ASG Perspectives

FACES of ASG: Meet Christopher Joy

Wednesday, October 03, 2018

 

A YEAR SINCE JOINING US at ASG, Christopher Joy has become an invaluable asset. With a 20-year background in self-funded employee benefits plans, Chris takes a ton of pride in helping employers craft competitive and affordable employee benefits solutions. And since he previously worked on "the other side of the desk" as a Broker and TPA, Chris knows all about building partnerships and structuring stop-loss solutions for the diverse needs of our employer groups.

 

 

What is your job title at ASG?

Underwriter

And what does that role entail?

Assessing risk and pricing coverage accordingly. Negotiating with Brokers and TPAs to arrive at a competitive stop-loss solution for their clients

How long have you lived in Gorham?

Two years

Do you have a family? Please tell us about them.

Yes, married with 2 young children

What was your first job, and how old were you?

Newspaper delivery, age 12

What advice would you give to a new hire in the stop-loss industry?

Don’t be afraid to pick up the phone and communicate with your clients and customers. Learn about the businesses that you are reviewing beyond the information provided on the financial reports.

What is your favorite season? Why?

Winter! I enjoy rising to the challenge presented by our robust Maine winters.

Do you have a favorite quote?

Tomorrow is whole new day!

 

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.”


 

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.

The Humanity of the RFP: An Underwriter's Perspective

Friday, April 28, 2017

by Michael Tushman, Regional Marketing Representative

Stop-loss underwriters work hard.

In any given year, an underwriter might review more than 750 groups. And I’m not going to lie… after awhile, they can all begin to seem like there’s little to differentiate one employer from another.

Unfortunately, this can be particularly true for fully insured groups looking to convert to self-funding.

All of our TPA and broker partners are very good at submitting the basics of a request for proposal. You know — the standard stuff, including a census, plan design, current rates, loss data (if available) and the type of stop-loss contract they’re looking for.

What’s missing though?

Well, from the perspective of this underwriter’s desk, I’d say something to capture our interest. Something that makes the prospect really stand out.

Just like regular people, we underwriters like to read stories. Stephen King, James Michener, Ernest Hemingway, Mark Twain…. All good stuff.

What we love to read stories about is why a group is being marketed. Their motivations. Their back stories. Their goals and objectives for working with a new stop-loss partner.

I promise you, we aren’t looking for an epic narrative destined for a Pulitzer Prize… just something that helps us come up with creative solutions to help you retain or win business.

So next time you market a current group or a prospect, give some consideration to telling us:

  • -Why is this group being marketed? Are they doing a simple market check (which is okay) or does the group intend to make a move?
  • -What creative strategies are you going to employ that puts you in the best position to win the business?
  • -What’s your relationship with the group or the agent working with you? Do you have a history with the group or previous success with the agent? Or do you see this as an opportunity to get your foot in the door? (We are here for you!)
  • -What’s the group’s financial goals? A ballpark estimate is fine… just give us an idea for scope.

Help us help you! Consider bringing your group to life by personalizing your next RFP and helping your client group to stand out from all the others.

 

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! 

 

Specialty Drugs: Typical or Trend?

Friday, April 08, 2016

We’ve been noticing an increase in the costs of specialty drugs for various diseases, and how the phenomenon is beginning to make a real impact on the cost of health insurance programs among businesses of all sizes.

It’s been reported that specialty pharmaceuticals today represent one of the fastest growing areas in health care, with these medications accounting for approximately 25% of total drug spending in the U.S.

Yet the situation is becoming a lot like a train that’s moving too fast – the costs of some of these drugs have begun barreling down the health care track and are about to get completely out of control.

No indication of slowing down

Last year, 17 of the 25 drugs approved by the FDA were specialty medications; already this year, the FDA has approved nine specialty drugs.

The agency is expected to continue approving specialty prescriptions in higher volumes, with some estimates predicting 70% of top-selling drugs to be specialty medications within the next four years.

With some experts predicting these drug expenditures to quadruple in the next six years, companies are more and more frequently looking to the flexibility of self-funded options as a way to lower and/or limit rising medication costs while still providing health care benefits to their employees.

Because our mutual goal is to ensure your employer clients have maximum liability in place, be assured we are watching the situation closely form the carrier side.

We hope you'll e-mail us at mguperspectives@asgrmi.com with any concerns or thoughts you have about this topic.

Visit Sara’s Corner for info on Hepatitis C and standard treatments.

Interested in more? Check out this report

We recently came across a PBS Newshour post on “How the growing cost of drugs might affect your employer’s health plan.”

The post says: More than half of large U.S. employers will more tightly manage their employees’ use of prescription drugs next year, according to a new survey. The increased expenses from costly drugs threaten to push some employer health care plans over a threshold that will make them subject to a high tax.

