2016 Developments in Health and Welfare Plansbenefitexpress
This webinar discussed the most current developments in Health & Welfare plans.
For more information:
http://www.benefitexpress.info
http://www.twitter.com/benefitexpress
http://www.facebook.com/benefitexpress
This document provides an overview of self-funding health plans as an alternative to fully insured plans. Key points include:
- Self-funding allows more flexibility in plan design and can provide bottom line savings through better management of health risks.
- Proper management of chronic conditions and wellness programs, which account for 80% of health costs, is important for self-funded plans to control costs.
- Integrating wellness, chronic disease management, and other programs together provides better outcomes than having them work independently. Data-driven predictive modeling can help identify high-cost members in advance.
- A thorough benefits audit can help employers understand how their current plan compares to alternatives and develop a strategy for managing health risks and
The Gardner Group's eighth newsletter provides updates on self-funded employee health benefits and data analytics. Self-funding allows employers to avoid premium taxes and state-mandated benefits, saving thousands per year. While it presents financial risk, purchasing stop-loss insurance mitigates exposure to catastrophic claims. Data analytics helps self-funded employers streamline inefficiencies, identify at-risk members, and lower costs through wellness programs. The newsletter also discusses consumer-directed health plans that function as a form of modified self-insurance, saving employers money versus traditional insurance.
Health Decisions Webinar: The Five Levers of Management Control for Your Heal...Si Nahra
As every employer knows, health plan costs are one of their largest and fastest growing expenses. Like any business expense, health plan costs must be managed strategically and proactively. This webinar is for employers and their health plan fiduciaries, executives, managers, administrators, and their advisory teams. The presentation is structured around the "Five Levers of Management Control" that encompass all the health plan management options available to employers.
For more information, please visit: http://www.healthdecisions.com
The document provides a timeline summary of key provisions from the 2010 Affordable Care Act (ACA) health reform law to be implemented between 2010-2018. Some key points include: expanded dependent coverage until age 26 starting in 2010; prohibiting pre-existing condition exclusions for children under 19 in 2010; establishing state health insurance exchanges by 2014; requiring individuals to have health insurance or pay a penalty starting in 2014; and increasing the Medicare Part D subsidy starting in 2011 to completely close the coverage gap by 2020.
We believe in the rewards of employee health. By listening, understanding and by partnering with you, we can deliver more than just a group benefits plan. Together we can deliver innovative benefits solutions for today and tomorrow. #SUNADVANTAGE is a solution for small business to help them reap the rewards of a healthier workforce.
FORUM 2013 Innovative solutions for health benefit programmesFERMA
The document discusses innovative solutions for employee health and benefits programs for cross-border businesses. It outlines an agenda for a workshop covering introductions, available solutions like multinational pooling and consolidated programs, stakeholders involved, and case studies. Employee benefits are defined as solutions employers provide in addition to public provisions to protect employees from risks like loss of income or medical expenses. Risk management can help apply global structures, solutions aligned with risk strategies, and leverage insurer relationships. Available solutions include captives, consolidated programs, coordinated programs, local policies, and self-insurance. Stakeholders involved are HR, finance, legal, procurement, and benefits advisors who may have competing interests. Case studies demonstrate consolidated programs and global life insurance programs.
2016 Developments in Health and Welfare Plansbenefitexpress
This webinar discussed the most current developments in Health & Welfare plans.
For more information:
http://www.benefitexpress.info
http://www.twitter.com/benefitexpress
http://www.facebook.com/benefitexpress
This document provides an overview of self-funding health plans as an alternative to fully insured plans. Key points include:
- Self-funding allows more flexibility in plan design and can provide bottom line savings through better management of health risks.
- Proper management of chronic conditions and wellness programs, which account for 80% of health costs, is important for self-funded plans to control costs.
- Integrating wellness, chronic disease management, and other programs together provides better outcomes than having them work independently. Data-driven predictive modeling can help identify high-cost members in advance.
- A thorough benefits audit can help employers understand how their current plan compares to alternatives and develop a strategy for managing health risks and
The Gardner Group's eighth newsletter provides updates on self-funded employee health benefits and data analytics. Self-funding allows employers to avoid premium taxes and state-mandated benefits, saving thousands per year. While it presents financial risk, purchasing stop-loss insurance mitigates exposure to catastrophic claims. Data analytics helps self-funded employers streamline inefficiencies, identify at-risk members, and lower costs through wellness programs. The newsletter also discusses consumer-directed health plans that function as a form of modified self-insurance, saving employers money versus traditional insurance.
