ASG Perspectives

Welcome to our new training program: Stop-Loss 101

Wednesday, March 23, 2016

In February, we kicked off a new training program to help incoming TPA and Broker vendors learn about the industry and get a better understanding of how things work from the MGU perspective.

Our goal in offering this free program is to help businesses become strong producers and work as seamlessly as possible with industry carriers and MGUs like us.

Inaugural Class

Our first attendees were Austin Urkiel and Wendy Tirrell from Consolidated Health Plans (CHP) in Springfield, Mass.

– Austin comes to his role as a CHP sales coordinator as a recent college graduate who had yet to see the underwriting process in action. He said his goal was to “better understand what information and data I should target from the groups we’re quoting to give us the best opportunity to win a case and how that information is used.”

– Wendy, an account manager who’s worked on the Underwriting side for over 12 years, mostly on fully insured rating, was curious about the differences in her new role, which involves pricing self-funded business.


ASG Vice President Mike Holland led Stop Loss 101 training in our Portland, Maine headquarters in February.

We covered a ton of info over the course of two days! Following an overview of self-funding, our Underwriting team walked Austin and Wendy through the basics of Stop-Loss (including how Specific Stop-Loss differs from Aggregate, and how they work together). We also covered the purpose and requirements of disclosures, how our in-house RN offers TPAs a great resource, and the ins and outs of the application process.

This was followed by information about the interaction between plan documents and policies. We wrapped up with a presentation about how reporting and submissions work on the Claims side.

Click here to see ASG’s distinctive Client Service Model.

For our part, we loved talking shop and comparing notes on what we’re each seeing in the business. Both of our attendees came ready with questions about industry trends (such as Level Funding and ELAP/Reference-Based Pricing) and were fantastic first-time “students” of Stop Loss 101!

If your organization is interested in participating in our free training program, please drop us an e-mail at info@asgrmi.com for more details.

 

On-Call with Sara Winand, RN – Focus on Hepatitis C

Monday, March 21, 2016

Hepatitis C is an infection caused by a virus that attacks the liver and leads to inflammation. The virus is spread by coming into contact with contaminated blood or body fluids – for example, when needles are shared or tattoo equipment is unsterile.

Those who contract Hep C typically show no symptoms, but may have fatigue, nausea, loss of appetite, and yellowing of the eyes and skin.

While standard treatment also includes the drugs pegatron and/or ribaviran, guidelines for treatment in adults are changing constantly with an array of new antiviral medications available. These newer drugs have significantly higher effectiveness – and some can actually eradicate the virus – but they also come with a higher cost for treatment.

Here are a few common brand names:

  • – Olysio (simeprevir)
  • – Sovaldi (sofosbuvir)
  • – Harvoni (ledipasvir/sofosbuvir)
  • – Viekira Pak (ombitasvir, paritaprevir, ritonavir with dasabuvir)
  • – Technivie (ombitasvir, paritaprevir, ritonavir combination tablets)
  • – Daklinza (daclatasvir)
  • – Zepatier (elbasvir/grazoprevir)

Cost-wise, just a few years ago the standard treatment with antivirals/immunosuppressants such as Pegasys (peginterferon) or Rebetol, Copegus, Virazole, or Ribasphere (ribavirin) was running around $45,000 to complete treatment; today’s new drugs can range from $90,000 to $185,000 per year.

For example, Solvadia, a new specialty pharmacy drug for treating Hep C, costs approximately $28,000 per month and $84,000 for the full 12-week treatment.

Click here for more about how the cost of today’s medications impact self-funded health plan claims. 

Spotlight on LBG Advisors: Why Relationships Matter

Friday, March 04, 2016

We recently chatted with Ron Kirkpatrick of LBG Advisors, an employee benefits firm based in Lynnwood, Wash., who we’ve been doing business with for the past few years. Ron made an interesting point about the relationship between a consultant (like LBG Advisors) and a risk bearer (like us) that we thought might resonate with our readers.


Ron pointed out that ours “is always a unique relationship because obviously, working directly with the client, we’re tasked to negotiate with that vendor. Our objectives can be the same, but a lot of times they’re not – the influences of the stop-loss carrier may conflict with ours, because the stop-loss carrier needs to make money off the premium – and that can become a risk to our client, the employer.”

The key to overcoming this obstacle, we agree, is establishing long-term relationships based on transparency and built on fairness. Ron’s correct in that the structure has to be profitable for the carrier and the advisor, but in the end, favorable to the client employer.

As he noted, risk certainly can be difficult to quantify long-term.

Today, with new variables like the high cost of specialty prescriptions muddying the picture and forcing both parties to hold a harder line, the tension can become even tighter.

So we at ASG agree wholeheartedly with Ron: With an increasingly greater regulatory environment, there is more and more of a risk structure around being able to run an insurance program effectively. However, if our mutual goal is to help employers keep their costs down, then we also have the option of looking at why we are doing certain things and how we can control them – perhaps even to change the system a little, including the way health insurance is delivered.

It’s a big topic, but at the core, we at ASG feel it’s our responsibility as a stop-loss vendor to work as closely as possible with you to remove conflict, maintain transparency and ultimately, do what we can to help our mutual clients keep their costs down.

Ron commented, “by using stable MGU or MGA partners like ASG, who are willing to work with us to offer fair quotes and renewals that are going to be open to transparency, we’re typically able to control the trends that our employers see. Bending that trend from between 6% and 8% down to 3% or 4%, which is more in line with the cost of living, combined with other techniques to control costs and increase transparency on their plan, typically allows us to save clients $1,000 to $2,500 per participant in the first year with matching or highly similar plan designs.”

Interesting, right? Drop us an e-mail at mguperspectives@asgrmi.com and let us know what you think.

If you’re a plan sponsor interested in this topic and other emerging issues affecting our industry, LBG is hosting its sixth annual LBG Advisors Benefits Symposium May 15-17 in Las Vegas. It’s the pre-eminent educational conference for group-based benefits and features the latest in cutting edge concepts for more effectively managing benefit programs. Click here to check it out, and maybe we’ll see you there!

 

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