Click here to view the report.

 

ASG Welcomes New Team Member

Tuesday, January 19, 2016

We’ve added a medical specialist!

Sara Winand, RN, has been named Director of Medical Management, responsible for medical underwriting support and proactive claims management for ASG clients.

 

 “I have always enjoyed the continuing challenge of assessing each case individually,” she said. “It requires daily research of new trends, new procedures and treatments and their costs, covering all health conditions.”

Sara brings more than 35 years of healthcare experience to our team, with 16 of those specific to the stop-loss insurance field.

“Our firm is recognized nationwide for our focus on high-touch customer service, which allows us to administer claims proactively while protecting employer interests,” said Peter Parent, President of ASG. “Sara provides our TPA and Broker clients with an experienced, knowledgeable resource for helping to control employer costs and achieve the best possible outcomes for everyone.”

 

 

Disclosure Process: An Important Underwriting Component

Friday, January 08, 2016
  • Having a proper Disclosure system in place is a benefit for all parties involved: the policy holder, the TPA/broker, and the carrier. An accurate and detailed picture of all known claimants or high-risk individuals allows us to reflect potential exposure in the final policy.

It is the quality of the claims information in the disclosure that impacts everything from the way the policy is structured (including the premium calculated) to how efficiently a claim will be handled.

The following are a few ins and outs of ASG Risk Management’s Disclosure process.

What is Disclosure?

A process of revealing the known claim risk of an employer at point of sale.

Why do we do it?

To evaluate the potential claim liability of an employer.

  • Prevent unexpected claim disputes or liability in the form of claim reductions or denials.
  • Provide a firm rate quote that is accurate and fair.

How do we do it?

Review of TPA/vendor-generated claim reports from a clinical perspective. This includes the following reports:

    1. – 50% reports
    2. – Rx reporting
    3. – Case Management reports
    4. – Pended claims report
    5. – Precertification report
    6. – Individual medical applications (if applicable)

Visit our Forms page to download commonly requested forms.

When do we do it?

  • 60 days prior to effective date.

When is the policy locked in?

  • Upon confirmation of coverage placement and completion of the items outlined above.

Please note: locking in after disclosure review may require updated reporting.

 

Be sure to ask your ASG rep for more specifics. We look forward to serving you and your clients!

 

 

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.

The Golden Rule Behind the Best Stop-Loss Policies

Monday, April 06, 2015

We’ve been noticing the word “integrity” being used in our industry:

“Integrity is at the core of every relationship.”

“We do business by adhering to the highest levels of integrity.”

And so on.

But what does that really mean, particularly within the context of a risk management company?

At ASG, we call ourselves “your stop-loss insurance partner” and for us, that phrase is so much more than a tagline—it’s about the relationships and the values that our business was founded on. It means the promises we make are the promises we keep. It’s in the people we hire and the level of service we deliver every day. It’s about the integrity that supports every relationship, new and old.

It’s a crucial cornerstone of our business, and has to be as solid as the granite rock our office’s foundation sits on.

For example, we all understand there are long-term implications to offering a quick sale. What happens when a carrier “buys business”—that is, offers a dirt-cheap premium then jacks up the rate the following year—is the complete opposite of working with integrity. It astonishes us that companies are willing to alienate their clients and undermine their credibility for a quick sale. In this business, referrals are everything and if we make our TPA or broker clients look bad, then it’s only the tip of the iceberg to making the entire industry look bad.

The exact opposite of working with integrity is failing to:

-Stand behind our product

-Offer personal customer service

-Support our partners’ businesses

You hear it all the time, but customer service really is the key to success. We’re proud that ASG has grown slowly and steadily, and we recognize we’ve been able to do that by committing to a few crucial best practices, all within the context of operating with integrity. We’ve learned that the best way to differentiate ourselves with TPA and broker clients is:

- Through the quality of the work we put out

- How responsive we are

- How accessible we are

It’s deceptively simple. Why ask you—an insurance professional operating in your local community—to put your reputation on the line and stand behind our product, without standing behind you? Why require you to make a million phone calls to resolve an issue, or wait 72 hours for someone to respond to your call? These practices and more only work to chip away at the integrity of our relationships and make life hard for everyone.

At ASG, we prefer to embrace the golden rule: Treat people the way they would like to be treated—with integrity!

From widget makers to retailers, consultants to salespeople, a lot of people lose sight of that guiding principle. We know that if we buy business, we lose business—so we just don’t. It hasn’t been through acquisitions or buying business that we’ve grown; it’s been by slowly establishing and valuing loyal, sustainable relationships. To us, that’s operating with integrity.

 

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