Health Decisions Webinar: The Five Levers of Management Control for Your Heal...Si Nahra
As every employer knows, health plan costs are one of their largest and fastest growing expenses. Like any business expense, health plan costs must be managed strategically and proactively. This webinar is for employers and their health plan fiduciaries, executives, managers, administrators, and their advisory teams. The presentation is structured around the "Five Levers of Management Control" that encompass all the health plan management options available to employers.
For more information, please visit: http://www.healthdecisions.com
The document provides a timeline summary of key provisions from the 2010 Affordable Care Act (ACA) health reform law to be implemented between 2010-2018. Some key points include: expanded dependent coverage until age 26 starting in 2010; prohibiting pre-existing condition exclusions for children under 19 in 2010; establishing state health insurance exchanges by 2014; requiring individuals to have health insurance or pay a penalty starting in 2014; and increasing the Medicare Part D subsidy starting in 2011 to completely close the coverage gap by 2020.
We believe in the rewards of employee health. By listening, understanding and by partnering with you, we can deliver more than just a group benefits plan. Together we can deliver innovative benefits solutions for today and tomorrow. #SUNADVANTAGE is a solution for small business to help them reap the rewards of a healthier workforce.
FORUM 2013 Innovative solutions for health benefit programmesFERMA
The document discusses innovative solutions for employee health and benefits programs for cross-border businesses. It outlines an agenda for a workshop covering introductions, available solutions like multinational pooling and consolidated programs, stakeholders involved, and case studies. Employee benefits are defined as solutions employers provide in addition to public provisions to protect employees from risks like loss of income or medical expenses. Risk management can help apply global structures, solutions aligned with risk strategies, and leverage insurer relationships. Available solutions include captives, consolidated programs, coordinated programs, local policies, and self-insurance. Stakeholders involved are HR, finance, legal, procurement, and benefits advisors who may have competing interests. Case studies demonstrate consolidated programs and global life insurance programs.
HUB International is an insurance brokerage that specializes in agribusiness insurance solutions. It has over 250 offices nationwide and ranks as the largest privately held insurance brokerage in the US. HUB works with various types of agribusiness operations, from grain elevators to dairy farms. It provides a range of insurance products like property and casualty coverage, employee benefits, and surety bonds tailored to its clients' needs. HUB also offers risk consulting services and alternative risk financing options to help lower clients' total cost of risk.
This document provides information about health insurance plans from Golden Rule Insurance Company, a UnitedHealthcare company. It outlines several types of plans they offer including copay plans, health savings account plans, and high deductible plans. It emphasizes their experience serving individuals and families for over 60 years. It also highlights the benefits of their large provider network which can offer savings of up to 35-45% on healthcare costs.
Health Care Reform Implementation For Employersjpwlinkedin
The document summarizes key provisions of the Patient Protection and Affordable Care Act (PPACA) that affect employers and health insurance. It notes that PPACA requires most employers to offer minimum health coverage and individuals to purchase and maintain coverage. Major reforms take effect in 2014, including the establishment of health insurance exchanges, an individual mandate, penalties for employers not providing affordable coverage, and modified community rating standards. The document provides timelines of upcoming changes and impacts on employers between now and full implementation in 2014.
The document outlines a distributed multiagent resource allocation approach for domains with diminishing marginal returns. It proposes an interaction protocol where agents and resource owners interact over multiple rounds to determine an allocation and payments. Suggested strategies are provided that are shown to converge to the optimal allocation in polynomial time. The approach incentivizes truthful behavior and handles strategic behavior while achieving an optimal and stable allocation without a central authority.
Using multiple discount rates to develop benefit plan cost
The document discusses alternative approaches companies have considered for determining discount rates to calculate interest and service costs for defined benefit plans, including using multiple discount rates. The SEC would not object to companies changing to an approach using individual spot rates from the yield curve. Companies considering a change need to evaluate accounting implications, such as whether it is a change in estimate. Recent SEC guidance indicates such a change could be treated as a change in estimate with certain disclosure requirements.
The document discusses guidelines for using Homelessness Prevention and Rapid Re-Housing Program (HPRP) funds. HPRP provides temporary financial assistance and services to help people who are homeless or at risk of homelessness gain housing stability. Eligible activities include short-term rental assistance, utilities assistance, security deposits, and case management services. Households must meet income and eligibility requirements to receive assistance, which is focused on either preventing homelessness or rapidly re-housing those who are already homeless. Case managers work with clients to assess needs and develop individualized housing stabilization plans.
