clients. In addition to traditional stop-loss products, BRM offers their sales and consulting background to assist clients who may not be well-versed in stop-loss, or who may need additional resources during the sales process. Their philosophy is to offer best in class service and product solutions to the broker/consultant community and Third Party Administrators. Visit brmuw.com.
Vālenz® Health Welcomes Srinivas Achukola as New Chief Information Officer
MyHealthGuide Source: Vālenz® Health, 4/19/2024
PHOENIX, AZ — Vālenz® Health announces that Srinivas (Srini) Achukola has joined the executive leadership team as Chief Information Officer.
Srini Achukola
Chief Information Officer
Vālenz® Health
For more than 20 years, Achukola has held executive roles with numerous IT organizations, notably for private equity-backed companies. He worked in retail and supply chain management before successfully leveraging the technological opportunities and ability to drive significant change in healthcare. Most recently, he served as Chief Technology Officer with Kepro, which partners with government and private healthcare payers in providing tech-enabled services for priority populations to help them remain in the community of their choice.
“Srini’s expertise in leading tech-driven transformations puts him in a tremendous position to advance our analytics, achieve higher levels of transparency, and further our mission to optimize the cost, quality and utilization of healthcare for everyone,” said Rob Gelb, Chief Executive Officer of Valenz. “We’re thrilled to have him join us in changing the way the industry works with self-insured employers, driving a member-friendly yet cost-effective experience, and ultimately, simplifying healthcare.”
Achukola also has held CTO or CIO positions with naviHealth Inc., CareCentrix and FuelQuest Inc., among several other global IT organizations. Currently based in Nashville, he earned his degree in electrical and electronics engineering from the National Institute of Technology, Tiruchirappalli, and an MBA from Ravishankar Shukla University.
“I believe deeply that technology plays a key role in accelerating organizational effectiveness and efficiency while also driving innovation, which fits so well within the Valenz culture,” Achukola said. “I’m looking forward to making an impact for the company using technology as a catalyst for exponential growth and new solutions, so we can further reduce healthcare costs for our customers and their members.”
About Vālenz® Health
Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible. Visit valenzhealth.com.
Market Trends, Surveys, & Opinions
Out-Of-Network (ONN) Claim Billing, Pricing and Adjudication
MyHealthGuide Source: Chris Hamby, Investigative Reporter, "Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill", New York Times, 4/9/2024
Editor's Note: This article seeks to shed light on Out-Of-Network (ONN) claim adjudication. Chris Hamby reviewed more than 50,000 pages of documents and interviewed more than 100 people for this article. The New York Times also petitioned two federal courts for materials under seal.
Excerpts & Paraphrases:
An Out-Of-Network (ONN) provider invoiced over $100,000 for a procedure. UnitedHealthcare relied on Multiplan's analysis and determined that $5,449 should be paid for the proceudre. The provider invoiced the patient for the balance (over $100,000).
A New York Times investigation shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee.
MultiPlan and health insurers typically receive a percentage of the “savings” on each claim, creating an incentive to recommend lower payments.
MultiPlan and the insurers say they are combating rampant overbilling by some doctors and hospitals, a chronic problem that research has linked to rising health care costs and regulators are examining. Yet the little-understood financial incentive for insurers and MultiPlan has left patients across the country with unexpectedly large bills, as they are sometimes asked to pick up what their plans didn’t pay, The Times found. In addition, providers have seen their pay slashed, and employers have been hit with high fees, records and interviews show.
In some instances, the fees paid to an insurance company and MultiPlan for processing a claim far exceeded the amount paid to providers who treated the patient. Court records show, for example, that Cigna took in nearly $4.47 million from employers for processing claims from eight addiction treatment centers in California, while the centers received $2.56 million. MultiPlan pocketed $1.22 million.
