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MyHealthGuide
Newsletter Published weekly by MyHealthGuide, LLC (www.MyHealthGuide.com). This Newsletter is for personal, non-commercial use only. This weekly newsletter is FREE OF CHARGE to subscribers. Subscribe free. Send news, press releases and announcements to mailto:Info@MyHealthGuide.com. TABLE OF CONTENTS
Market Trends, Studies, Books & Opinions Legal, Legislative & Regulatory News
Increased Response and Survival in Ovarian Cancer Patients New Treatment, Cost Savings Ranged 10% to 62% Editorial Notes, Disclaimers & Disclosures AMPS Delivers 23.7% Average Savings for 2009 MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 6/1/2010, www.advancedpricing.com Atlanta, GA, June 2010 -- Advanced Medical Pricing Solutions (AMPS) announced this week that it's average annual savings rate on claims under management increased to 23.7% for the year ending December 2009.
"AMPS savings are in addition to PPO discounting so this increase is significant to us and our clients," said Mike Dendy, CEO/President of AMPS. "We are seeing an increasing number of payers abandon the practice of paying hospital bills with nothing more than a UB-92 in hand and the fact that AMPS has licensed physicians reviewing bills for accuracy has both increased the market's appetite for our product and the savings we help create", continued Dendy. A measurement of the scale of the medical billing problem was announced by the New York State Comptroller, Thomas DiNapoli, in December 2008 regarding medical bill overpayments. DiNapoli's office had recently overseen an audit of the system and turned up $1.8 billion in overpayments by the state of New York. The Federal Government launched the RAC audit program on behalf of Medicare in all 50 states last fall. The national expansion of this program came on the tail of a test program in three states that returned over $900 million in overpaid claims (mostly from hospitals) to the Medicare Trust Fund. "Businesses are more in-tune with healthcare cost containment measures than ever before", said Dendy. "The expansive public debate on health insurance reform earlier this year sensitized senior management to healthcare costs and to how their money is being managed. For too long now we have seen the private payer industry issue client monies to hospitals without a thorough investigation of what they are actually paying for. The data we have collected over the past six years shows conclusively that hospitals are overcharging for their services in a number of ways and payers and employers alike have a right and a fiduciary obligation to verify billing validity before payment is made", finished Dendy. AMPS recently announced the completion and deployment of its proprietary hospital pricing transparency and analysis model (TAM). AMPS' TAM system evaluates claims by comparing its clients' hospital billings against reasonable and customary fees for like services from similar facilities and by juxtaposing cost to charge ratios for hospital based events. AMPS generates the data base for the TAM system through both public and private sources including Medicare claims data (MedPAR and OPPS), hospital cost reports, and other files obtained from the federal Centers for Medicare and Medicaid Services (CMS). About AMPS Advanced Medical Pricing Solutions (AMPS), a privately held company, is working with clients across the U.S. to achieve accurate billing by hospitals for healthcare services provided. Founded in 1995, AMPS has offices in Atlanta, GA; and Phoenix, AR. Over the last five years AMPS' reviews have yielded an average cost savings on adjusted hospital claims of 19.75% (over and above PPO discounts). With an average size of claim reviewed of $52,500, this has yielded an average additional dollar reduction of $10,368 per claim. AMPS average success (hit) rate on claims greater than $15,000 reviewed is 88.5%. Contact Jim Delaney, COO, in Atlanta, GA at 678-528-3041 and visit www.advancedpricing.com. TriZetto and Milliman Care Guidelines Offer New Powerful Integrated Healthcare Tools MyHealthGuide Source: The TriZetto Group, Milliman, 5/20/2010, www.TriZetto.com, www.careguidelines.com and www.milliman.com SEATTLE -- Healthcare payors can now use Milliman's CareWebQI® interactive software