General & Company News

• 2021 Employer Health Benefits Survey
• HCAA Announces Its All-Star Lineup of Speakers for Executive Forum Scheduled February 21-23, 2022
• Vālenz® Unveils Solutions to Replace Traditional Reference-Based Pricing
• Cornerstone Healthcare Consulting and Azeros Health Plans Partner to Introduce Health Plan Innovation
• Marpai Announces New Service to Fill Gaps in Care to Promote Member Health and Drive Down Healthcare Costs
• The Phia Group Announces Recording: COVID-19 Vaccine Mandate Update
• UnitedHealth Exec’s Court Testimony Hints at MultiPlan Trouble

People News

• Self-funded Pioneer, Key Deyhle, Passes
• Allegiance's Ron Dewsnup to Retire, Stephen Tahta Named as Next President & General Manager
• The Phia Group adds Scott Bennett to The Team
• Symetra Appoints Melissa Pearce, M.D., Stop Loss Medical Director
• Flume Health Adds Healthcare Innovator Andrew MacGill As Vice President Of Product
• HealthComp Appoints Jon Dimmock to Vice President of Sales

Market Trends, Studies, Books & Opinions

• National Survey of Health Plan Brokers Reveals Growth for Referenced Based Pricing

Legal News

• New Law Regulating Health Care Benefit Managers in Washington State Can Impact TPAs, PBMs, Others

Medical News

• Oncology Drugs are 40 Times More Likely to be Deemed Cost-effective When the Study was Funded by Pharmaceutical Company Compared with No Funding 

Recurring Resources

• Medical Stop-Loss Providers Ranked by 2020 Annual Premium - Over $25.6 Billion
• ICD-10 stop-loss Trigger Diagnosis Tools 
• The Value of Self-Funding 
• An Introduction to Self-Funding: What, Who & How 

Upcoming Conferences

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 new format was prompted the Newsletter becoming so large that some filters and email systems blocked the delivery.  

• Voya Financial Seeks Stop Loss Actuary (11/22)
• Odyssey Reinsurance Seeks Senior Claims Examiner (11/22)
• Flume Health Open Positions: Director of Claims, Account Manager - Benefit Insurance, EDI Analyst (11/22)
• Renalogic Open Positions: Renalogic Open Positions: Client Service Manager, Regional Sales Director, Software Developer, Solutions Architect & Developer (11/22)
• HM Insurance Group Open Positions: Senior Actuary Stop Loss and Sales Director for Phoenix Regional Sales (11/15)
• Kismet Risk Management Associates, LLC (KRMA) Open Positions: Stop Loss Sales Representative and Senior Medical Stop Loss Underwriter (11/15)
• Pareto Health Open Positions: Regional Vice President - Sales, Marketing Programs Manager, Marketing and Communications Specialist, Market Development Representative (11/8)
• Marpai Health Seeks Assistant Vice President of Claims (11/8)
• 6 Degrees Health Seeks Vice President of Business Development (11/1)
• Liberty Mutual Seeks Senior Claims Analyst, Employer Stop Loss (11/1)
• Ullico Seeks an Associate Actuary (10/25)
• The Phia Group Open Positions (10/25)
• Symetra has open positions: Director, Stop Loss and National Group Manager (10/18)
• HCSC Blue Cross Blue Shield has open positions: Senior Product Development Consultant – Stop Loss, Senior Underwriter – Stop Loss (10/18)
• Risk Strategies Seeks Specialty Program Auditor (10/18)
• American Trust Administrators Seeks Vice President of Operations (10/18)
• Berkley Accident and Health Open Positions: Underwriting, Clinical, Sales, and More (10/18)

Editorial Notes, Disclaimers & Disclosures


General & Company News


2021 Employer Health Benefits Survey

MyHealthGuide Source: Kaiser Family Foundation (KFF) and Health Affairs, 11/10/21, 2021 Employer Health Benefits Survey

Excerpts

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2021 survey included 1,686 interviews with non-federal public and private firms. 

Key findings

• Annual premiums for employer-sponsored family health coverage reached $22,221 this year, up 4% from last year, with workers on average paying $5,969 toward the cost of their coverage.
• The average deductible among covered workers in a plan with a general annual deductible is $1,669 for single coverage.
• 58% of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 59%.

Self-Funding

• 64% of covered workers, including 21% of covered workers in small firms and 82% in large firms, are enrolled in plans that are self-funded.
• The percentage of covered workers enrolled in self-funded plans is similar to the percentages five years ago (61%) and ten years ago (60%).

Stop-Loss Coverage

At large firms (200 or more workers),

• 62% of covered workers in self-funded health plans are in plans that have stop-loss insurance, similar to percentages last year (61%) and in 2018 (59%).
• The percentage of covered workers in large firms in self-funded plans with stop-loss insurance (62%) is similar to the value when the survey first asked about stop-loss insurance in 2011 (57%)

Level-Funded Plans Grow

In the past few years, insurers have begun offering health plans that provide a nominally self-funded option for small or mid-sized employers that incorporates stop-loss insurance with relatively low attachment points.

Often, the insurer calculates an expected monthly expense for the employer, which includes a share of the estimated annual cost for benefits, premium for the stop-loss protection, and an administrative fee.

The employer pays this “level premium” amount, with the potential for some reconciliation between the employer and the insurer at the end of the year, if claims differ significantly from the estimated amount. These policies are sold as self-funded plans, so they generally are not subject to state requirements for insured plans and, for those sold to employers with fewer than 50 employees, are not subject to the rating and benefit standards in the ACA for small firms.

• 42% of small firms report that they have a level-funded plan, higher than the percentage (13%) last year.
• The substantial increase for 2021 suggests that that there may be a significant shift in the small group market toward health-status-based rating, so it will be important to monitor this trend to see if continues over the next several years.
• These arrangements combine a relatively small self-funded component with stop-loss insurance which limits the employer’s liability to low attachment points that transfer a substantial share of the risk to insurers.

Due to the complexity of the funding (and regulatory status) of these plans, and because employers often pay a monthly amount that resembles a premium, respondents may be confused as to whether or not their health plan is self-funded or insured. We asked employers with fewer than 200 workers whether they have a level-funded plan.



Health Care Price Transparency

New federal rules will require health plans (including self-funded plans) make information available to enrollees about the estimated cost of services and cost sharing on a “real-time” basis.