As to the issue of patients being billed for unpaid balances, Aetna said it offered employers “various options and strategies” to minimize the risk of unexpected charges. Cigna said that payment decisions could be appealed, and that it collected no fee if the patient was ultimately billed the balance. UnitedHealthcare blamed “egregious” charges by out-of-network providers and suggested that criticism of its work with MultiPlan had been stoked by a private-equity-backed medical staffing firm that is suing the insurer.
Growting Contention between Provider and Payer
After MultiPlan’s founder sold it to private equity investors in 2006, the company pursued a more aggressive approach. It embraced pricing tools that used algorithms to recommend lower payments, and no longer protected patients from having to pay the difference, documents show.
Meanwhile, private equity ramped up investments in physician groups and hospitals and, in some instances, began billing for extraordinary sums. Once insurers were no longer obligated to use the nonprofit database, FAIR Health, they began looking for ways to combat that billing and other charges they considered egregious. Because FAIR Health’s data was based on what doctors typically charged, insurers contended that overbilling would skew payments too high.
Large employers also have trouble getting data from insurers, said James Gelfand, head of the ERISA Industry Committee, which represents big companies with employee benefit plans. Cost-containment programs can be a “revenue center” for insurers, Mr. Gelfand said, but are “extremely difficult for employers to police.”
Legal News
Fight Brewing Over ERISA Preemption Gets House Hearing
MyHealthGuide Source: Sara Hansard, Senior Reporter, Bloomberg, 4/15/2024
Editor's Note: The Self-Insurance Institute of America (SIIA) actively informs and promotes self-fundeing with federal and state legislators and regulators. For questions or "how to engage", contact with SIIA Government Relations Team: Chris Condeluci, Anthony M. Murrello, and Catherine Bresler.
Employers target state actions they say erode ERISA preemption State attempts to regulate PBMs attract preemption controversy
The growing tension between state law and federal preemption over regulating drug benefits will be high on lawmakers’ agenda at an upcoming House hearing on strengthening the Employee Retirement Income Security Act (ERISA) as the law turns 50.
“When you’re talking about ERISA in Congress, you know preemption is the main focus,” said James Gelfand, president and CEO of the ERISA Industry Committee (ERIC), which represents large employers. “Employers love preemption,” he said, but groups that represent state interests “don’t like the preemption we already have, much less do they want to see it strengthened.”
Many business groups that responded to a recent request for comments from the House Education and the Workforce Committee want to alleviate problems they say they’re experiencing from “a rash of state efforts to place mandates on ERISA pharmacy benefits,” among other state actions.
Groups testifying at the hearing Tuesday will likely encourage the committee to draft legislation as it revisits the 1974 law that sets minimum standards for most voluntarily established retirement and health plans in private industry and generally prevents states from regulating the plans. An estimated 153 million employees and dependents are covered by employer-sponsored health plans, which are governed by ERISA.
A 2020 US Supreme Court decision, Rutledge v. Pharmaceutical Care Management Association, found that an Arkansas law requiring pharmacy benefit managers (PBMs) to reimburse state pharmacies at least as much as wholesale costs wasn’t preempted by ERISA. A number of states have since put laws in place that employer groups say infringe on ERISA protections.
In the States
Laws enacted in recent years in Oklahoma, Tennessee, and Florida seek to control network standards, cost-sharing practices, and reimbursement rates for PBMs, the pharmaceutical industry middlemen who negotiate health plans’ pricing and rebates, but who have been criticized for certain business practices.
States see the new laws as an effort to help community pharmacists who may be harmed by PBM practices, but employer groups say the laws could block them from designing their health plan benefits in ways that reduce pharmacy costs.
In August 2023, the US Court of Appeals for the Tenth Circuit struck down part of Oklahoma’s law regulating PBMs in Pharm. Care Mgmt. Ass’n v. Mulready, and the state is expected to ask the Supreme Court to review the appeals court decision.