tools within The TriZetto Group's CareAdvance Enterprise® 4.6 application. A newly developed interface embeds guideline-based decision-making in the CareAdvance application workflow. The interface goes beyond a simple integration of the evidence-based Milliman Care Guidelines® clinical content to seamlessly incorporate CareWebQI's consistent point-and-click care management, documentation of variances from best practice, guideline customization and more. The result is reporting on real-time client data that helps identify gaps in care, resource delays and other variances. The CareAdvance system also directly integrates content from the Chronic Care Guidelines product, giving TriZetto's clients a powerful tool to address the growing number of patients with challenging chronic conditions. As part of this strategic alliance partnership, TriZetto's CareAdvance application team worked closely with Milliman Care Guidelines clinical and software developers to create a certified interface that care management clinicians will find easy to use. The Milliman Care Guidelines Strategic Alliances team uses a structured integration certification program that certifies and supports CareWebQI interactive software and content integrations, ensuring overall quality and client satisfaction. This integration with TriZetto has achieved the "Certified Integration" designation. "The CareAdvance application integration with CareWebQI software provides TriZetto's customers with interactive access to evidence-based clinical guidelines, enabling timely support for nurses and ultimately members," said Jeffrey Rideout, M.D., TriZetto's Chief Medical Officer and Senior Vice President of Cost and Quality of Care. "Our combined solution can improve quality of care for our customers through timely access to relevant clinical guidance and can reduce cost through improved workflow for nurses." "This integration is part of our long-term strategy of tightly integrating the Care Guidelines content and interactive software with industry-leading workflow tools from our Strategic Alliance Partners," said Lynn Nemiccolo, Milliman Care Guidelines Vice President of Product Management. "Our long-standing strategic partnership with TriZetto led its CareAdvance team to design and build one of the best interfaces we've seen with Care Guidelines interactive software and content. Our mutual clients will get a lot of value from this integration," she added. About TriZetto Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry, with its technology touching half of the U.S. insured population. TriZetto's vision for the industry, Integrated Healthcare Management, is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The company's offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation. Visit www.TriZetto.com. About Milliman Care Guidelines Milliman Care Guidelines LLC, A Milliman Company, is located in Seattle, and independently develops and produces evidence-based clinical guidelines and software used by more than 1,700 clients, including more than 950 hospitals, seven of the eight largest US health plans, and 25 Centers for Medicare and Medicaid audit contractors. Covering the continuum of care, the seven-product Care Guidelines series is updated annually by an experienced team of clinicians and are used to support the care management of a majority of US health plan members. Visit www.careguidelines.com. About Milliman Milliman Care Guidelines is a wholly owned subsidiary of Milliman, Inc., which is among the world's largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson, the company now has 52 offices in key locations worldwide. Milliman employs more than 2,400 people. The firm has consulting practices in healthcare, employee benefits, property and casualty insurance, life insurance, and financial services. Milliman serves the full spectrum of business, financial, government, union, education, and nonprofit organizations. Visit www.milliman.com.
National Health Options
Creates First Private National Health Care Assistance Program for Employers; Includes
Free Pharmacy Discount Card
"We took more than
60 years of health insurance and human resources experience to
create the single best solution available anywhere in the country," says Lungen.
"Market receptivity is already palpable."
