ASG Perspectives

SPOTLIGHT ON: Brown and Brown of Pennsylvania

Thursday, February 21, 2019

Brown and Brown of Pennsylvania is an established national brokerage that continues to thrive via a business model that provides all the resources and advantages of a major enterprise, yet allows individual offices to operate on a local level.

According to Bill Shoemaker, benefits sales rep for the Mechanicsburg office in southern Pennsylvania, this means that each office is given the latitude to respond to—and accommodate—employer trends unique to their particular region.


As the sixth largest brokerage in the country, Brown and Brown has more than 8,000 employees in 200 offices nationwide. Brown and Brown of Pennsylvania is considered a profit center for the three locations that work together in the region: Philadelphia, Conshohocken, and Mechanicsburg.

“The offices are decentralized, meaning we work locally—and we truly do work that way, but we are able to leverage Brown and Brown national programs,” Bill explains. “So you could have a stop-loss carrier like ASG working with three Brown and Brown offices, which is great because we are communicating constantly and can see that any time one office excels at something, we have an opportunity to do more to leverage that model.”

Bill, who works primarily in the 50-plus employee market, partners with employers in his region to write primarily traditional, self-funded plans. “That’s the sweetheart spot and the majority of how we work with ASG,” he notes.

Trends Impacting Employer Options

In his position, Bill is able to keep his finger on the pulse of key marketplace trends. One emerging issue he points to has to do with employers, especially those in the manufacturing space, who are struggling to simply hire qualified employees.

“Central Pennsylvania is heavy blue-collar manufacturing,” he says. “In our region alone, we’re looking at one out of 10 candidates who have potential for an interview—and yet we hear from other Brown and Brown offices that it’s hard to find younger help who are skilled with their hands or have a trade.”

How this relates to brokering the right plan hinges on the swing to self-insured for smaller employers. Bill points out that self-funding is becoming more viable—even commonplace—for companies with fewer than 50 employees; however, stop-loss carriers are naturally more cautious about risk.

“Before, the process of writing a self-insured group was not as detailed as it is now,” he says. “The underwriting process today has to be more strict, in that employers and carriers have to make sure that employees are actually at work. If an employee goes out sick, or is out on an FLMA or another leave policy, all companies—especially if they’re stop-loss—should have a policy in place that will protect them if an employee is not working. If eligibility is not defined, it could result in a claim not being paid by the stop-loss carrier. You can’t assume any more.”

Responding to Industry Restructuring

Meanwhile, massive consolidations within the health care system are also impacting communities. “We’re going through a lot of change in our market, with large carriers and health systems consolidating,” says Bill. “Of the 150+ general acute hospitals in Pennsylvania, only about 25 remain independent.

"Again, that changes the landscape of healthcare because you have different pricing mechanisms: whereas the cost of services in regional facilities was previously relatively cheap, now you’ve got the small hospital paying inner-city prices. There’s a lot of struggle, and the carriers have to change to navigate the additional layers.

Ongoing Challenges Mean Stronger Partnerships

In such an ever-changing climate, Bill says he values being a long-time ASG partner more than ever.

He points out that one of our core values—making the ASG underwriting team available to all broker and TPA partners—“is simply good business. We get to talk to them, and tell them the whole story behind this employer or that one. With ASG, we know they’re going to honor the contracts and pay the claims timely, because they’re just good people and we trust them.”

 

For more information, please visit Brown and Brown of Pennsylvania online.

Spotlight on: Significa Benefit Services

Thursday, July 19, 2018

The more our ASG team does business with Lancaster, Penn.-based TPA Significa Benefit Services, the more we marvel at the value of a true partnership.

We first began working with Significa this past winter when Sales Executive Steve Shirk came to us with an opportunity to underwrite an employer group that presented several unusual cases, yet required timely coverage.

He recalls, “Time was of the essence and there was some pricing the broker wanted—in a level-funded format—so we worked around these things and ultimately, were able to move forward in a way that we all felt benefitted our customer.”

Get to Know Significa

Over the past months, it’s become clear that the 30-year-old firm shares more than a few core values with us at ASG.