Turnarounds in the NHS: Why it pays to think differentlyTTCLLP
Turnarounds in the NHS are difficult. Here are 5 practical ways to improve your chances of success from a turnaround practitioner that works in both the public and private sectors.
Insurance reforms were implemented between 2010-2018 that prohibited lifetime or annual limits on coverage, pre-existing condition exclusions, and cancellations. Standard coverage documents and definitions were also developed. A "Cadillac tax" on high-cost employer health plans went into effect in 2018. Hospitals with high readmission rates faced reduced Medicare payments beginning in 2012. Individuals and families making over $200,000/$250,000 respectively paid higher Medicare taxes starting in 2013.
Credit: A Key Building Block for DB SchemesRedington
This document discusses using credit as a core building block for defined benefit pension schemes investing in a low yield environment. It presents strategies for including various types of credit investments, from liquid to illiquid, in a portfolio to increase returns while managing risk. Absolute return credit strategies and allocating to alternative credit sub-asset classes are presented as ways to boost returns. The document also discusses restructuring a large client's credit portfolio to reduce risk and increase expected returns.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
What Is Life After Coronavirus? How To Claim SBA Disaster & CARES Act LoansRea & Associates
The document provides an overview of SBA loan programs and resources available to small businesses during the COVID-19 crisis, including the Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL). It summarizes the eligibility requirements, loan terms, forgiveness provisions, and application process for PPP and EIDL loans established under the CARES Act. It also reviews how these new SBA loan programs coordinate with other CARES Act relief for small businesses.
This document provides a summary of the major provisions of the Affordable Care Act that impact employers and recommendations on how to prepare. It includes an overview of requirements that are already in place and future requirements. It also notes that Colonial Life's voluntary benefits are exempt from many of the health insurance reforms and discusses important considerations for voluntary benefits like the health insurance exchanges, employer reporting on W-2 forms, and the excise tax.
The document provides sample reports and outcomes from a comprehensive workers' compensation claims reporting and management dashboard. It includes standard reports on injuries, medical costs, lost time, and program effectiveness. Customized reports and auto-triggered reports are also available. Graphs and analyses show that early injury reporting within 3 days of occurrence leads to lower medical and lost time costs compared to later reporting. A hotline for reporting injuries achieved high supervisor satisfaction ratings. Medical case management reduced lost time days and costs compared to national benchmarks.
This document discusses financing employee benefits through self-funding. It notes that rising healthcare costs have made fully insured plans increasingly expensive for employers. Self-funding involves the employer establishing a trust fund to directly pay for medical claims, keeping excess funds. It requires purchasing stop-loss insurance to limit exposure to large claims. Using a third party administrator to manage the self-funded plan can reduce costs compared to traditional insurance by avoiding premium taxes and retaining investment interest. The document outlines the services a TPA provides and how self-funded plans can help control costs while remaining compliant with PPACA regulations.
Self-Funded Plan Administrators provides affordable self-funded health plans for employers that meet ACA requirements at a lower cost than traditional insurance. They offer plans with different coverage levels and maximum out-of-pocket costs. Their services include ACA compliance support, online enrollment, and an HR platform to manage benefits administration. As a third party administrator, they process claims and provide stop-loss insurance to limit employers' risk from large claims.
Covenant Advantage offers employer groups with 200+ participants a multi-year guarantee for controlling healthcare costs by implementing wellness, on-site clinic, and medical navigator programs. It provides an annual cap on renewal costs and guarantees maximum costs for future years if the programs are followed. The exclusive program is from Covenant Services Group, a leader in integrated health plan administration serving over 100,000 members.
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
Cost-Savings Strategies Beyond COVID-19: Keep Benefit Plans Top of MindCBIZ, Inc.
With many businesses turning their focus to reopening, as budgets strain it may be important to consider benefit plan cost-savings strategies. This article discusses cost savings for all plan types, as well as specific strategies for: Small ACA Health Plans; Small to Medium, Level-Funded Health Plans; Insured Health Plans; and Self-Funded Health Plans.
This document provides information about different options for employers related to health insurance, including group captives. It discusses the benefits of self-funding health plans and using a group captive structure to spread risk across multiple employers. This allows smaller employers to gain advantages typically only available to large companies. The document outlines Berkley's group captive program, which combines self-funding, a group captive structure, and collaborative health risk management. It provides examples of potential cost savings and financial scenarios for employers participating in a group captive program compared to traditional insurance. The summary also discusses characteristics of employers that may be good candidates for a group captive.