• 2626% of large employers offering health benefits believe that providing employees with additional information about the cost of services will help their health care decision-making “a great deal” and an additional 50% say that it will help their decision-making “somewhat”.
• Employers were less certain about the impact of health care costs, with only
  • 3% of large employers saying that the new transparency rules will reduce health spending “a great deal”.
  • 15% say that they will be reduce health spending “not at all.”
  • 38% of these firms say that the new rules will reduce spending “somewhat” and
  • 40% say that they will reduce spending “very little”.

High-Deductible Health Plans with Savings Option

The survey treats high-deductible plans paired with a savings option as a distinct plan type – High-Deductible Health Plan with Savings Option (HDHP/SO) – even if the plan would otherwise be considered a PPO, HMO, POS plan, or conventional health plan.

Specifically for the survey, HDHP/SOs are defined as (1) health plans with a deductible of at least $1,000 for single coverage and $2,000 for family coverage20 offered with an HRA (referred to as HDHP/HRAs); or (2) high-deductible health plans that meet the federal legal requirements to permit an enrollee to establish and contribute to an HSA (referred to as HSA-qualified HDHPs).

HDHP/SO Growth Declines

For employers sized 3-199 workers, the growth rate of HRA and HSA plans has declined since 2018.  For large firms, the growth rate showed its greatest decline since 2006.


Methodology

KFF conducted the annual employer survey between January and July of 2021. It included 1,686 randomly selected, non-federal public and private firms with three or more employees that responded to the full survey. An additional 2,413 firms responded to a single question about offering coverage. For more information on the survey methodology, see the Survey Design and Methods Section.  Visit kff.org.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.


HCAA Announces Its All-Star Lineup of Speakers for Executive Forum Scheduled February 21-23, 2022

MyHealthGuide Source: Health Care Administrators Association (HCAA), 11/18/2021

Executive Forum 2022 is back – live and in person! Not only will you have the chance to network and create those important connections within the self-funding industry, but we are bringing back some of the most impressive and memorable keynote speakers of conferences past to enlighten and inspire us all! This year's agenda will bring you a full slate of relevant topics surrounding the self-funding industry of 2022 and beyond.


Join your fellow self-funding industry colleagues in-person from February 21-23 at the beautiful Bellagio hotel in Las Vegas for days packed full of in-person networking, content and fun.

Can't make it to the in-person event? Don't worry! We will also have a real-time, live-streaming option available.

Register by Dec. 1 to save with the best early-bird rate!

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.


Vālenz® Unveils Solutions to Replace Traditional Reference-Based Pricing

MyHealthGuide Source: Vālenz®, 11/19/2021

Innovative reimbursement strategies maximize plan dollars, improve provider relationships and drive significant savings

PHOENIX, AZ — At a recent customer event, Vālenz® leaders unveiled a package of solutions that offer innovative alternatives to traditional reference-based pricing (RBP) agreements, designed to give self- insured employers more leverage in their local markets.

According to Rob Gelb, CEO of Valenz, the market needs to move away from traditional RBP approaches, which continue to be focused on basic payment reductions. “Now is the time to change the way you look at a reference-based approach to reimbursement that is defensible and allows customers to position in the market without contracts,” Gelb said. “The new Valenz package is designed to do this, plus it offers options to share risk with our customers.”

Each solution is fueled by data-driven insights and supported via the proprietary Valenz VMS™ Repricing Methodology, (VMS) to yield fair, market-sensitive reimbursements that deliver improvement in savings as high as 75 percent, according to Gelb.

Valenz solutions offer options for self-insured employers to choose the path to smarter, better, faster healthcare that is best for their markets:

• Access Open Solution maximizes plan dollars with a non-network reimbursement strategy that fosters equitable provider relationships. With integrated care navigation that lowers costs, this solution provides transparent quality and outcomes data for fair, defensible and consistent reimbursement recommendations.
• Access Assured Payment builds on Access Open Solution to eliminate the risk of balance billing, member disruption and provider friction by offering assured payments for up to 91 percent of claim volume. The remaining claims undergo comprehensive, line-by-line bill review with provider sign-off for secured savings.
• Access Amplified offers an out-of-network wrap solution – complete with care navigation, bill review and assured payment – to replace wrap networks. This solution directs members to high-quality care at fair, reasonable costs and secures appropriate, accurate charges for every out-of-network claim, resulting in significant savings.
• Providing an alternative reimbursement approach for non-Medicare-based pricing – one that, like the other solutions, embeds VMS for fair, equitable, market-sensitive reimbursement rates.

“These solutions help maximize savings opportunities, reduce risk to the health plan, and put leverage back in the self-insured employer’s favor,” Gelb said. “That’s the power of the Valenz ecosystem. It lets us do what we do best, which is creating partnerships through contracts with providers.

About Valenz

Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. Visit valenzhealth.com. Valenz is backed by Great Point Partners.


Cornerstone Healthcare Consulting and Azeros Health Plans Partner to Introduce Health Plan Innovation

MyHealthGuide Source: InsuranceNewsNet, 11/19/2021

Preface: Azeros CEO Ron Zoeller was the founder and CEO of North American Health Plans in 1983, which administered self-funded plans for over 400 groups and 400,000 members, paying $2 billion in annual claims. Azeros partner Kevin Gannon, an employee benefits broker over 35 years, was the founder/President of Niagara Benefits Group and later led the growth of M & T Benefits Agency.  Melissa Marsocci formerly owned urgent care centers and developed tailored programs such as college student telemedicine and occupational health combined with on-site health centers. .

Cornerstone Healthcare Consulting and Azeros Health Plans intend to bring change to Western New York healthcare delivery and funding. "Our goal is not to do what is easy," says Melissa (Missy) Marsocci, Owner of Cornerstone. "We will do what is necessary for the employer community that to date has been ill-served by the healthcare infrastructure.”

Buffalo, NY -- Cornerstone Healthcare Consulting and Azeros Health Plans intend to bring change to Western New York healthcare delivery and funding. "Our goal is not to do what is easy," says Melissa (Missy) Marsocci, Owner of Cornerstone. "We will do what is necessary for the employer community that to date has been ill-served by the healthcare infrastructure.”

Azeros designs health plans that provide quality care and lower costs to employers. Cornerstone provides consulting and marketing services to medical professionals and practices. Combining their collective backgrounds, the companies have teamed up to introduce the region to Direct Primary Care (DPC) supported by an Exclusive Provider Organization (EPO).