For one, Regional Sales Director David O’Shea David notes that “as a TPA, we’re closer to the customer—we understand the customer’s needs. And that translates into our philosophy that the plan should be customized to fit the group, not the other way around.”

Transparency is key to achieving this end. “Without transparency, a business doesn’t know what to do to get control of its healthcare costs,” he explains. “By having access to claims data, and understanding the usage in that employer’s population, it helps us to design that plan in a way that helps control costs.”

Steve notes, “When we understand the customer, we understand what kinds of carriers and programs we want to bring to the program. Telemedicine programs, bringing in a fiduciary group—we’re tailoring the administration of that plan to meet the customer’s very specific needs.”

The second key is managing claims costs. David points out, “In our world, we’re auditing the emergency room client, we’re monitoring the surgical claims—we’re constantly looking for savings for the customer by managing the risks on a regular basis.”

Lastly, transparency—often a tricky achievement in our line of business, but key to proactively managing costs by managing care. At Significa, says Steve, “We have a robust claim reporting tool. We’re understanding the usage in our groups’ populations. After nine months or so we understand what the population is doing, and at that point, we can make changes to the plan.

“For example, when we see high utilization, we know the plan design is wrong. We want the employer to begin to get some control over costs—so we are able to reduce fourth, fifth, or sixth-year costs through a proactive approach to managing costs, managing care, and providing satisfying health benefits.”

The result of this diligence: knowledgeable employers and happy employees. “We find that once the employers see that full transparency, they’re able to make good decisions about managing healthcare costs effectively,” says David.

A Hands-On Approach

Significa also maintains relationships with vendors that the firm can match with the unique needs of employer groups. Steve explains, “By farming the data and understanding what’s going on, we can bring the right vendor to the table—and then we can control expense and enhance the experience with that customer.”

Significa is applying that model and differentiating itself with a third key partner: brokers. Specifically, by building consortiums, customers can buy in as participants, allowing Significa and its broker partners to grow business together.

“The small employer with 30 lives, 50 lives—they don’t have a lot of negotiating power. But in a consortium with thousands of lives that we can negotiate on their behalf, they now have the power of a large employer with the ability to negotiate insurance costs while spreading risks among several groups.”

Recognized for Experience and Caring

Here at ASG, we’ve often heard about the accolades Significa receives on a regular basis for its highly experienced claims professionals and dedication to customer service. “I think we bring a very good, experienced package with compassion and understanding about how we can assist our customers in managing risk,” notes Steve. “Being able to make recommendations, prove those recommendations to the customer, then implement those recommendations and measure those successes in subsequent years truly sets us apart.”

We value our relationship with Significa and look forward to many years of mutual success and growth!

 

SPOTLIGHT ON: INTERLINK COE Networks & Programs—Proactively Managing Plan Expenses

Monday, February 05, 2018

 

There’s a rapidly growing company in Hillsboro, OR, that’s been around for 23 years and is currently on the brink of changing the world.

Well, the world of cancer care management—which could prove to be monumental for all of us in the healthcare insurance industry.


For over 23 years, INTERLINK COE Networks & Programs has provided transplant network services for reinsurance carriers, insurance companies, self-funded employers, and other managed care clients in the United States.

INTERLINK is an established Center of Excellence-based company that recognizes the value of ensuring geographic coverage of evidence-based care protocols for plans across the nation. Its Centers of Excellence network provides access to high-cost, low-frequency medical procedures used by health plans of a range of sizes.

The company was founded by John Van Dyke, a former PPO negotiator, in 1995. In 2010, INTERLINK saw an opportunity to work with reinsurers to develop targeted cancer care management programs into the Centers of Excellence model.

INTERLINK’s CancerCARE program extends the firm’s Center of Excellence networks with specialized cancer case management nurses who provide consultative support for members looking to choose providers and seek treatments. Targeted cancer benefit language for employer plans is also included at no cost.

“Cancer is the number one employer-paid stop-loss deductible; number one reinsurer reimbursed claim at all levels; and also the number one cause of bankruptcy for members who are covered,” notes Van Dyke.

During a time when health plan premiums have increased 7% to 9% per year, the cost of cancer treatment has jumped an average of 20%. Van Dyke adds that health plans have no control over the frequency of cancer diagnoses, but can influence care quality with benefit incentives and definitions when inserted in the plan document.