National Health Options is the nation's first membership-based, health care assistance program of its kind designed to offer a comprehensive, retail solution offering multiple options for accessing high quality, affordable health care products and services. Visit www.nationalhealthoptions.com. Sedgwick CMS Sale Transaction Completed with Stone Point Capital LLC and Hellman & Friedman LLC for $1.1 Billion MyHealthGuide Source: Sedgwick Claims Management Services, Inc. (Sedgwick CMS), 5/28/2010, www.sedgwickcms.com, www.stonepoint.com and www.hf.com Memphis, TN -- Sedgwick Claims Management Services, Inc. (Sedgwick CMS) reported the closing of the previously announced transaction whereby investment funds affiliated with Stone Point Capital LLC and Hellman & Friedman LLC, together with management, have acquired 100% ownership of Sedgwick Holdings, Inc. (Sedgwick) for $1.1 billion. Sedgwick is the sole shareholder of Sedgwick CMS, the largest independent North American provider of claims and productivity management solutions to corporate, institutional and association clients. "We have been very pleased by the response of all Sedgwick CMS stakeholders, especially our clients and colleagues, to this next stage of our company's development," said Sedgwick CMS President and Chief Executive Officer David A. North. "The arrangements and approvals for today's closing have proceeded smoothly as anticipated; and our organization's service teams have continued their uninterrupted focus on the delivery of highly responsive, cost-effective claims and productivity management solutions for Sedgwick CMS clients. About Sedgwick CMS Sedgwick Claims Management Services, Inc. is the leading North American provider of innovative claims and productivity management solutions. Sedgwick CMS and its affiliated companies deliver cost-effective claims administration, medical management, risk consulting and related services to clients through the expertise of 6,600 colleagues in a hundred and thirty offices in the U.S. and Canada. The company specializes in workers' compensation; disability, FMLA and other employee absence; and general, automobile and professional liability; and warranty and credit card claims services as well as Medicare compliance solutions. Sedgwick CMS and its affiliates design and implement customized programs based on proven practices that meet client needs. Visit www.sedgwickcms.com. About Hellman & Friedman Hellman & Friedman LLC is a leading private equity investment firm with offices in San Francisco, New York and London. Since its founding in 1984, Hellman & Friedman has raised over $25 billion of committed capital. The firm focuses on investing in superior business franchises and serving as a value-added partner to management in select industries including business services, insurance, financial services, software, internet and digital media, media, healthcare, energy and industrials. Representative investments in insurance services include Emdeon Business Services, SSP Holdings plc and Vertafore, Inc. Visit www.hf.com. About Stone Point Capital Stone Point Capital is a global private equity firm based in Greenwich, Connecticut. Stone Point serves as the manager of the Trident Funds, which have raised more than $10 billion in committed capital to make investments in the insurance, employee benefits and financial services industries. Stone Point has a 25-year record of making successful investments in the financial services industry, including in the insurance services sector. Visit www.stonepoint.com.
Industry Veteran, Dick Ridder, Passes
Editor: Dick Ridder, his wife, Mary Ann and son Kurt, have been pioneers in the self-funded industry designing and offering stop loss and other services with innovation, consistency and professionalism. Dick's knowledge, friendliness and supportive spirit will be missed greatly by all of us.
Mr. Richard L. Ridder Richard, "Dick" Ridder, 81 of Indianapolis, a much loved husband, father and grandfather passed away in his home Saturday, May 29, 2010. He is preceded in death by his son, Guy Ridder and his first wife, Rita (Palanca) Ridder. He is survived by his loving family: his wife of 26 years, Mary Ann (Dolatowski) Ridder; children Richard (Molly) Ridder; Kurt (Lisa) Ridder and Carolyn (Jack) Aspenson; grandchildren Allison and Sean Ridder, Kate and Hope Ridder, Erika, Morgan and Justin Aspenson and the children of his daughter in-law Molly; Sean, Kelly and Andrew Sullivan and Laura Shropshire. Born November 18, 1928 in Royal Center, Indiana he was the only child of Lowell Kistler and Carolyn Hall Ridder. An adventurer at heart, Dick left home while a teen, traveling the US with his best friend Gene Lottes. Together they experienced life in a way only young men could. During these times Dick worked odd jobs on the railroad and at one point lied about his age to work on a ship to Panama. He often talked of his teen years, remembering them fondly. Dick returned home, finished school and attended Indiana University until enlisting in the United States Army, where he spent many years moving up the ranks and serving our country with pride. He felt honored and humbled to be a part of the military and after earning the honor of Lieutenant Colonel, retired as a Major from the Indiana National Guard. As a professional, Dick worked in the insurance industry. In 1990, partnered with his wife, Mary Ann and son Kurt, he founded Spectrum Underwriting Managers, based in Indianapolis. Dick was instrumental in the success of Spectrum, retiring in 2001 but retaining his involvement as Chairman Emeritus. Through Dick had retired he often visited the employees and was well liked within the company. Dick continued his love of adventure after retirement, spending time overseas in England, France, Italy and other countries with Mary Ann and family. Though he enjoyed traveling, he most loved being at home in Indianapolis. He knew so much about his city many suggested he become a tour guide. A supporter of many causes, Dick was a staunch constitutional conservative. He felt honored and blessed to be a part of this country and did his part to support what he believed to be the core values America was built upon.