In its March 15 letter to the Education and the Workforce Committee, ERIC cited Florida’s Prescription Drug Reform Act (SB 1550), which it said mandates “specific pricing terms for existing contracts between employers and their PBMs,” and requires “specific plan design elements.” It also cited Oklahoma, Tennessee, New York, and New Jersey laws that have an impact on cost sharing, mail order drugs, and which pharmacies must be covered.
“State legislation in this area impermissibly attempts to directly control the design and administration of self-funded ERISA plans, and further increases health care costs instead of reducing them,” ERIC said.
ERIC recommended that vendors with critical roles in plan design and administration, including PBMs, be designated as fiduciaries—as employer plan sponsors are—making them subject to required disclosures of plan information. The status would also help ensure they act in the best interest of plan participants, it said.
The National Community Pharmacists Association (NCPA), which supports efforts by states to further regulate some PBM practices, pushed back at arguments by employer groups that ERISA is in danger of being weakened.
“Our opponents are making so much into an ERISA issue, inappropriately expanding almost everything into a benefit design argument,” Joel Kurzman, NCPA director of state government affairs, said in an email.
“This strategy is both misleading and premature as it relates to ongoing developments with the Mulready case,” Kurzman said. Groups “who would prefer PBM practices remain opaque” are using ERISA “as an excuse to tank meaningful reform,” he said.
Big v. Small Companies
As federal lawmakers consider ERISA preemption of laws to regulate PBMs, they’ll be faced with discrepancies between the interests of large and small employers.
Large companies with multistate operations have relied on preemption to prevent a patchwork of state laws from emerging to govern employee drug benefits and pricing.
However, some 100 million Americans or so who are under mid- and small-market companies’ health plans may have different interests from participants in large company plans, said Chris Deacon, principal and founder of employer health care consulting firm VerSan Consulting LLC.
“They’re not always aligned, and I think that their voice often gets lost,” she said. Regional employer coalitions don’t have as much clout with Congress and don’t get an opportunity “to make their case,” she said.
State efforts to more closely regulate PBMs may help smaller employers with a regional presence that are less concerned with compliance over a larger number of states, according to Deacon.
The question of how much states can and should legislate on health-care benefits is an issue that goes beyond PBM-related laws. The issue may be especially important for medium and smaller businesses that appear to be struggling most with health-care spending.
About 98% of firms with 200 or more workers offer health benefits to at least some workers, but only 53% of firms with three to 199 workers do, according to a 2023 report from health-care research organization KFF.
“As healthcare costs soar, states are employing various strategies to enhance transparency and curb expenses, impacting all citizens, including ERISA plan participants,” Deacon and Lee Lewis, chief strategy officer for the Health Transformation Alliance, said in their March 15 comment letter to Congress.
Costs and Transparency
Increased health care costs, including through mandates imposed by the Affordable Care Act, have resulted in an erosion in small business coverage, said Joel White, president of the Council for Affordable Health Coverage. As the government increases subsidies for ACA plans, many employees are moving to marketplace coverage and Medicaid, he said.
“Several states have effectively eliminated small employer access to self-funded plans by attempting to make the sale of reinsurance to small employers illegal, banning the sale of level-funded plans to certain size groups, or making the sale of low attachment point plans (which are needed by most small employers seeking a level-funded plan arrangement) illegal,” the CAHC said in its letter.
Protecting small business access to self-funded plans in all states “would involve clarifying ERISA preemption with respect to self-funded arrangements for small businesses,” CAHC said.
The National Association of Insurance Commissioners said in its March 1 comment letter that “not all self-funded plans are offered by multistate employers,” and some employers that use self-funded plans aren’t large.
Concerns have arisen among state regulators that want to ensure that federal preemption protects only employers that are truly self-funded, rather than third parties that act as insurers, NAIC said. State insurance departments normally have jurisdiction over fully insured plans.
Another issue that commenters brought to the House committee that cuts across plans and employers of all sizes is data transparency.