However, he believes, there is an opportunity to control costs and increase optimal member outcomes, simply through improved quality of treatment. Better treatment translates into minimized complications and risk of reoccurrence—and ultimately, lower plan costs.

“Our CancerCARE program, from a plan level in managing cancer, is the number one investment that a plan could make to manage their members’ cancer care,” he says.

In 2018, the company CEO estimates the expected frequency of transplants will be 14.66 per 100,000 insured members; and of those 14.6 forecasted transplants, nearly half (6.0 of 14.66) will be for a cancer-related diagnoses.

“With benefit caps removed, a single poor outcome transplant can now cost the plan many millions,” says Van Dyke, “but if you put the CancerCARE benefit language in your plan, you could identify 41% of your transplant cases proactively. With this early notice, you can better manage your expenses within the plan."

Taking Risk Management to the Next Level

“Once you put CancerCARE in your plan, you’re already managing your transplant risk.”

–John Van Dyke, CEO

INTERLINK’s TransplantCARE and CancerCARE programs are based on performance narrowed concepts through networks that are built on “value-driven principles, the best providers, and timing for the best cost,” says Van Dyke. “When you performance narrow with INTERLINK, and outcome improving your very low-frequency, high-cost medical procedures, we’re not disrupting care, but improving member decision quality.”

The Data Tell the Story

The INTERLINK performance model addresses all solid organ transplant programs. The data-accepting capabilities of the model was extended in 2017 to accept transplant outcome data for all transplant teams throughout the U.S.

“We’re looking at 25 of the most telling outcomes for all transplant teams,” explains Van Dyke. "Which identifies for us those transplant teams posting the best outcomes.”

That data, says Van Dyke, "comes to us risk-adjusted by transplant center and team—so we have the cleanest data set in healthcare to rank the lowest-rated to the number one outcome provider in the country.”

For example, should a covered member require a liver transplant, he explains, “INTERLINK’s narrow-performance network directs them to a facility where the surgical team is high-performance, high-competency. We’re looking for a great member outcome, which almost always comes with a lower cost.”

A New Era in Cancer Care Management

As Van Dyke continues to work with brokers, consultants and health plans of all types to incorporate the Centers of Excellence model to cancer treatment, he understands that the healthcare market can be slow to adapt to new concepts. Yet after nearly three decades working in the business, he is confident INTERLINK’s solution is about to have a significant impact.

“I see the cancer care and transplant programs as examples of today’s most important initiatives,” he says. “Our focus is on quality care, and the outcome of quality care is reduced price. So if healthcare moves on this pathway, I believe this is how we’re going to solve our healthcare crisis.”


 

On-Call with Sara Winand, RN — Let's Get Creative with Corporate Wellness

Thursday, January 04, 2018

Many wellness programs offer paid time off as a reward for completing certain ongoing tasks—like taking so many steps in a designated two-week period can earn an employee one hour of PTO. For example, Blue Cross Blue Shield South Carolina offers its Get in the Habit of Moving More Challenge to help employees move toward better health. We started looking into this trend, and discovered the following article from Benefits Broker Pro, which we thought would be of interest to any TPA or Broker looking to offer a new twist on corporate wellness.

 

Corporate wellness is having its moment 

A cloud has been hanging over the corporate wellness industry, in no small part due to an often-cited RAND study which shows wellness programs are having little to no effect on reducing employer health costs.

Findings like this spell bad news for wellness solutions, not to mention for the HR departments that have invested billions in them. Does this mean it’s time to throw in the towel? Hardly.

Reverting to business as usual isn’t a winning strategy. Chronic illness, health costs, and lost productivity are all on the rise. Companies that ignore these issues do so at their peril.

All of the above is why I believe in 2017 the wellness industry is having its moment. While the initial hype behind wellness has led to serious disillusionment, we are now at a pivotal turning point, where thoughtful approaches, as well as some hard-learned lessons, start leading to real results.

Lesson #1: Stop creeping out your employees

All too often, wellness programs alienate employees long before any progress can be made. This usually begins with the health risk assessment -- a deeply flawed but widely used tool. These impersonal assessments ask employees to answer invasive questions like, “How many times do you cry per week?”