The EPO model provides physicians an independence from the “Mother – May I?” oversight of health insurers and the outdated fee-for-service medicine that complicates billing and payment. Under the DPC model, new clinics offer employees experience greater access to primary care at a fixed monthly payment and zero co-pays for the care. When combined with an international specialty pharmacy program, employers save 20% off current costs.

While building the Western New York EPO, the companies will introduce employers to Direct Primary Care vendors PeopleOne Health and Everside Health. The DPC converts an existing medical facility or builds a new clinic at their expense.

The EPO is not exclusive to primary care providers or those operating with a DPC model. The EPO network extends a much-needed opportunity to all physician specialty types by offering them independence, visit capacity and cost control. Cornerstone and Azeros are excited to share this model with the physicians and employers of Western New York.

About Cornerstone Healthcare Consulting and Management

Cornerstone Healthcare Consulting is a physician-centric company with the experience, expertise, and resources to assist physicians in many aspects of their professional lives. They offer an array of services for individual physicians or entire practices including marketing and branding needs, sustainable organizational change, and opening new practices. Contact Melissa (Missy) Marsocci at missymarsocci@cm-hi.com and visit cornerstonehealthcareconsultant.com.

About Azeros Health Plans, LLC

Azeros Health Plans is the only Managing General Administrator in the self-funded insured health plan industry. They provide employers with transparency and plans that significantly reduce their costs, as well as offer an international pharmacy benefits program to help employers save on prescription drug costs. Contact Kevin Gannon at k.gannon@azeros1.com and visit azeros1.com.


Marpai Announces New Service to Fill Gaps in Care to Promote Member Health and Drive Down Healthcare Costs

MyHealthGuide Source: Marpai via PRNewswire, 11/16/2021

TAMPA, FL -- Marpai, Inc., ("Marpai") (Nasdaq: MRAI), a deep learning technology company transforming third-party administration in the healthcare self-funded market, announced the launch of its Gaps in Care service helping health plan members stay current with annual exams, vaccines, and health screenings. The effort is an expansion of Marpai's premium, AI-powered services and automatically sends personalized texts and emails to remind members when it is time to make an appointment.

Marpai is an alternative to traditional TPAs (third party administrators) that promotes proactive health with AI-powered services, including the use of deep learning models to help predict near-term health risks in order to prevent and reduce costly chronic illness and procedures. The new Gaps in Care service aims to help members maintain annual health visits to stay on the best health journey and enable early detection of developing issues. Marpai is addressing an industry representing over $1 trillion in health claims, $20 billion in administrative fees, and 95 million Americans.

Early intervention can prevent and reduce chronic illness and costly health events. For example, according to the American Cancer Society, when breast cancer is detected early and is in the localized stage, the 5-year relative survival rate is 99%, yet the CDC reported that only 66% of women over 40 are getting annual mammograms. Colorectal cancer is the third most common form of cancer among men and women, yet only 67.4% of adults aged 50 to 75 years were up-to-date with annual screenings, according to the CDC.

"Our goal in offering this new service is to empower members to take charge of their health by providing the friendly reminders they need to take action on these important visits. We believe that when we guide members to proactive care, it ultimately creates healthier lives across diverse populations and reduces costs in the long run," said Lisa Willet, Vice President of Population Health and Member Engagement at Marpai. Ronnie Brown, Marpai COO, adds, "Maintaining annual checkups can help people stay on top of their health and ahead of potential adverse health events, which could save money and avert real suffering."

"We are aggressively using advanced technology to empower healthier lives and reduce costs. We believe that helping members fill these gaps in care is a big step forward in staying on the best health journey," said Edmundo Gonzalez, CEO of Marpai.

About Marpai, Inc.

Marpai, Inc. ("Marpai") is an AI-driven health technology company using deep learning to transform third-party administration (TPA) in the self-funded market to radically reduce costs, improve lives and simplify everything. Marpai uses proprietary algorithms to predict near-term health needs and intervene to prevent illness by guiding health plan members to appropriate top-quality providers. Marpai's SMART technology platform works to eliminate cost excesses in claims processing, reduce the cost of claims, and lower stop-loss premiums with future health cost predictions. Marpai's deep learning system makes it easy for members to take better care of their health and stay ahead of emerging needs. Operating nationwide in serving over 65 self-funded companies and 50,000 members, Marpai provides access to world-class provider networks including Aetna and Cigna, and partners with brokers and consultants across the U.S. Marpai does not provide medical prognosis or healthcare, and is not engaged in the practice of medicine. Visit marpaihealth.com .


The Phia Group Announces Recording: COVID-19 Vaccine Mandate Update

MyHealthGuide Source: The Phia Group, 11/19/2021

Recording Title: COVID-19 Vaccine Mandate Update

Description: Listen to Empowering Plans, Kelly Dempsey and Kevin Brady discuss the controversial OSHA vaccine mandate rules – where they started, where they stand now, and the many legal challenges that have arisen. This won’t be the last you hear of this topic and despite the legal challenges, employers should not delay in getting their action plan and policies in place. Recording Link.

About The Phia Group

The Phia Group, LLC, headquartered in Canton, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, Contact Garrick Hunt at ghunt@phiagroup.com , 781-535-5644 and visit www.PhiaGroup.com.


UnitedHealth Exec’s Court Testimony Hints at MultiPlan Trouble

MyHealthGuide Source: Atlanta Business Journal, 11/16/2021

UnitedHealthcare sued TeamHealth in the U.S. District Court for the Eastern District of Tennessee in late October, saying the emergency room group deliberately and systematically tricked the health insurer into paying more than $100 million in fraudulent claims.

TeamHealth did not provide a response by deadline.

UnitedHealthcare did not respond to an interview request.

UnitedHealthcare does not comment on its outside partners and contracts, MultiPlan wrote in a letter to shareholders on Monday.

Clients still wanted to use the wrap networks, the prospective fee negotiations that MultiPlan provides, and we were willing to accommodate that,” Haben told the court. “We’re not going to force a client to move.”

In 2023, UnitedHealthcare had planned to transition its self-funded customers from MultiPlan to an in-house program that it estimated would save it more than $300 million in annual vendor fees, according to an internal document from the insurer that TeamHealth submitted as evidence to the court. UnitedHealthcare is still seeking redactions of some evidence, and the court has ordered that document not be made public until the judge rules on whether surfacing the slide is relevant to the case.

But the documents partially confirm the claims made in a short-seller report last year that MultiPlan vehemently denies. The report alleged that UnitedHealthcare—MultiPlan’s largest customer—was phasing the company out of its service line. The report speculated that UnitedHealthcare represented a third of MultiPlan’s total business.