Under ERISA, self-insured plans must be able to shop for the best quality of care at the lowest prices, and to make sure that billing and claims data are accurate, said Cynthia Fisher, founder and chairman of Patient Rights Advocate, which works on health-care transparency issues.
“Employers are having a really difficult time getting access to the billing and claims data from the third party administrators,” many of which are part of large health insurers, she said.
Medical News
Shifts in Diagnostic Testing for Headache in the Emergency Department
MyHealthGuide Source: Dustin G. Mark, MD; Brandon H. Horton, MPH; Mary E. Reed, DrPH; et al., 4/19/2024, JAMA Network
In this study of 198,109 emergency encounters from 21 emergency departments between 2015 and 2021, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of unruptured intracranial aneurysms and no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis.
Subarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied.
Primary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis.
Study findings
- Among 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White.
- Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (−11.1%; 95% CI, −12.0% to −10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%).
- Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = −.34, respectively).
Recurring News
Medical Stop-Loss Providers Ranked by 2022 Annual Premium - Over $31.5 Billion
Source: MyHealthGuide, 6/12/2023
The Medical Stop-Loss Provider Ranking has been updated based on 2022 Annual Premium. In addition, Rankings from prior years are incorporated into a single table. Click below to view full listing with premium: The Medical Stop-Loss Provider Ranking.
- The top 94 stop loss carriers are ranked.
- The Medical Stop-Loss Provider Ranking table data reflect Direct Earned Premium from the "Accident and Health Policy Experience Exhibit" ("Supplemental Pages, Insurance Expense Exhibit” section) of publicly available Statutory Reports filed annually by each insurance carrier.
Stop Loss premium based on 2022 annual premium is $31,508,195 (thousands), over a 2X increase over 2016 annual premium of $15,004,224 (thousands) for a compounded annual rate of 13.2%.
Top 10 and 20 Carriers Premium Concentration
The concentration of stop loss premium among of the Top 10 and Top 20 carriers has modestly reduced as 12 new carriers enter the market and other factors.
- Top 10 stop loss providers ($21.5 Billion) compose 68.2 % of the total market ($31.5 Billion), down from 71.2 % of total market last year.
- Top 20 stop loss providers ($25.9 Billion) compose 82.3 % of the total market ($31.5 Billion), down from 86.7 % of total market last year.
In the new 2022 ranking compared to 2021, there were
- 14 providers that did not change their ranking position, down from 23 last year.
- 74 providers moved up in the ranking, up from 49 last year.
- 12 providers moved down in the ranking, down from 15 last , year.
- 12 providers are new to the ranking, up from 0 last year, and
- 6 providers dropped out of the listing. up from 5 last year.
The top 20 stop loss providers based on 2022 annual stop loss premium:
- Cigna
- UnitedHealth Group
- Sun Life Financial Inc.
- CVS Health Corp.
- Elevance Health Inc., (formerly Anthem)
- Tokio Marine HCC
- HCSC
- Voya Financial Inc.
- HM Insurance
- Symetra
- Humana
- W. R. Berkley Corp
- Blue Cross Blue Shield of SC
- QBE
- Fairfax Financial (C&F Ins)
- Swiss Re
- Allstate Corp.
- Western & Southern Financial
- Blue Cross Blue Shield of MI
- Nationwide
Upcoming Conferences & Webinars
April 24, 2024 - webinar 11:00 am PT
Health Care Policy & the Political Landscape," presented by 6 Degrees Health. In this Fireside Chat, Ryan Work, President & CEO of the Surety & Fidelity Association of America (SFAA), is a renowned expert in healthcare policy. He will provide attendees with invaluable updates on recent developments in health policy. From discussing the implications of these policies to dissecting the current political landscape, Work will offer valuable insights into what to expect in 2024 and beyond. Click Here to Register
April 25, 2024 Webinar- 1:00 PM EDT
Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help! presented by The Phia Group. On Dec. 27, 2020, the No Surprises Act (NSA) was signed into law, with an eye towards protecting patients against so-called “surprise” balance bills. The law leaned heavily on “good faith” negotiations between payers and providers, as well as “objective” decision making via independent dispute resolution. Three years later, The Brookings Institution reported that you are paying nearly four-times what Medicare pays (an average of 390%) and are spending at least 50% MORE than an average PPO network. The bottom line? Providers are winning and you are paying MORE now than you did before the NSA’s passage. The Phia Group can help you formalize a process that ensures timely triaging of disputes, insert an objective third party for correspondence with providers and IDR, utilize intelligent out-of-network pricing methodologies, implement multifaceted benchmarking for objective yet aggressive defense, and utilize a tiered program to ensure continuous advocacy on behalf of your plan. Want to join the winning team? Webinar Link.