Lesson #2: You can’t force employees into better health

If your employees believe they are being forced into a program or penalized for not participating, that new Fitbit you’ve rolled out can quickly look like a pair of handcuffs. It’s crucial instead to nudge employees into wanting to participate and be proactive in maintaining or improving their own health.

This level of trust and engagement will never happen in a program where employees feel berated for not losing enough weight or taking too few daily steps. Wellness programs must dig deeper to determine what employees want and what will motivate them to achieve long-term health goals.

It’s important to remember trust goes both ways. Allowing employees to opt-out if they aren’t ready is a leap of faith employers must be ready to take. The focus for these non-participants then becomes determining what they need to feel ready and capable of improving their health.

Sound like a lot of effort? It is. But the alternative is failure. A mandatory, punitive wellness program ultimately won’t create positive engagement or meaningful behavior change.

Gym stipends and other perks such as on-site yoga classes are great. Companies should absolutely offer them if it makes sense for their employees. But workout perks can’t be the final word in a wellness program. Social determinants of health should factor in, too.

If an employee is dealing with anxiety that makes getting out of bed a daily struggle, what good will a gym membership do them? In addition to exercise and nutrition components, a wellness program should fulfill behavioral health needs. Services such as stress management workshops, financial counseling, and substance abuse treatment can make a world of difference in the health of employees.

Lesson #4: Culture is king

What these lessons have in common is that they are all points to consider before rolling out a wellness program in the first place. To that point, there is no value in offering a program until leaders have a thorough understanding of their company’s culture.

I tend to view corporate culture as the iceberg that lives beneath the surface of any wellness program investment. Culture single-handedly determines how much ROI is observable at the top. Companies which lack strong cultures -- where employees feel valued, believe in their company mission, and trust peers and leadership alike -- will continue to see their investments in wellness sink, dragged down by internal dysfunction, fear and mistrust.

There’s no quick and easy way to make wellness programs work, but the right formula is simple. Successful programs accurately reflect employee health needs at the individual level, are built on solid work cultures, and engage employees in a spirit of co-creation. When these dynamics are in place, a wellness program is primed to provide useful, personalized solutions which lead to a healthy return on investment for employees and the company alike.

 

Spotlight on Moreton & Company: Data, Innovation & Service — Oh My!

Thursday, December 14, 2017

 

Almost universally, there is a belief among business-to-business companies that two key ingredients make a relationship work: quality and trust. According to Julie Acocks, manager of the underwriting department at Moreton & Company, the relationship with ASG fits that bill just right.

As Utah’s largest independent insurance broker with more than 100 years of experience providing brokerage services to organizations in the Salt Lake Valley and across the United States, Moreton & Company has built a solid business on a foundation of superior customer service and innovative solutions for its clients’ most challenging insurance needs.

Julie’s perspective takes that commitment a level deeper. She says, “When it comes to stop-loss, many think it’s a commodity, but it is not: the difference lies in when it comes to getting the claim paid and dealing with difficult things — because things come up, and that’s a reality with stop-loss.

“The promise then becomes, who can I count on to be there to deal with this situation, handle the tricky conversations about how to make it work, and eventually, ensure the claim gets paid? We have been in that situation, and I have always felt like ASG has had my back.”

 

We’ve been honored to help make the tough stuff happen for Moreton, a company that has a great reputation for integrity and honoring its work. In fact, we first started working with the firm when our Vice President Mike Holland flew out to Utah to introduce himself personally — an effort that was not lost on Julie: “Mike met our team, and really wanted to make sure I felt comfortable with the company and what’s going on in the marketplace. We became a great partner from then on.”

Julie notes that Moreton tends to be proactive about staying current with industry trends and helping its clients stay informed and knowledgeable. “In the time I’ve worked with ASG, I so appreciate that they take the same approach to working with clients. I would tell you that ASG is probably my top stop-loss partner.”

We also appreciate that brokers like Moreton are always working with one eye toward the future. Julie explains that Moreton stays ahead of the curve by providing its clients not just with insurance coverage, but with the tools and knowledge they need to evaluate their needs, choose coverage that is right for them, and protect their company and their employees.