HUB International is an insurance brokerage that specializes in agribusiness insurance solutions. It has over 250 offices nationwide and ranks as the largest privately held insurance brokerage in the US. HUB works with various types of agribusiness operations, from grain elevators to dairy farms. It provides a range of insurance products like property and casualty coverage, employee benefits, and surety bonds tailored to its clients' needs. HUB also offers risk consulting services and alternative risk financing options to help lower clients' total cost of risk.
This document provides information about health insurance plans from Golden Rule Insurance Company, a UnitedHealthcare company. It outlines several types of plans they offer including copay plans, health savings account plans, and high deductible plans. It emphasizes their experience serving individuals and families for over 60 years. It also highlights the benefits of their large provider network which can offer savings of up to 35-45% on healthcare costs.
Health Care Reform Implementation For Employersjpwlinkedin
The document summarizes key provisions of the Patient Protection and Affordable Care Act (PPACA) that affect employers and health insurance. It notes that PPACA requires most employers to offer minimum health coverage and individuals to purchase and maintain coverage. Major reforms take effect in 2014, including the establishment of health insurance exchanges, an individual mandate, penalties for employers not providing affordable coverage, and modified community rating standards. The document provides timelines of upcoming changes and impacts on employers between now and full implementation in 2014.
The document outlines a distributed multiagent resource allocation approach for domains with diminishing marginal returns. It proposes an interaction protocol where agents and resource owners interact over multiple rounds to determine an allocation and payments. Suggested strategies are provided that are shown to converge to the optimal allocation in polynomial time. The approach incentivizes truthful behavior and handles strategic behavior while achieving an optimal and stable allocation without a central authority.
Using multiple discount rates to develop benefit plan cost
The document discusses alternative approaches companies have considered for determining discount rates to calculate interest and service costs for defined benefit plans, including using multiple discount rates. The SEC would not object to companies changing to an approach using individual spot rates from the yield curve. Companies considering a change need to evaluate accounting implications, such as whether it is a change in estimate. Recent SEC guidance indicates such a change could be treated as a change in estimate with certain disclosure requirements.
The document discusses guidelines for using Homelessness Prevention and Rapid Re-Housing Program (HPRP) funds. HPRP provides temporary financial assistance and services to help people who are homeless or at risk of homelessness gain housing stability. Eligible activities include short-term rental assistance, utilities assistance, security deposits, and case management services. Households must meet income and eligibility requirements to receive assistance, which is focused on either preventing homelessness or rapidly re-housing those who are already homeless. Case managers work with clients to assess needs and develop individualized housing stabilization plans.
Turnarounds in the NHS: Why it pays to think differentlyTTCLLP
Turnarounds in the NHS are difficult. Here are 5 practical ways to improve your chances of success from a turnaround practitioner that works in both the public and private sectors.
Insurance reforms were implemented between 2010-2018 that prohibited lifetime or annual limits on coverage, pre-existing condition exclusions, and cancellations. Standard coverage documents and definitions were also developed. A "Cadillac tax" on high-cost employer health plans went into effect in 2018. Hospitals with high readmission rates faced reduced Medicare payments beginning in 2012. Individuals and families making over $200,000/$250,000 respectively paid higher Medicare taxes starting in 2013.
Credit: A Key Building Block for DB SchemesRedington
This document discusses using credit as a core building block for defined benefit pension schemes investing in a low yield environment. It presents strategies for including various types of credit investments, from liquid to illiquid, in a portfolio to increase returns while managing risk. Absolute return credit strategies and allocating to alternative credit sub-asset classes are presented as ways to boost returns. The document also discusses restructuring a large client's credit portfolio to reduce risk and increase expected returns.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
What Is Life After Coronavirus? How To Claim SBA Disaster & CARES Act LoansRea & Associates
The document provides an overview of SBA loan programs and resources available to small businesses during the COVID-19 crisis, including the Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL). It summarizes the eligibility requirements, loan terms, forgiveness provisions, and application process for PPP and EIDL loans established under the CARES Act. It also reviews how these new SBA loan programs coordinate with other CARES Act relief for small businesses.
This document provides a summary of the major provisions of the Affordable Care Act that impact employers and recommendations on how to prepare. It includes an overview of requirements that are already in place and future requirements. It also notes that Colonial Life's voluntary benefits are exempt from many of the health insurance reforms and discusses important considerations for voluntary benefits like the health insurance exchanges, employer reporting on W-2 forms, and the excise tax.