May 1, 2024
Medical Captive Forum (MCF 2024) presented by Roundstone. As part of Roundstone's ongoing commitment to realign the healthcare industry around the needs of employers and their employees, the company launched MCF as an educational event designed to simplify the complexities of self-funding and democratize access to better health benefits. It is a gathering of forward-thinking HR, finance, CEOs, business owners, benefits advisors, and solution providers all united by a common goal to provide better care at an affordable cost.. JW Marriott New Orleans. Information and Registration
May 6-8, 2024
Corporate Growth Forum presented by Self-Insurance Institute of America (SIIA). This unique industry event is designed to help companies active in the self-insurance marketplace better understand common growth strategies made possible by corporate financial transactions (mergers, acquisitions, capitalizations, etc.). In addition to targeted educational content and the ability to engage with other members with similar interests, attendees will have the opportunity to connect with important sources of capital, including angel investors, venture capital, private equity and strategic investors. Westin Poinsett, Greenville, SC. registration@siia.org and 800-851-7789.
May 8, 2024 - Webinar 12 Noon EST
Exploring Unique Plans – Group Medical with Embedded Dental presented by 90 Degree Benefits. Here news about our Group Medical with Embedded Dental (GMED) solution! Join hosts Tyler Fletcher, and Tom Davenport from our Georgia office, as they sit down with our partner and Managing Director at OnePlan, Steve Schultz to discuss the ins and outs of GMED on May 8 at Noon EST. Register Now.
May 14 - 16, 2024
Medical Excess Claims Conference presented by Davies (formerly Northshore). Davies specializes in accident and health audits, consulting, and claims management services to risk-bearing entities such as TPA, Managed Care Organizations, MGUs, and Carriers. The conference will be at the historic seaside Hawthorne Hotel in Salem, Massachusetts. It will feature educational sessions on industry claim and cost containment topics presented by experts in the field. We also expect to offer additional sessions on relevant actuarial, captive, and subrogation topics of interest in 2024. Attendees will receive information critical in today’s claim and cost containment environment and the opportunity to meet and discuss common issues with industry peers. This invitation-only conference is open to MGUs, Carriers, and Reinsurers. To learn more about Davies, visit: davies-group.com/us/solutions/insurance-services.
May 20-21, 2024
SPBA Annual Spring Meeting presented by the Society of Professional Benefit Administrators (SPBA). Washington, D.C. Two days’ worth of educational sessions that focus on timely regulatory issues and developments that affect self-funded health plans. The Capital Hilton, Washington, DC. Please email SPBA at Info@spbatpa.org for more information. (This event is open to members only and those eligible for membership).
May 29-30,2024
Cell and Gene Therapy Stakeholder Forum presented by Self-Insurance Institute of America (SIIA). Join leading experts in the Cell & Gene Therapy field as well as thought leaders with the self-insurance industry who will discuss the latest industry developments along with related implications for self-insured payers. You will leave with detailed knowledge of the CGT pipeline, manufacturer perspective on pricing, value-based pricing consideration, potential financial mitigation/risk strategies, plan document guidance and more. JW Marriott Minneapolis, Mall of America. registration@siia.org and 800-851-7789.