For example, Julie notes that she and the firm are “all about the data — presenting the data to the client and making sure that they get the most bang for their buck. The whole brokerage industry requires being entrepreneurial and innovative, especially when there’s enough flexibility in the client’s budget to dig into the data.”

She recalls a jumbo group she had been working with: “Of the hundred million dollars they were spending, 30% of it was cancer. That’s a big budget, so you have to go out and find someone who can cover it. You have to look at the top claims on a client-by-client basis — because hundreds of thousands on a big claim can make a big difference. And when you work with a company like ASG — a company that you know has your back — you are able to evolve with the times and deliver innovative solutions to your clients.”

We look forward to continuing our partnership with Julie and the team at Utah’s largest independent insurance broker!

Moreton & Company is the Assurex Global Partner in Utah. Assurex Global is an exclusive partnership of the most prominent independent agents and brokers in the world, and it enables Moreton & Company to find and place coverage for its clients in all parts of the world.


 

 

A Value-Based (and Very Smart) Approach to Partnerships

Thursday, June 29, 2017

It’s always gratifying to be called number one, and we were especially pleased when we came out on top of the list of preferred carriers for western Nebraska’s Regional Care, Inc. (RCI), an independent TPA.

That’s according to RCI’s Vice President of Sales Tom Applehans, who recently chatted with ASG about a number of steps the firm has been taking to provide more value to the marketplace.

“Our leadership team has taken a hard look at how we were interacting with our stop-loss partners. We felt that we maybe could do better if we worked a little bit closer with some of the carriers and the reps that had done the best job for us. So I surveyed the team and asked: of all the partners that we work with, who are the ones who are the most responsive, the most reliable on renewables, and so forth. ASG was a resounding number one on the list of responses from the team.”

He continues, “We like that ASG takes pride in their interpersonal relationships. The group gets along well with the team, and ASG is consistently competitive in its underwriting. You’ve also been reasonable in terms of medical underwriting and blocking in proposals. The biggest thing right now is finding partners that are reliable and that we like.”

That input prompted the RCI leadership team to green-light a preferred program within the company. While the program is “somewhat informal” at this point, its objective is to narrow the wide net of potential markets the company goes to for the bulk of its business.

This relationship-building aspect of our partnership translates into serious value for RCI, which serves over 200 clients with members in all 48 states from its headquarters in western Nebraska.

“What we’ve been explaining to our clients is that there is exposure if we aren’t selective and working closely with our stop-loss markets,” Tom notes. “So by taking this approach, we can do more business with vetted carriers, which reduces their exposure and improves our competitive position—it’s a way of managing risk and driving competitive pricing via consolidation and relationships, while still providing quality information and services. Rather than over-shop, we’re encouraging our people to simply do a better job working within defined markets.”

Tom points to the equal importance of bringing proactive solutions to existing and prospective clients. “It can be as simple as going back and looking at the network that’s in place, and taking the time to perform a discount analysis to uncover whether there’s an opportunity to improve pricing through a change,” he says.

The firm has also recently introduced telemedicine, and added a clinical program to help clients who have employers with high claims. Enhanced wellness and well-being programs (which include biometric screenings) and a new pharmacy program help RCI provide more thoughtful strategies while also controlling costs.

The goal in providing these tools, says Tom, is to enable RCI representatives to become trusted advisors with their clients. “And as we have those conversations, we’re working closer with our stop-loss partners so they have an idea of the direction we’re taking,” he says, adding that “if we can impact risk, that’s ultimately factored into the renewal and pricing on the front end.”

Response to the updates has been favorable among RCI clients. Tom notes the staff is also excited for the opportunity “to have those types of conversations, and try to get at underlying cost drivers rather than taking a more transactional approach to marketing.”

It’s all hands on deck at RCI headquarters, he adds. “We’ve been making some pretty sweeping changes over the past couple of years. It’s a work in progress, so every week we meet with our respective teams and leadership groups to try and constantly refine how we’re doing things internally and working with our clients. Everybody is being asked to find best in class solutions to address the kinds of problems our clients are facing. Historically, this company has had a very good reputation—as having great people, offering great service, etc.—so I think that we’re building on that, but also pushing the boundaries toward a high degree of excellence.”