The document provides sample reports and outcomes from a comprehensive workers' compensation claims reporting and management dashboard. It includes standard reports on injuries, medical costs, lost time, and program effectiveness. Customized reports and auto-triggered reports are also available. Graphs and analyses show that early injury reporting within 3 days of occurrence leads to lower medical and lost time costs compared to later reporting. A hotline for reporting injuries achieved high supervisor satisfaction ratings. Medical case management reduced lost time days and costs compared to national benchmarks.
This document discusses financing employee benefits through self-funding. It notes that rising healthcare costs have made fully insured plans increasingly expensive for employers. Self-funding involves the employer establishing a trust fund to directly pay for medical claims, keeping excess funds. It requires purchasing stop-loss insurance to limit exposure to large claims. Using a third party administrator to manage the self-funded plan can reduce costs compared to traditional insurance by avoiding premium taxes and retaining investment interest. The document outlines the services a TPA provides and how self-funded plans can help control costs while remaining compliant with PPACA regulations.
Self-Funded Plan Administrators provides affordable self-funded health plans for employers that meet ACA requirements at a lower cost than traditional insurance. They offer plans with different coverage levels and maximum out-of-pocket costs. Their services include ACA compliance support, online enrollment, and an HR platform to manage benefits administration. As a third party administrator, they process claims and provide stop-loss insurance to limit employers' risk from large claims.
Covenant Advantage offers employer groups with 200+ participants a multi-year guarantee for controlling healthcare costs by implementing wellness, on-site clinic, and medical navigator programs. It provides an annual cap on renewal costs and guarantees maximum costs for future years if the programs are followed. The exclusive program is from Covenant Services Group, a leader in integrated health plan administration serving over 100,000 members.
This presentation is designed to provide the information needed to understand self-funding, assist you in explaining the solution to clients and then determine whether it is right for their company by comparing and contrasting it to a fully insured solution.
Cost-Savings Strategies Beyond COVID-19: Keep Benefit Plans Top of MindCBIZ, Inc.
With many businesses turning their focus to reopening, as budgets strain it may be important to consider benefit plan cost-savings strategies. This article discusses cost savings for all plan types, as well as specific strategies for: Small ACA Health Plans; Small to Medium, Level-Funded Health Plans; Insured Health Plans; and Self-Funded Health Plans.
This document provides information about different options for employers related to health insurance, including group captives. It discusses the benefits of self-funding health plans and using a group captive structure to spread risk across multiple employers. This allows smaller employers to gain advantages typically only available to large companies. The document outlines Berkley's group captive program, which combines self-funding, a group captive structure, and collaborative health risk management. It provides examples of potential cost savings and financial scenarios for employers participating in a group captive program compared to traditional insurance. The summary also discusses characteristics of employers that may be good candidates for a group captive.
This document discusses why the Mid-Market Med group captive program is a viable solution for mid-market employers given changes under the Affordable Care Act. The program offers comprehensive services, low collateral requirements, top-tier reinsurance, flexibility, and has achieved positive results including an 18% annual premium return and 99% client retention. The program allows mid-market employers to share risks and lower healthcare costs through a medical stop loss group captive.
Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
Trend Neutralizer - Health Plan Strategy Ronald Lain
BCG's Trend Neutralizer is a proven
program that guarantees a
reduction in your medical trend
costs, based on the level of your
company’s participation in
various health plan best
practices.
Five Macro Trends Driving Healthcare Industry Investment in 2011 and BeyondCognizant
Here are five industry trends that will strongly influence where and how healthcare ecosystem participants will invest business development and technology dollars this year and into 2012.
This chapter establishes the context for topics covered in the text by highlighting key issues affecting healthcare organizations. It is organized into three sections that address: (1) changing methods of healthcare financing and delivery; (2) addressing the high cost of care; and (3) establishing value-based payment mechanisms. The document discusses the Affordable Care Act and its provisions for expanding insurance coverage and Medicaid. It also covers trends in healthcare such as the rise of uninsured individuals, accountable care organizations, and value-based purchasing systems.
This chapter establishes the context for topics covered in the text by highlighting key issues affecting healthcare organizations. It is organized into three sections that address: (1) changing methods of healthcare financing and delivery; (2) addressing the high cost of care; and (3) establishing value-based payment mechanisms. The document provides an overview of the Patient Protection and Affordable Care Act and its provisions for expanding insurance coverage and Medicaid. It also discusses trends in healthcare such as the rise of uninsured individuals, accountable care organizations, and value-based purchasing systems.