It came months after Multiplan went public as an $11 billion special-purpose acquisition company, with some analysts questioning whether the deal represented an actual growth opportunity or solved a looming bond maturity problem faced by MultiPlan. When the report was released, the company also faced questions about how it would remain relevant once the No Surprises Act goes into effect in 2022.

MultiPlan has said it plans to grow by investing in new business lines and targeting payers beyond traditional insurers. Others argue that MultiPlan’s services offer a “legal shield” to insurers, allowing them to blame their low rates on the vendor rather than their own decisions.

MultiPlan continues to deny the short-seller report, saying that, over the past three years, its revenue from UnitedHealthcare has grown more than 30% and that the two companies have a partnership that MultiPlan expects to grow beyond 2022.

“The false claim that UHC was terminating its relationship with MultiPlan was perpetuated by short sellers, motivated by their own economic self-interest,” MultiPlan wrote in a letter to shareholders
Monday.

But many investors believe UnitedHealthcare is developing an in-house alternative to MultiPlan. A June policy document from UnitedHealthcare describes Naviguard as its “lead out-of-network offering” for employers to resolve disputes with providers.

Naviguard was not developed to replace MultiPlan and currently offers a different suite of services, according to Haben, who said he managed UnitedHealthcare’s relationship with MultiPlan.

Naviguard is an internal customer advocacy tool that helps members understand their benefits, steer patients to in-network providers and address any out-of-pocket expenses, Haben described. MultiPlan offers a network of provider agreements, negotiation services, outlier cost management and fraud and waste prevention tools, he added.

Haben did not immediately respond to an interview request.

“The UHC “termination” rumor has been used by opportunistic short sellers to profit by driving down MultiPlan’s stock and other securities,” MultiPlan wrote to stockholders Monday morning.

This isn’t the first time the company’s management has addressed its relationship with UnitedHealthcare.

In July, MultiPlan said that it does not expect a UnitedHealthcare policy change to have a “material impact” on its finances for 2021.

That month, UnitedHealthcare enacted a program to no longer pay out-of-network claims when fully insured customers seek non-emergency care outside their local coverage area. A week after news of UnitedHealthcare’s updated guidelines went public, MultiPlan’s stock price dove 25%.


People News


Self-funded Pioneer, Key Deyhle, Passes

MyHealthGuide Source: Deseret News via Legacy, 11/12/2021

Kenneth Chris Deyhle, died peacefully November 9, 2021 surrounded by his loving family.


Ken was an extraordinary stop-loss underwriter.  While comfortable with computers, his preference to use a pencil and yellow legal pad to calculate a stop-loss quote.  Each of the characteristics of a given quote had their reserve spots on the yellow pad.  Within minutes, he had captured sufficient information to render a quote.  He was one of the earliest stop-loss underwriters transcending decades and producing profitable business for stop-loss carriers.

He helped to established and was the first president of the Self-Insurance Institute of America ... and the only individual to serve two successive terms as president.

Ken retired in 2000 and spent his retirement serving in The Church of Jesus Christ of Latter Day Saints. He traveled with his wife Gloria around the world preparing temples for open houses.

Ken loved sports ... and loved people through his charity

Ken was born to LeRoy and Jayne Deyhle on June 14, 1939 in Springfield, Ohio. He attended Ohio State University and was a life long fan of Ohio State football. Ken loved all sports and was a professional bowler. He coached little league baseball for 29 years. Then he coached men's slow pitch softball and is in the Utah Softball Hall of Fame.

Their travels allowed them make connections in many countries. He created The Deyhle Foundation in 1998 and focused on world wide literacy. He was able to get new children's books from publishers and donate them to school libraries in third world countries.

He was a member of the board for Deseret International, Charity Vision, The Christmas Box House International, and Eagle Condor. He dedicated his life to charity work.

In 2008, Ken and Gloria were called to be full time missionaries in the Utah, Salt Lake City mission where they served for 10 years. He helped over 3,000 couples navigate the legal system to get married so they could be baptized. He was a regular at the marriage office in Salt Lake City. He had an incredible way of communicating with people even though they often didn't speak the same language.

Ken is survived by his loving wife Gloria, their 6 children, 10 grandchildren, and a great grandchild.


Allegiance's Ron Dewsnup to Retire, Stephen Tahta Named as Next President & General Manager

MyHealthGuide Source: Allegiance Benefit Plan Management, Inc. 11/19/2021

Missoula, MT — Allegiance Benefit Plan Management, Inc., announced that Stephen Tahta, MD, will succeed Ron Dewsnup as president and general manager of the company. The transition is effective January 7, 2022.

Dr. Tahta joined Allegiance in 2018 as the company’s chief medical officer. He previously worked private practice as a cardiothoracic surgeon and has several years of experience in administrative leadership at provider organizations. Dr. Tahta holds an Executive Masters of Business Administration degree from the Wharton School of the University of Pennsylvania.

“I look forward to working with Dr. Tahta in his new role and continuing to expand Allegiance and serve our clients and their employees around the nation,” said Dirk Visser, chairman and CEO of Allegiance.

Dewsnup joined Allegiance in 2005. During his tenure, the company grew from serving 70,000 customers in Montana and adjoining states to 500,000 customers across the country.

“Ron has been instrumental in Allegiance’s growth and direction over the years,” said Visser. “His influence has made an indelible impact on all of the Allegiance team members and our clients. I want to thank Ron for all he has done for the development, growth and progress of Allegiance.”

About Allegiance

Originally founded in 1981 as a full service TPA in Montana, Allegiance has grown to serve customers in all 50 states. In 2008, Allegiance became a wholly-owned subsidiary of Connecticut General Life Insurance Company (CGLIC), a subsidiary of Cigna Corporation, when CGLIC purchased Allegiance’s holding company Benefit Management Corp. Allegiance Benefit Plan Management, Allegiance Care Management, Allegiance Life & Health Insurance Company and Allegiance COBRA Services are all subsidiaries of Benefit Management Corp.

Allegiance works with Cigna, independent consultants and advisors to serve Employers and Health Plans who require customized TPA services capable of enabling client specific plan design and select integrated product services of their choice. Allegiance has seen significant growth across the nation as a result of our highly customizable suite of services and our affiliation with Cigna.