Speaking for ASG, we are thrilled to be leading the charge with our valued partners!

Click here if you’d like to find out more about RCI.

Relationships: The Heart of Teamwork

Friday, May 12, 2017

Here at ASG, we frequently talk about relationships with our TPA and Broker partners. That’s because the interactions we have are incredibly important not only to our mutual business, but to ensuring we both offer the best possible services while striving to protect our employer groups’ interests.

In several instances, we also maintain important relationships with companies directly.

This is the case with Canon Virginia, Inc., a global manufacturer for Canon’s office and consumer products based in Newport News, Va.


Since 2004, we’ve worked in partnership with Phil Gilstrap, an Independent Broker, and Canon’s Benefits Administration group, led by Jackie Wall and Rhonda Bunn. Jackie and Rhonda administer coverage for the approximately 1,200 employees of Canon Virginia and a nearby subsidiary, all located in and around the Virginia Beach area.

Our relationship with Canon began when the company had been seeking a carrier change. ASG founding member Al Graffam happened to be the first Stop-Loss representative to respond with a complete presentation – and “the relationship has been a success since then,” notes Phil.

At the time, he recalls, the carrier that Canon had been working with seemed to have a philosophy based on looking at all clients equally. “If they had a pool that was bad, they just increased the rate on all players the same way,” he explains. “As a result, Canon was seeing tremendous cost increases on their policies. It seemed like the actuaries were looking at the numbers and saying, ‘Let’s just increase everybody.’”

ASG and Companion Life took a different stance. “Even without any longevity of experience with Canon, they still gave us some relevance when it came to our own loss ratio, and that was key,” says Phil. “Now that we’ve got 14 years in, we feel that ASG can really look at our medical claims and predict our needs. This holds rates down, and saves a ton of money. I crunched some numbers and determined that if we had stayed with the other carrier, based on the increases Canon had in its last year with them, by this time it would have cost Canon in the area of several million dollars.”

The value of this relationship has not been lost on Jackie, Canon Virginia’s Benefit Supervisor. “We know that ASG cares about Canon Virginia and we’re grateful to them for taking care of us,” she says. “It’s refreshing that whenever anything is needed, it’s no more than a phone call or e-mail away. I know I can talk to just about anybody at ASG and have the confidence that it’s being done right.”

Mutual Challenges and Goals

Rhonda, who works as Canon Virginia’s HR & PR Director, notes that like other employers throughout the country, an aging workforce has become a challenge that must be met head-on. “We’re all getting older, and so we’re dealing with things we haven’t had to deal with in the past,” she notes.

For example, 20 years ago the company had a younger workforce and covered more pregnancies, “whereas now it’s dealing more frequently with things like muscular skeletal issues,” says Rhonda.

On the flip side, notes Phil, “Canon is still hiring, and many of the people they’re hiring are young – but they too present a different set of issues. However, because Canon stays ahead of the curve and we’re working with a partner like ASG, the company is able to address trends as they come.”

The team points to the many preventative measures the company has implemented as proactive efforts to keep claims down. Examples include hiring a registered dietician and offering Weight Watchers on-site, both of which have been met with extremely positive reception among team members.

“We’re definitely in touch,” says Jackie. “We try to have that open relationship and have our members tell us what’s happening… what kind of environment would you like to see. They’re very comfortable coming up to HR and saying, ‘What doctor should I see?’ or ‘Can you explain this part of my policy?’ And we are here for them.”

In fact, she notes, Canon Virginia is especially proactive in communicating the economics of insurance coverage with its family members. “We tell them we’re self-funded, and we tell them what it is. We want them to understand their premiums are based on the rates that they pay. If they go unnecessarily not caring about staying in-network or not taking care of themselves, they know that what they do will impact their costs as well. We show them the numbers and they see what they contribute, and what we contribute, and they get it.”

Keeping these lines of communication open feeds into the overall culture at Canon Virginia, which Rhonda notes is based on caring about employees and vendors as a family. She sums up the company’s approach: “We want to work with people who understand our environment and treat us like family – who are responsive, and who customize, and pay attention to the details – and that’s what we get with ASG.” 