This chapter establishes the context for topics covered in the text by highlighting key issues affecting healthcare organizations. It is organized into three sections that address: (1) changing methods of healthcare financing and delivery; (2) addressing the high cost of care; and (3) establishing value-based payment mechanisms. The document discusses the Affordable Care Act and its provisions for expanding insurance coverage and Medicaid. It also covers trends like the rise of accountable care organizations and value-based purchasing systems.
This chapter establishes the context for topics covered in the text by highlighting key issues affecting healthcare organizations. It is organized into three sections that address: (1) changing methods of healthcare financing and delivery; (2) addressing the high cost of care; and (3) establishing value-based payment mechanisms. The document discusses the Affordable Care Act and its provisions for expanding insurance coverage and Medicaid. It also covers trends like the rise of accountable care organizations and value-based purchasing systems.
The South Central Ohio Insurance Consortium (SCOIC) allows public sector employers to join together to better manage employee health benefits. [1] By pooling resources, SCOIC is able to reduce costs through larger provider networks, stop-loss insurance, and eliminating insurance company profits. [2] SCOIC provides self-funded health plans that are managed by a board of representatives and administered by Employee Benefit Management Corp. [3] The consortium has grown to over 3,000 members across Ohio and allows members to maintain control over their health plans while achieving stability in costs and services not possible alone.
Some ways employers can manage rising healthcare costs in 2010 include offering voluntary benefits and high-deductible health plans paired with wellness programs. Conducting dependent eligibility audits and increasing cost transparency for employees can also help lower costs. Promoting generic drugs, prescription drug plan redesigns, on-site clinics and disease management programs are further innovative ways to save on benefits costs. Loss forecasting is an important first step for analyzing optimal insurance programs, though forecasts have limitations since future losses are uncertain.
This document discusses limited medical plans, also known as "mini-med" plans. It provides an overview of what limited medical plans are, when they may be suitable for employers to offer, and important considerations for employers. Limited medical plans offer more limited health coverage at a lower cost compared to traditional plans. They may be a good option for employers with part-time, temporary, or lower-wage employees. The document emphasizes the importance of clear communication about the specific benefits and limitations of these plans.
This document discusses risk adjustment in payer-provider contracting. It begins by outlining the evolution of risk adjustment models from the 1980s to present day. It then discusses the shift from fee-for-service to value-based arrangements and the spectrum of risk-based models now being used. Key considerations for different payment models are outlined. The uses of risk adjustment in contracting are explained, and limitations of traditional models are noted. The document concludes by discussing blended models, customized risk adjusters, and operational tactics for providers taking on risk.
Similar to Covenant Services Group - Summary of Programs (20)
HFMA 2016.08.16 - Risk Adjustment for Payer-Provider Contracting - Siegel
Covenant Services Group - Summary of Programs
1. The Covenant Services Group factors and fixed costs.
• Access Your Claims - With CovenantCare, you have access
As a leading Third Party Administrator (TPA) since 1992, The Covenant to your own claims experience. This will allow you to
Services Group concentration is to be more than just a claims processor manage your healthcare program.
or even a claims manager, but to be a Healthcare Risk Manager. The • Health Risk Management - With CovenantCare, you will
Covenant Services Group provides Health Benefits Risk Management have at your finger tips true risk management programs that
Programs and Administration Services to over 100,000 member lives by allow you to control and direct the future outcomes of your
harnessing the industry’s most powerful technology and applying sound plan. You will be able to reduce or eliminate the future
fundamental healthcare strategies. Our global focus is to provide Health impact of claims.
Risk Management solutions that will have a dramatic impact on the • Lower Maximum Cost - CovenantCare favorably resembles
bottom line costs by providing techniques to eliminate exposure to risk a fully insured program. Similar to a fully insured plan,
and reduce the cost impact of known risks. CovenantCare affords the client consistent monthly plan
costs.
Our commitment to the level of service we provide is best exemplified • No Lasers / Even At Renewal - A great advantage to
by our name itself. We are honor bound, far beyond the stipulations of CovenantCare is that no “lasers” will be placed as a
any paper contracts between us. We settle for no less than to exceed condition of renewal. Laser is a self-funded term where the
your expectations. At Covenant, we believe and are committed to the stop-loss contract can carve out certain individuals due to
following… “Covenant...More Than A Promise” high claims liability and apply larger stop-loss deductibles.