Since its earliest days, Allegiance has been a leader in providing TPA services for health and flexible benefit plans to employer groups and their plan participants. Allegiance is known for customized TPA services flexibility and outstanding customer service. That commitment continues today as strong as ever. Visit askallegiance.com.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Cigna delivers choice, predictability, affordability and access to quality care through integrated capabilities and connected, personalized solutions that advance whole person health. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth companies or their affiliates, and Express Scripts companies or their affiliates. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products.

Cigna maintains sales capability in over 30 countries and jurisdictions, and has over 190 million  customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.


The Phia Group adds Scott Bennett to The Team

MyHealthGuide Source: The Phia Group, LLC, 11/12/2021

Canton, MA – The Phia Group announced that Scott Bennett has joined their already robust team of health benefit professionals, as its Vice President of Provider Relations. Scott will strengthen The Phia Group’s efforts to empower plans by leading a team that enhances the overall provider experience.

With a focus on quality and cost metrics, their mission is to make benefits more affordable and accessible. Under Scott’s leadership, The Phia Group’s Provider Relations team will continue to support plans and partners that utilize or manage innovative pricing methodologies, while also providing Phia Group based solutions such as Claim Negotiation and Signoff, Phia Unwrapped, and Balance Bill Support.

As new laws and regulations impact how health benefit plans process and pay medical claims, Scott and his team will develop new approaches to the future of claims processing, while continuing to provide ancillary support to other programs as well. Relevant to this mission, Scott boasts an impressive background as an attorney, data analyst, and a certified professional coder. Scott's past experience includes: Vice President at a national third party administrator, a Director of dispute resolution, and the designated company witness for six years at a nationwide medical bill review company focused on commercial reimbursement and workers’ compensation fee schedules and disputes.

In addition to designing and defending cost containment programs, Scott has successfully litigated and participated in trials, depositions, negotiations, and mediations concerning medical billing disputes among providers, patients and payors involving reference-based pricing, workers compensation, ERISA, antitrust law, and personal injury damages.

“Adding Scott to the team solidifies The Phia Group as a leader in the industry. It means we can continue to develop and offer solutions and services that empower plans,” remarked The Phia Group’s CEO, Adam Russo. “We have always been proud of our ability to stay ahead of regulatory hurdles; the hurdles are getting bigger, but adding Scott ensures we can conquer whatever comes next.”

Regarding his new role at The Phia Group, Scott Bennett remarked, “I am thrilled to be part of such a respected company, and look forward to working with this expert team to further develop their already extensive products and services, especially at a time where increased data transparency and new regulations will challenge the industry to innovate.”

To learn more about The Phia Group, what it is doing to empower plans, and to learn more about its Provider Relations solutions, please contact Garrick Hunt by email at ghunt@phiagroup.com or by phone at 781-535-5644.

About The Phia Group

The Phia Group, LLC, headquartered in Canton, Massachusetts, and with offices in Hartford, Boise, and Louisville, is an experienced provider of health care cost containment techniques offering comprehensive claims recovery, plan document and consulting services designed to control health care costs and protect plan assets. By providing industry leading consultation, plan drafting, subrogation and other cost containment solutions, The Phia Group is truly Empowering Plans.  Visit www.PhiaGroup.com.


Symetra Appoints Melissa Pearce, M.D., Stop Loss Medical Director

MyHealthGuide Source: Symetra, 11/17/2021

Bellevue, WS — Symetra Life Insurance Company, a leading medical stop loss carrier for more than 45 years, announced the appointment of Melissa Pearce, M.D., as stop loss medical director.

In this new role, Dr. Pearce will provide clinical expertise across Symetra’s group benefits product lines, with emphasis on stop loss, where she will work closely with the team of registered nurses who support underwriting with the review of complex cases.


Dr. Pearce most recently served as medical director in utilization management for CareSource, a nonprofit, multi-state health plan recognized as a national leader in managed care. She was previously medical director with AmeriHealth Caritas, a Medicaid managed care and health solutions carrier. Prior to that role, Dr. Pearce spent eight years in private practice and as a hospitalist in South Carolina, specializing in obstetrics and gynecology.

Dr. Pearce received her medical degree from University of Florida College of Medicine and completed her residency at Medical University of South Carolina.

About Symetra

Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation, a diversified financial services company based in Bellevue, Washington. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent financial professionals and insurance producers. Visit symetra.com.


Flume Health Adds Healthcare Innovator Andrew MacGill As Vice President Of Product

MyHealthGuide Source: AIThority News Desk, 11/12/2021

MacGill will establish product roadmap and build world-class team for fast growth healthcare company.

Flume Health announced that Andrew MacGill has joined the company as Vice President of Product. MacGill brings 15 years of product development and management experience at healthcare and employee benefits challenger brands, including Pager, Rally Health (acquired by United Healthcare), Spotlite, and PerkSpot. MacGill is tasked with creating a world-class platform, infrastructure, and product team for Flume Health as the company experiences a period of monumental growth.


As healthcare continues to evolve with a new wave of digital startups entering the market, consumers will begin to see more health plan options that have the ability to be tailored to their unique health needs and preferences. MacGill’s mandate is to continue the march toward innovation as Flume seeks to further disrupt the US healthcare system.

“Throughout my career, I’ve been fortunate to work with digital health companies striving to change a dysfunctional system. Traditional health and insurance systems have failed to meet growing consumer demand for personalization, creating a big opportunity that challengers can seize,” said Andrew. “I’ve joined this team to finally deliver on the promise that healthcare can be radically different and better.”

Healthcare industry disaggregation is a boon for consumers who are able to take advantage of point solutions, but it leads to greater complexity for employers. With more than 50 percent of employees receiving benefits from their employers, employers are often tasked with becoming healthcare experts rather than focusing on their core business. Flume is the modern gateway for strategic innovations on benefit plan design and management for both challenger health plans, incumbents, and health systems.

“Andrew has deep knowledge of both the multi-faceted healthcare infrastructure system and the future of personalized healthcare plans,” said Cedric Kovacs-Johnson, founder and CEO of Flume Health. “We’re pleased to have Andrew on board as we build our vision of innovative consumer experiences, care delivery models, and technologies.”

About Fume

Flume creates plans for self-insured employers who demand seamless, sustainable healthcare. We removed barriers in traditional insurance to unlock better outcomes at a fraction of the price. Contact Kevin Schlotman, CCO, at Kevin.Schlotman@FlumeHealth.com and visit flumehealth.com.