For more information about Canon Virginia, visit http://www.cvi.canon.com/.

 

Advancing Health — and a Healthy ROI

Saturday, September 17, 2016

From medical plans and health administration to the latest online benefit management tools, our partner POMCO offers a wide variety of solutions built to advance member health while containing employer costs.

The Syracuse, N.Y.-based TPA has been a valued ASG partner for more than two years, and we’ve found a great common ground in providing value through collaborative high-touch services.

Mansi Johri Gupta, POMCO’s Manager, Business Development Analytics, recently shared her perspective on how POMCO sets itself apart in the increasingly complex benefits administration industry.

First, she explained, “We try to align ourselves with clients who have a strategy of meeting goals and high expectations with regard to service. Whenever we talk with someone about their health or their business, it’s really important that our clients know we are working together to find the best solutions.”

Specializing in Client Excellence

POMCO has developed a specialty in municipalities and labor groups due to the high level of flexibility the company is able to offer through its self-funded solutions.

For example, municipality or labor unions may work under annual contracts that require returning to the bargaining table in order to make changes. By offering fully customized and highly flexible options, POMCO is able to ensure clients get the most from their health benefit investments.

Mansi added that this specialty further aligns with collective bargaining groups, who “really look to us to help manage those budgets without raising co-pays or other costs. At the end of the day, it’s all about saving costs: They have a budget at the beginning of the year, and they want to stay within that budget. We help them meet that goal.”

POMCO also works closely with a high concentration of both private- and public-sector hospital and healthcare centers; the company works with several university clients as well.

Industry Trends and How POMCO Adapts

Mansi touched briefly on the impact the ACA has had on self-funding since being implemented in 2010.

She said “For groups looking at high deductible health plans, or plan design strategies that mitigate costs, POMCO has a pretty aggressive cost containment approach where we look at every possible way to reduce costs. We look at case management, different types of ancillary services – all possible ways to help our clients meet their goals. Our focus is on how we can help them meet their budget without shifting costs.”

Additionally, POMCO is actively pursuing promising opportunities by working strategically with related industry partners to offer employer groups a menu of more than traditional benefit plan designs.

The company is also staying competitive relative to the technology it can offer both clients and members. “We know that healthcare is advancing with technology, and meeting the expectations of clients who are living in a digital forward space, right now, is critical,” she said.

Lastly, Mansi noted that POMCO currently has a very aggressive growth strategy for this year that involves building on its client base in California and continuing expansion into the west.

“We’ve been very successful since we started this expansion nearly three years ago, and we hope to bring in more clients from targeted states as we continue to grow,” she added.

We’re looking forward to continuing to build on our relationship with POMCO to help companies contain costs and continue their good work.

Visit POMCO.com to learn more about this valued partner’s benefit, risk management, and business process outsourcing solutions.

 

Lasers: Finding the Balance Between Risk and Reward

Wednesday, June 08, 2016

by Nathan Savage, Underwriter and April St. Cyr, Claims Manager

As we hear more and more people talking about stop-loss policies, the hot topic that keeps coming up seems to be lasers.

In its simplest form, a laser involves adjusting the stop-loss deductible for an individual who has a very high likelihood of exceeding the group’s regular individual specific deductible.

Lasers can present the group with additional liabilities – but as with any insurance, the coverage is for unknown risks, rather than known risks. There is also a cap that when hit, would start reimbursements. This allows a group to have a max cost, even on riskier members. (For example, we may have a laser of $250,000 for a cancer diagnosis but if the member’s claim goes over that amount, we still reimburse over the laser.)

Lasers can also be conditional, and are typically based on events such as transplants or chemotherapy. When this is the case, the covered member must meet the group’s specific deductible for anything that does not pertain to the condition set.

So when are lasers considered?

We start looking at members during the underwriting process. If there are obvious claimants who we predict will be over the group’s deductible, we make a note of it on our initial quotes.

Lasers are finalized when a group’s disclosure is signed and sent to us with supporting documents. The disclosure is an important tool that gives us an accurate and detailed picture of all known claimants or high-risk individuals. It’s also the last time that we look at the group to set lasers.

Click here to read more about the role disclosures play in the underwriting process.