• Client Funding is Capped / No More Cash Calls - With
CovenantCare, the only monies the client is required to fund
Uniquely Designed Healthcare Programs on a monthly basis are aggregate premium rates and
aggregate claim factors. The CovenantCare Program will
automatically and immediately fund any claims above the
monthly funded equivalents.
An Alternate Funded Healthcare Program • Potential for Reimbursement - Unlike a fully insured
product, should actual claims come in lower than the
The CovenantCare benefit program is an attractive self-funded attachment point at year-end, reimbursement is a
alternative for employers and health plan sponsors with 25 to 200 possibility. This is not an option with a fully insured product.
employee lives who are currently fully insured and want the advantages
of self-funding but are hesitant to leave the safety of fixed premiums Covenant Advantage - A Multiple Year Guarantee
and limited liability provided by fully insured medical plans. In essence, it
provides a way to apply health risk management strategies to your During these volatile healthcare and economic times, the ability to
benefit plan like large employer groups but with the same financial safe provide a multiple year cost guarantee to an employee benefit health
harbors of fully insured programs. You will truly be able to take control plan is INVALUABLE. Covenant Advantage has been created to control
of your healthcare benefit program. The benefits of choosing the rising healthcare costs and improve cash flow without sacrificing quality
CovenantCare Alternate Funding Plan include the following: healthcare coverage. It allows employer groups the opportunity to have
• Capping the Risk - Just like self-funded plan sponsor’s use a multiple year budget stabilization in operating their healthcare benefit
of aggregate reinsurance to cap maximum liability, plan.
CovenantCare also caps the risk based on expected claim
2. Covenant Advantage highlights: in reducing healthcare unit costs. Our risk management strategy will
• Program marketed to partially self-funded employee pave the way to allow your organization to win the battle over rising
benefit plans with 200 or more employee lives. healthcare costs. Listed below is a summary of our strategic programs:
• Program will provide a multiple year cost guarantee of the
employee benefit health plan costs. • Lifestyle Management - New legislation allows employer-
• Employer groups must agree to implement the following sponsored health plans to provide results-based incentives
Covenant Risk Management Strategies, which improve the for wellness. This program provides a unique way to assist
overall management and costs of the health plan, in order in improving the health of employees through lifestyle
to receive this guarantee. changes. Our lifestyle habits are responsible for over 71%
⇒ A Results Based Lifestyle Management Program of every claim dollar associated with our health plans.
⇒ An On-Site Primary Care Clinic Thus, by controlling these habits, savings will drop straight
⇒ Medical Advocate Program to the bottom line of an employer’s health plan. Under the
• The multiple year rate guarantee maximizes the annual cost plan, a confidential health screening will take place to
increase of the health plan to no greater than 8% per year. assess each employee’s basic health in the key areas of:
We anticipate that the entire costs of the health plan will • Blood Pressure
decrease. However, our reinsurance and administrative • Cholesterol (LDL)
contracts guarantee the entire cost of the health plan to be • Body Mass Index (BMI)
limited to 8% annually. • Tobacco/Nicotine Use
Based on the number of these categories that are shown
Covenant Administrators is…. to be acceptable, the employee will have higher or lower
deductibles for the plan. Annually, each employee will be
Your Health Benefits Risk Management Solution re-tested for their progress in these lifestyle categories. As
their health categories improve, their deductible will
reduce. This approach has proven very successful in
Covenant’s Healthcare Risk Management Solutions multiple companies across America.
The Covenant Services Group is leading the way in providing state-of- • On-Site Primary Care Clinic - This is a return to a more
the-art initiatives that control and reduce the high cost of healthcare, traditional health strategy that is driven by several factors:
while improving the quality of care. This comprehensive risk ⇒ Employer’s desire for greater risk management and
management program is identified as CAST, “Covenant Applied Savings regulatory compliance.