Dick was a man of honor who lit up a room with his sense of humor. He was often
the center of attention, telling stories and jokes and always making people smile.
Though he played the part of a curmudgeon, he was truly happy and enjoyed life to
the fullest. He had a spectacular way of telling a story and even though he may
have told the story before, it was never quite the same the next time. He felt it
was the small details that made stories much more exciting.
Symetra Names Tom Bittner Regional Vice President of Group Division MyHealthGuide Source: Symetra Life Insurance Company, 6/2/2010, visit www.symetra.com BELLEVUE, WA -- Symetra Life Insurance Company announced that Thomas E. Bittner has joined its Group division as regional vice president for the Western Region. Based in Los Angeles, Bittner will lead the sales teams located in Symetra's Seattle, San Diego, Austin and Dallas offices. Bittner brings to Symetra more than 20 years of experience in the employee benefits market. Most recently, he served as head of sales for Aetna's Western Region. In that role, he significantly grew the territory's book of business while implementing successful sales processes and training programs for his staff. "By leveraging his extensive background and field experience, Tom will continue building business with our existing relationships while looking for new opportunities to expand our medical stop-loss sales," said Rick Lyons, vice president, Symetra Group Distribution. Prior to Aetna, Bittner was a benefits consultant at The Segal Company and an employee benefits broker with Arthur J. Gallagher. He began his career selling healthcare alliances to small business owners. About Symetra Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation (NYSE: SYA), a diversified financial services company based in Bellevue, Wash. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent agents and advisors. Visit www.symetra.com. Cypress Benefit Administrators Adds Sharon Jones, Brian Bergman and Promotes Justin Horn MyHealthGuide Source: Cypress Benefit Administrators, 6/1/2010, www.cypressbenefit.com Omaha, NE -- Cypress Benefit Administrators, Omaha branch, has announced the addition of two new employees -- Sharon Jones and Brian Bergman -- along with the recent promotion of Justin Horn within the company. Sharon Jones, Operations Manager Sharon Jones has been appointed Operations Manager. She will be responsible for overall direction of the Cypress Omaha operations, including the claims department, provider relations, customer service and support services. Jones brings over 30 years of claims management experience to Cypress, and is licensed in multiple insurance lines. Brian Bergman, Account Executive Brian Bergman has been hired as an Account Executive. His responsibilities will include service to Cypress' large employer accounts in the Omaha area, installation of new business, broker relations and consulting services. Bergman has more than 20 years of large group, self-funded client management and is a licensed insurance consultant. Justin Horn, Director of Sales and Service Justin Horn, with Cypress since 2008, has been recently promoted to Director of Sales and Service at Cypress. In his new role, he will be responsible for the overall strategic direction at the Omaha office, to include establishing and enhancing broker and consultant relationships, securing new client/business relationships and also maintaining a superior value proposition through the management of the account executive staff. About Cypress Benefit Administrators Since starting business in 2000, Cypress Benefit Administrators, a privately held company, has become more than a third party administrator (TPA). Cypress has been pioneering the way toward cost containment in healthcare as the country's first TPA to bring claims administration, consumer driven health plans and proven cost control measures together in one package. Cypress' customized employee benefit packages combine the right mix of health insurance options that allow for adaptability to the ever-changing healthcare environment that makes sense for employers of 25 to 18,000 throughout the United States. Cypress Benefit Administrators lead by experience. On average, the Cypress Management team has at least 20 years of experience while claims analysts