June 12-14, 2024
11th Annual AMS Conference presented by Advanced Medical Strategies (AMS). Attendees can expect an all-star lineup of dynamic breakout sessions, guest speakers, keynotes from Dr. Marty Makary of John Hopkins University School of Medicine and AMS' Founder & Chief Medical Officer, Dr. Stacy Borans. Come together with key decision makers and executives representing various sectors of the healthcare industry, including prominent Health Plans, TPAs, Stop-loss Carriers, Reinsurers, MGUs, Brokers, Consultants, Captives, Risk Management, Payment Integrity, and Revenue Cycle Management professionals. Contact Stephanie Belschner, Event Organizer, at sbelschner@amspredict.com. Hotel Commonwealth. Boston MA. Information and Registration
June 27–28, 2024
2024 Onsite Employee Health Clinics Forum. Leading Strategies to Build & Expand Worksite Clinics: Reduce Medical Expenses, Ensure/Maintain a Competitive Benefits Strategy and Achieve a High-Performing & Healthy Workforce. Swissotel Chicago • Chicago, IL. Information and Registration.
June 27, 2024
Health & Voluntary Benefits Association® (HVBA) Benefit Networking Roadshow. This exclusive event will feature three compelling Continuing Education (CE) sessions, offering invaluable insights into the latest updates in legislation related to the Consolidated Appropriations Act (CAA), Employee Retirement Income Security Act (ERISA), and Long-Term Care (LTC) as well as Decoding Medicaid and Medicare. Event offers a platform for professionals to network, forge valuable business connections, and explore potential prospects in the industry. Attendees can also enjoy delectable hors d'oeuvres, premium cocktails, and an atmosphere conducive to fruitful conversations. Contact Jenny Jenkins, SVP of Operations, at jjenkins@vbassociation.com or call (561) 398-1060. Complimentary tickets to this event: conference.vbassociation.com
July 15-17, 2024
HCAA TPA Summit 2024 presented by Health Care Administrators Association. Join your self-funding industry colleagues for three days of networking and thought-provoking discussions. Together, we'll collaborate and educate on ways our industry can continue fostering a transparent self-funding marketplace! Hyatt Regency St. Louis at the Arch. Information and Registration
July 22-24, 2024
International Conference presented by Self-Insurance Institute of America (SIIA). This unique event has been designed to help self-insurance/captive insurance industry professionals identify and understand business development and/or risk management opportunities that are global in scope and focus. The targeted educational program will be supplemented by multiple networking opportunities, including hosted events designed to provide attendees with an authentic Dublin experience. Host hotel is The College Green Hotel Dublin. Information and Registration
September 22-24, 2024
SIIA National Conference. JW Marriott Desert Ridge, Phoenix, AZ SIIA.org
Sept. 27-28, 2024
Hint Summit 2024: Elevating Healthcare: DPC’s Climb to Mainstream presented by Hint. Join us in Denver, CO for Hint Summit 2024 as we celebrate the rise of Direct Care. Hint Summit brings together Direct Primary Care enthusiasts, pioneers, and innovators to share ideas, build meaningful new relationships, and celebrate the impact of DPC—all with the goal of growing the Direct Care movement and making it the new standard in US healthcare. Denver, Colorado. Information and Registration.
February 10-12, 2025
HCAA Executive Forum 2025 presented by Health Care Administrators Association. Bellagio Las Vegas. Contact Susan Crolla
October 12-14, 2025
SIIA National Conference. JW Marriott Desert Ridge, Phoenix, AZ SIIA.org
Editorial Notes, Disclaimers & Disclosures
- Articles are edited for length and clarity.
- Articles are selected based on relevance and diversity.
- No content in this Newsletter should be construed as legal advice. All legal questions should be directed to your own personal or corporate legal resource.
- Internet links are tested at the time of publication. However, links change or expire often.
- Articles do not necessarily reflect views held by the Publisher.
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