Techniques”. The sole purpose of CAST is to enable employer groups to ⇒ Case and Medical Management that improves
not only control healthcare costs but to eliminate exposures to risk that effectiveness in the workplace.
will eventually produce significant unwanted costs if not addressed. ⇒ Population Health and Absence Management
Healthcare costs are based on a simple formula: With an on-site clinic, the improved access to primary
care and pharmaceutical services improves an
Unit Cost X Frequency = Total Claims Cost employer's ability to intervene and treat problems early,
leading to a decrease in specialty care, emergency
CAST’s Healthcare Risk Management Program will provide your room use, hospitalization and absence
company with a comprehensive and seamless plan that will eliminate from work.
exposures to risk by decreasing the frequency of high risk claims or
potentially high risk opportunities. CAST will also have a positive impact
3. An employee can receive their primary care visits and healthcare today…. Access, Affordability, and
prescriptions for a $0 Co-Pay. The “On-Site Clinic” will Convenience. TelaDoc can be used to treat problems such
provide annual health risk assessments, coordinate care as Allergies, Bronchitis, Respiratory Infection, Rx Refill
and serve as the Primary Care Physician for all covered (short term only), Sinusitis and Urinary Tract Infections.
employees and dependents that choose this method of
care. The savings generated by this delivery of care will • MEDInnovations (TC3) - is a suite of loss control and
dramatically reduce the overall cost of the plan. decision support capabilities that will improve the
management of medical risk. MEDInnovations works in the
• The Medical Advocate Program (MAP) - will assist following arenas to improve cost outcomes for employer
employees in receiving the highest quality and the most groups.
efficient health care available. With a simple phone call, ⇒ Integrated Fraud & Abuse / Detection & Prevention
the program uses an advocate nurse to guide and coach Suite
employees through their episode of care to the higher ◊ Provide Match Program
qualified physicians and the most cost effective facilities. ◊ Fraud Diagnostics
◊ Intelligent Fraud Analytics
For employers who want to reduce and manage their sm
◊ TruClaim Code Edit Compliance
medical costs, MAP provides a “transparent” solution ◊ Case File Investigations Unit
through an extensive data base that profiles the quality of ⇒ Re-pricing Optimizers
every specialist and the cost of every medical facility in the ◊ AccessPlus PPO
United States. ◊ Provider R&C Negotiations
• MEDai Predictive / Risk Analysis - is a prediction engine • MehraVista Health - specializes in solving employer’s
that applies the right combination of today’s technology to behavior health costs and productivity problems. They
correctly identify patients at risk and forecast future health offer a variety of custom designed products that allow you
plan costs. This technology allows an employer to be to choose the program best suited to your company’s
proactive in establishing proper programs that will manage needs.
and alleviate health conditions before they become a strain ⇒ Behavioral Health Benefits Management -
on healthcare costs. It will also identify gaps in care and assumes responsibility for all clinical and
immediately recognize those individuals with the greatest administrative aspects of behavioral health care.
impact potential from both a financial and a quality of life ⇒ Employer Assistance Program (EPA) - provides
perspective. education and prevention as well as early
intervention and solution-oriented counseling to
• TelaDoc Medical Services - is a national network of
employees with personal problems.
licensed, board certified primary care physicians offering
medical consultations via the telephone 24 hours a day, 7
days a week. TelaDoc consulting physicians treat illnesses
that arise quickly and tend to run a brief course, typically 5-
10 days. Consulting physicians address acute, episodic, self-
limited and minor illnesses as opposed to chronic
conditions such as hypertension, epilepsy or diabetes.
TelaDoc addresses three of the key challenges facing
4. What’s the bottom line on the bottom line? The Covenant CAST Risk Management Funnel of Savings
Are you looking for savings and security? Then you have come to the
right place. Our healthcare risk management programs will provide real
bottom line savings.
Based on our proven strategies, we can save you from 18% to 30% in
the first year of coverage. You can see it illustrated with our funnel of
savings. And this is not just a one-year proposition. Our strategies are
engineered to continually have a positive effect on your healthcare
budget year-after-year.
Lifestyle Management
Let the Covenant Services Group illustrate to you how we can provide
8% Savings 12% Savings
a positive impact to your healthcare program by reducing costs and
reducing the ever rising health care trend on your healthcare pro-
gram, while not sacrificing quality to your employees. MEDInnovations
MEDai
“Covenant…..More Than a Promise” 3% Savings 5% Savings
TelaDoc
On-Site Clinic
3% Savings 7% Savings
MehraVista
MARYLAND NORTH CAROLINA SOUTH CAROLINA VIRGINIA Health
Dean Holmes, CLU, RHU
Regional Sales Director 4% Savings 6% Savings
phone 919.605.9160
dholmes@covenantservicesgroup.com MAP
CORPORATE OFFICE
Covenant Services Group, LLC
1745 North Brown Road Suite 400
Lawrenceville, Georgia 30043
phone 678.258.8200 800.680.8728
fax 678.258.8298 18% - 30% Potential Claims Reduction
www.covenantservicesgroup.com