HealthComp Appoints Jon Dimmock to Vice President of Sales

MyHealthGuide Source: HealthComp, 11/18/2021

Executive to Drive Growth in the Southeast Among Mid- to Large-Sized Employer Groups

FRESNO, CA – HealthComp, the largest independent health benefits administrator in the country, announced the appointment of Jon Dimmock to the position of Vice President of Sales. In this role, Dimmock will drive growth among brokers and their mid- to large-sized employer groups in the Southeast – with an emphasis in Georgia, where he is based.

“We’re excited to bring Jon on board,” said Tom Martel, CGO at HealthComp. “He has extensive experience in the health benefits market and has driven sales for both a large carrier as well as third-party administrators (TPAs). In all of his positions, Jon has achieved award-winning levels of sales. And through his tenure, he has become a trusted and well-connected executive in the Southeast. His combination of expertise, relationships, and leadership is just what HealthComp needs to drive growth and success in this region.”

“What’s appealing about HealthComp is the company is nimble and innovative,” said Jon Dimmock. “It can turn on a dime to meet market needs. It helps employer groups provide comprehensive health benefits to employees, while driving down healthcare spending and delivering a superior member experience. Many customers experience a zero to negative trend in their healthcare spending and reap the benefits of a member services model that has sustained a Net Promoter Score (NPS) of 80, whereas the industry average is 12. As such, employers can rest assured that their employees will receive an exceptional level of service.”

Dimmock added that the nation is at a crucial point in its economic recovery from COVID-19. “One consequence is the tough labor market. Employers want to be able to entice top candidates with an attractive health benefits package, but they also can’t afford to keep paying escalating premiums. Many are throwing up their hands and saying, this just isn’t sustainable. HealthComp provides relief by leveraging analytics to identify and address problem areas with true cost savings.”

Dimmock noted that traditional health plans offer a limited menu from which employer groups must order – with very little room for customization. “By comparison, working with a benefits administrator of HealthComp’s sophistication, groups have the flexibility to design and assemble a custom fit of coverage and point solutions that meet the needs of their member populations.”

“I’m powering forward with my goal to raise awareness among brokers and benefit advisers about the benefits HealthComp can offer their employer group customers, and I’m strategizing with them on how we can bring our cost-containment expertise and service excellence model to bear on their client’s top healthcare challenges,” concluded Dimmock.

Dimmock has 30 years of experience in the employee benefits field, of which he’s spent 17 years with TPAs in sales and sales management roles in Florida, Georgia, Tennessee, and Texas. Most recently in his role as a sales executive with Anthem Blue Cross Blue Shield in Georgia, he achieved seven consecutive years as a “Blue Blazer,” a program that recognizes the company’s top 1% of sales executives.

About HealthComp

HealthComp, a New Mountain Capital company, is the nation's largest independent health plan administrator for self-funded employer groups. Our solution brings together concierge-level service, best-in-class operations, powerful analytics and expert medical cost management and integrates seamlessly with any benefits ecosystem. The result is an industry-leading experience that delivers better clinical outcomes for our members and higher savings for our book of business. HealthComp Holdings is the parent company of HealthComp (Fresno, CA), BAS Health (Homewood, IL), Benefit Assistance Company (BAC) (Ripley, WV) and Significa Benefits Services (Lancaster, PA). Visit healthcomp.com.


 Market Trends Studies, Books & Opinions


National Survey of Health Plan Brokers Reveals Growth for Referenced Based Pricing

MyHealthGuide Source: Renalogic, 11/9/2021

PHOENIX, AZ and CHICAGO, IL  – Renalogic, the industry leader in dialysis risk management and cost containment sponsored market research with the country’s top benefits consultants to gauge frontline perspective on the evolution of reference-based pricing (RBP) programs. With survey respondents expecting 4-7x growth in utilization of RBP by their clients over the next three years, savvy brokers are adopting RBP for massive plan savings.

“The survey was completed by about 200 health plan brokers across the U.S.,” Scott Vold, Chief Commercial Officer at Renalogic said. “The respondents confirmed that the need for referenced based pricing and cost containment is growing. Brokers are adopting cost-saving measures available to plans.”

The research survey clearly suggests that Dialysis may be a specific situation where RBP can be adopted aggressively. Because dialysis is a relatively low incidence, high-cost situation, employee abrasion fears are largely mitigated, if not wholly eliminated. It is much easier for an employer and vendor to support, work with and explain RBP to just a few dialysis patients on a health plan, than 40-50% of members that might use a hospital-based service that is impacted by a general RBP plan.

The industry survey was conducted September 15 through October 10, 2021. Here are some more key findings:

• Traction is growing particularly for high-cost patient management with specific diseases. The survey asked how likely brokers are to recommend a RBP program to manage costs for: dialysis, diabetes, transplant, orthopedic, oncology, pharmacy, long-term acute care (hospital), surgery, cardiac, behavioral health and acute/inpatient claims. Responses show a healthy interest in presenting the RBP option “some of the time” for all categories. Additionally, diabetes, dialysis and transplant showed on average close to 20 percent of brokers willing to recommend RBP for those conditions “all the time.” Employers are laser-focused on disease prevention, management, and cost avoidance as a top priority.
• Kidney disease is the most preferred disease category for RBP.  While brokers believe that a minority of their clients are using RBP for dialysis claims today, brokers rank dialysis as the leading category that they are willing to recommend for RBP. Interestingly, the related categories of transplant and diabetes were next highest. Medical claims data can identify members at all stages of diagnosed chronic kidney disease and kidney impairment, but typical large case management models do not have a program that focuses on the issue of kidney disease, end-to-end renal care, or renal cost management solutions.
• Benefits consultants still learning about vendor partners.  When presented with a list of leading RBP vendors, 40-50 of brokers could provide a clear perception of any of the individual companies. While the survey sponsor, Renalogic, was the highest ranked in terms of perception, the overall lack of familiarity with vendors suggests that brokers would benefit from additional education around the performance and pros and cons of RBP vendors.

See the Full Report here.
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About Renalogic

Renalogic has been the industry leader in dialysis cost containment for nearly 20 years and continues to innovate through the impact of the Kidney Dialysis Avoidance Program. We are revolutionizing the industry by delivering predictive analytics to identify the progression of the disease, simplifying the costs and clinical complexities of chronic kidney disease to make a positive impact and reduce the dialysis incidence rate in every population we touch. Nearly every chronic condition leading to End Stage Renal Disease is manageable and even preventable when identified early. Contact Carrie Tedore, Senior Director of Marketing, at ctedore@renalogic.com and renalogic.com.