Limiting exposure to all parties involved

When a notice is received on behalf of a high risk member, our Medical Management team reviews the notice using the following typical reporting:

– High claim reports

  • – Pended reports
  • – Pre-certification reports
  • – Case management reports

Based on the findings in these reports, we further research costs using web-based tools that provide critical information (such as clinical and financial analytics) and help with managing, reimbursing, and underwriting catastrophic claims.

Our team may also reach out to the TPA or case manager for any additional questions or information pertaining to the group in general, or the claim in particular.

And that’s not all.

ASG has established relationships with leading vendors who are willing to work with us, our TPA partners, and the employer group to secure deeper discounts for coverage of high-risk members.

Often, a medical bill review and audit company, or a medical cost containment and claims flow management organization, is able to negotiate with a provider and get sign-off on a rate that benefits all parties. Transplant networks for solid organ and bone marrow transplants offer excellent contracts to help mitigate the financial sting of complex care.

When Lasers Meet Claims

As we stated above, the laser is conditional and therefore specific to the covered individual. Following is a typical example.

Say Sue Smith’s policy includes a $150,000 conditional laser in the event of chemotherapy, and her employer group carries a $50,000 regular deductible.

If Sue undergoes a chemotherapy regimen and meets her laser of $150,000, our TPA partner would send in all required reporting for filing a claim as it would for anyone on the plan, regardless of a specific deductible. Our claims analyst would review and process the claim the same way as if there were no laser.

On the other hand, if Sue goes in for a knee replacement – which obviously is different than chemotherapy – and the knee replacement costs $70,000, we would simply reimburse the company the $20,000 difference over their deductible.

No matter the size of the policy or number of lasers included, what’s most important to an MGU like us is confirming that the claims:

  • – Are paid according to the plan document
  • – Meet all requirements of the stop-loss policy

At the end of the day, our goal is to write and stand by a policy that works for all parties involved.

We’re here to answer your questions about lasers. Contact us at any time! 

 

The Underwriters’ Perspective: The Building Blocks of a Strong Policy

Wednesday, June 10, 2015

By Sue Peebles, Underwriting Manager & Maggie Moynihan, Senior Marketing Underwriter

When it comes to underwriting a group of any size, there are many things that come into play, and a few key attributes are critical to success. Working together with a broker and/or TPA to meet the client’s needs, returning calls promptly, and consistently making due dates are just a few basics we keep in mind on a day to day basis. But a good foundation of knowledge and experience is essential when it comes to actually getting the job done.

A strong underwriter understands the importance of customer service, but additionally has complete understanding of group health insurance, ACA, managed care, HIPAA, and risk evaluation, along with the different roles played by TPAs, brokers, BUCAs, MGUs, and others. A lot of this experience comes from on the job training, and common sense should not be underestimated. The number of years someone has been underwriting also comes into play.

The ability to partner with a broker, TPA or consultant in a constructive manner is another key attribute developed over time. ASG is able to pride itself on these long-standing relationships that have been built. Our commitment to partnership has only become stronger over the years, as we continue to work closely with leading professionals who work from the same values.

Read more about Independent Insurance Marketing Executive Nancy Ferrell, a valued ASG partner for more than two decades. 

An important aspect to a strong underwriter is recognizing a good risk when it’s presented, combined with the willingness to go the extra mile in order to write the group. Taking the time to look over different options with the broker and/or TPA can be well worthwhile in the long run. Determining a common goal is the first step.

Working efficiently to get the job done and respond appropriately in a stressful, high volume environment comes with years of experience and again a strong foundation. Strong communication skills, also developed over time, are absolutely critical when it comes to developing partnerships and creatively closing business deals.

In addition to experience, what it really comes down to is integrity, honesty and transparency. These are the principles that ASG was founded on and that we continue to strive for in everything that we do.

Sue Peebles manages all underwriting, underwriter and support staff development, and RFP and renewal activity for ASG. With more than three decades of experience in group health insurance, she is an expert in the stop-loss field.

Maggie Moynihan works closely with our claims and marketing departments to evaluate employer stop-loss quotes while also building and maintaining relationships with brokers and TPAs. Maggie began her insurance career with ASG in June of 2006.

Meet the entire ASG team.

 

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