Legal News


New Law Regulating Health Care Benefit Managers in Washington State Can Impact TPAs, PBMs, Others

MyHealthGuide Source: Steven Imber, Justin Liby, Jennifer Osborn, Polsinelli via JDSupra, 11/19/2021

Last summer, state of Washington passed a law requiring TPAs that administer self-funded workers compensation to become licensed with the Washington Department of Labor.

Now, Washington has enacted another law governing Health Care Benefit Managers (“HCBMs”), effective January 1, 2022, codified at Wash. Rev. Code §§ 48.200.010 et seq. The law requires HCBMs to become registered with the Washington Office of Insurance Regulation (“OIC”). The purpose of the new law is to regulate entities not currently subject to regulation that act as intermediaries between health carriers, health care providers, and consumers and that are involved in making health care decisions on behalf of health carriers. The OIC has recently adopted regulations to implement the new law.

The term “HCBM” is defined in the new Washington law in section 48.200.020(4)(a) as:

[A] person or entity providing services to, or acting on behalf of, a health carrier or employee benefits programs, that directly or indirectly impacts the determination or utilization of benefits for, or patients access to, health care services, drugs, and supplies including but not limited to the following services:

• Prior authorization or preauthorization of benefits or care.
• Certification of benefits or care.
• Medical necessity determinations.
• Utilization Review.
• Benefit determinations.
• Claims processing and repricing for services and procedures.
• Outcome management.
• Provider credentialing and re-credentialing.
• Payment or authorization of payment to providers and facilities for services or procedures.
• Dispute resolution, grievances or appeals relating to determinations or utilization of benefits.
• Provider network management.
•  Disease management.

TPAs and PBMs Impact

The new Washington law requires Pharmacy Benefit Managers (“PBMs”), who were previously required to register as PBMs, to now become registered as HCBMs instead. Additionally, the new law applies to TPAs that provide services such as claims processing, repricing, or benefit determinations for health carriers in Washington. The law does not apply to TPAs that administer life benefits or that only collect and remit premium. Prior to the enactment of this law, Washington was one of only a few states having no requirements to license or regulate TPAs.

Entities providing services to “employee benefit programs” are also subject to the new law. However, the statutory definition of employee benefit programs is limited only to programs under the state’s public employees’ benefits board or the school employees’ benefits board. Pursuant to the regulations, the law does not apply to service providers for self-insured health plans under ERISA. Wash. Admin. Code § 284-180-120.

Under the new law, health carriers and employee benefit programs are strictly “responsible for the compliance of any person or organization acting directly or indirectly on behalf of or at the direction of the carrier or program, or acting pursuant to carrier standards or requirements concerning the coverage of, payment for, or provision of health care benefits, services, drugs and supplies.” Wash. Rev. Code § 48.200.050(5)(b).

Health carriers are also responsible for an HCBM’s violations of the new law, and carriers are subject to fines for an HCBM’s acts under their contract with a HCBM. If an HCBM violates any or laws or regulations pertaining to HCBMs, the OIC is permitted to place an HCBM on probation, suspend or revoke the registration, issue a Cease and Desist Order, levy a fine up to $5,000 per violation, or require corrective action. Carriers must file all contracts and contract amendments entered into with an HCBM with the OIC within 30 days following the effective date of the contract or amendment.

To obtain an HCBM application, a request must be submitted with the OIC for an HCBM. Once the OIC’s staff reviews the information in the request, the OIC will send an email that will include instructions to log onto the OIC’s online system and pay the required $200 fee.


Medical News


Oncology Drugs are 40 Times More Likely to be Deemed Cost-effective When the Study was Funded by Pharmaceutical Company Compared with No Funding

MyHealthGuide Source: Alyson Haslam, PhD; Mark P. Lythgoe, MD; Emma Greenstreet Akman; et alVinay Prasad, MD, MPH, 11/18/2021, JAMA Network

In this study, pharmaceutical funding was associated with greater odds that an oncology drug would be found to be cost-effective. These findings suggest that simply disclosing potential conflict of interest is inadequate. We encourage cost-effectiveness analyses by independent groups.

In this cross-sectional study of 116 drug approvals and 228 cost-effectiveness studies and 254 analyses, a drug was 40 times more likely to be deemed cost-effective when the study was funded by pharmaceutical companies compared with no funding.

This retrospective cross-sectional study included 254 cost-effectiveness analyses for 116 oncology drugs that were approved by the US Food and Drug Administration from 2015 to 2020.

Each drug was analyzed for the incremental cost-effectiveness ratio per quality-adjusted life year, the funding of the study, the authors’ conflict of interest, the threshold of willingness-to-pay, from what country’s perspective the analysis was done, and whether a National Institute for Health and Care Excellence cost-effectiveness analysis had been done.

The main outcome was the odds of a study concluding that a drug was cost-effective.

Study findings

• There were 116 drug approvals with 254 studies and country perspectives.
• Of the country perspectives, 132 (52%) were from the US.
• 47 of 78 drugs with cost-effective studies had been shown to improve overall survival, whereas 15 of 38 of drugs without a cost-effectiveness study had been shown to improve overall survival.
• Having a study funded by a pharmaceutical company was associated with higher odds of a study concluding that a drug was cost-effective than studies without funding (odds ratio, 41.36; 95% CI, 11.86-262.23).

Recurring Resources


Medical Stop-Loss Providers Ranked by 2020 Annual Premium - Over $25.6 Billion

Source: MyHealthGuide, 9/18/2021

The Medical Stop-Loss Provider Ranking has been updated based on 2020 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 89 stop loss providers 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 Growth

Stop Loss premium based on 2020 annual premium is $25,645,704 (thousands), a 69% over 2016 annual premium of $15,004,224 (thousands) for a compounded annual rate of 14.0%. Stop Loss premium totals by year:

• 2020 - $25,645,704 (thousands)
• 2019 - $23,588,932
• 2018 - $19,849,233
• 2017 - $16,451,079
• 2016 - $15,004,224

Top 10 and 20 Percent of Total 2020 Market

• Top 10 stop loss providers ($17.3 Billion) compose 67.4 % of the total market ($25.6 Billion)
• Top 20 stop loss providers ($21.5 Billion) compose 83.8 % of the total market ($25.6 Billion)

Top 20 and Ranking Changes

The top 20 stop loss providers based on 2020 annual premium:

1. Cigna
2. UnitedHealth Group
3. Sun Life Financial
4. CVS Health Corp
5. Anthem
6. Tokio Marine HCC
7. HCSC
8. Voya Financial Inc.
9. Symetra
10. HM Insurance
11. Humana
12. Companion Life/Blue Cross Blue Shield of SC
13. Swiss Re
14. QBE
15. Fairfax Financial (CF Ins)
16. Western & Southern Financial
17. W. R. Berkley Corp.
18. Blue Cross Blue Shield of MI
19. Allstate Corp (acquired National General 1/2021)
20. Nationwide

In the new 2020 ranking compared to 2019, there were

• 14 providers that did not change their ranking position,
• 55 providers moved up in the ranking,
• 20 providers moved down in the ranking,
• 12 providers are new the ranking, and
• 3 providers dropped out of the ranking.

Upcoming Conferences


December 2, 2021 – Webinar 10 AM - 2 PM CT
How Hospitals Can Offer Worksite Clinics to Their Employees and Area Employers presented by National Association of Worksite Health Centers (NAWHC). Learn from legal, consultant and hospital leaders on the benefits, challenges and value of a hospital offering a worksite health center for its own employees, as well as creating a worksite clinic service for area employers. Registration.

December 6-8, 2021 - In Person
Crowdsourcing Forum presented by Self-Insurance Institute of America (SIIA).  This in-person with live-stream connection option, will feature a series of moderated open discussion sessions in which attendees will be encouraged to openly provide their ideas, commentary, and potential solutions for some of the most important topics in the self-insurance industry. Specific discussion topics will include:

• Price Transparency
• Specialty Drugs
• Cell & Gene Therapies
• Technology Strategies
• Workforce Development

Crowdsourcing is a new format for SIIA and we anticipate the conversations to be lively and candid. Sessions will be moderated by industry leaders with a deep understanding of their respective topic with a role of setting the stage for the discussion by asking thoughtful questions and furthering the group’s conversation.   Belmond Charleston Place Hotel, Charleston, SC. Please click here for details and registration.


January 20-21, 2022 - In person
2022 Onsite Employee Health Clinics Summit. DoubleTree Resort by Hilton Paradise Valley, Scottsdale, AZ. Information and Registration

January 24-26, 2022 - In person
Institute for Apprenticeship, Training and Education Programs presented by International Federation of Employee Benefit Plans (IFEPB).  Apprenticeship programs continue to grow in popularity as North America confronts a significant skills shortage and the increasing cost of postsecondary education. The Institute for Apprenticeship, Training and Education Programs provides education on effective trust fund management and best practices.  Virtual Option Available.  San Diego, California.  Information and Registration.

January 25, 2022 -Webinar 12:00 PM CT
Selecting a Worksite Health Center Partner and Transitioning Clinic Partners presented by National Association of Worksite Health Centers (NAWHC). Successful worksite health centers have a foundation of partnership between the sponsoring employer and their service partner – whether a third-party vendor or a local health provider. This highly rated session from the 9th Annual Forum provides key directions and recommendations for finding an initial partner and how to ensure a smooth transition when a change in partner is needed. Registration.

January 31-February 2, 2022 - In person
31st Annual Health Benefits Conference & Expo (HBCE).  Join your peers this January in Clearwater Beach, Florida for the premier benefits and wellness conference of 2022. HBCE delivers education that provides real-life solutions to real-life challenges. If you are responsible for a health plan or wellness program, HBCE has the education you need. With a variety of educational offerings—including case studies presented by industry peers, featured sessions presented by subject matter experts, and sessions presented by service providers—all attendees find value in the robust agenda.  Clearwater Beach, Florida.  Information and Registration.

February 8, 2022 - 11:00 am – 12:00 pm CT
Planning Your First Worksite Health Center and the Value of Accreditation presented by National Association of Worksite Health Centers (NAWHC). Learn the key steps in planning and setting up your first worksite health center. One key area to consider is the value of getting your new or existing center accredited by an independent quality entity. This session will include information on the accreditation areas of focus and the process.  Speakers: David Keyt, National Worksite Clinic Consulting Group Leader, Mercer; Dennis Schultz, MD, Accreditation Association on Ambulatory Health Care. Information and Registration.

February 21-23, 2022 - In person
HCAA's Executive Forum 2022 presented by Health Care Administrators Association, Live and In-Person! HCAA is bringing the glitz and glamour back to the self-funding industry! Bellagio, Las Vegas, NV. Information

March 2-4, 2022 - Hybrid Conference
The Thirty-First National HIPAA Summit.  Chairs: Adam Greene, JD, MPH, Partner and Co-chair, Health Information & HIPAA Practice, Davis Wright Tremaine LLP, HIPAA Summit Distinguished Service Award Winner, Former Senior Health Information Technology and Privacy Specialist, Office for Civil Rights, HHS, Washington, DC; Kirk J. Nahra, JD, Partner and Co-chair of the Privacy and Cybersecurity Practice, Wilmer Hale, Washington, DC. Iliana Peters, JD, LLM
Shareholder, Polsinelli, Former Acting Deputy Director, Health Information Privacy, Office for Civil Rights, US Department of Health and Human Services, Washington, DC.  Robert M. Tennant, MA
Vice President, Federal Affairs, Workgroup for Electronic Data Interchange (WEDI); Former Director, HIT Policy, Medical Group Management Association; Washington, DC.  . Grand Hyatt, Washington, DC.  Registration: hipaasummit.com.

May 4-6, 2022 - In person
Smart Data Solutions Customer Symposium.   This events connects and facilitate conversations between Payers and Network Partners surrounding industry challenges and ways to efficiently address them. Topics include integration of Machine Learning and Artificial Intelligence into workflow processes, new mandates surrounding the No Surprises Act, Medical Record Analysis, FHIR, Prior Authorizations, and more!  Hosted by Smart Data’s Co-CEOs, Pat Bollom and John Prange. Call 651.894.6400 and visit www.sdata.us.

July 18-19, 2022 - In person
HCAA's TPA Summit 2022 presented by Health Care Administrators Association, Hyatt Regency St. Louis at The Arch, St. Louis, MO. Information


July 17-18, 2023 - In person
HCAA's TPA Summit 2023 presented by Health Care Administrators Association. Hyatt Regency, Dallas, TX. Information


Job News

Job listings are still here! Each listing (above) is now linked to a separate web page. This change was prompted the Newsletter becoming so large that some filters and email systems blocked the delivery.

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