bring over 13 years to the job. Cypress has over 70 employees serving members in 39 states. Contact Tom Doney, President, Cypress Benefit Administrators, (920) 968-4613 or tomd@cypressbenefit.com and visit www.cypressbenefit.com. Sedgwick CMS Appoints Jason Hood as EVP and Chief Legal Officer MyHealthGuide Source: Sedgwick Claims Management Services, Inc. (Sedgwick CMS), 6/2/2010, www.sedgwickcms.com Memphis, TN -- Sedgwick Claims Management Services, Inc. (Sedgwick CMS), North America's largest independent provider of claims and productivity management solutions, announces the recent appointment of Jason P. Hood as executive vice president and chief legal officer. As CLO, Hood is the company's senior attorney with strategic and management responsibility for all legal and compliance matters of the firm. He is also a member of the Sedgwick CMS Executive Committee. Prior to joining Sedgwick CMS, Hood was vice president, general counsel and secretary for Wright Medical Group, Inc., a publicly-held global manufacturer of medical devices. He began his legal career in private practice with Glankler Brown PLLC in Memphis, and was an attorney with an international employee benefits consulting firm before joining Wright Medical. Hood is a member of the American, Tennessee, and Memphis Bar Associations, the Association of Corporate Counsel, the Defense Research Institute, and the Society for Corporate Secretaries and Governance Professionals. He is a graduate of the University of Tennessee College of Law and Rhodes College. "Jason Hood brings great experience in providing leadership and legal counsel to growing companies in complex environments," said David A. North, president and chief executive officer of Sedgwick CMS. "His background in litigation, compliance, corporate governance, contract negotiation, human resources and financial transactions adds depth and scope to our highly qualified Sedgwick CMS legal team. We look forward to his contributions to the continued success of Sedgwick CMS." About Sedgwick CMS Sedgwick Claims Management Services, Inc. is the leading North American provider of innovative claims and productivity management solutions. Sedgwick CMS and its affiliated companies deliver cost-effective claims administration, medical management, risk consulting and related services to clients through the expertise of 6,500 colleagues in a hundred and fifty offices and service locations in the U.S. and Canada. The company specializes in workers' compensation; disability, FMLA and other employee absence; and general, automobile and professional liability; and warranty and credit card claims services as well as Medicare compliance solutions. Sedgwick CMS and its affiliates design and implement customized programs based on proven practices that meet client needs. Visit www.sedgwickcms.com. Market Trends, Studies, Books & Opinions Average Family Medical Costs $18,074 MyHealthGuide Source: Milliman, 5/11/2010, www.milliman.com Seattle -- Milliman, Inc., one of the premier global consulting and actuarial firms, announced that average total medical spending for its "typical American family of four" reached $18,074, an increase of $1,303 over last year. The total-dollar increase is the highest in the history of this study. The Milliman Medical Index (MMI) tracks the changes in average yearly healthcare costs when the family of four is covered by an employer-sponsored preferred provider organization (PP0). The Milliman study provides not only a total cost number for this family but also the share of costs between employers and employees. It also tracks cost differences among 14 metropolitan areas. "This year's MMI offers an interesting example of that old axiom, 'the more things change, the more they stay the same," said study co-author Lorraine Mayne, Milliman principal and consulting actuary. "The cost of group insurance continues to increase at a historically-consistent pace, even with reform now the law of the land. While there will be short-term cost implications, especially for particular employees and certain employers, this year reflects a continuation of the prevailing cost trends." "Most employers have held off making significant changes while they awaited detail on healthcare reform," said MMI co-author Ron Cornwell, Milliman principal and consulting actuary. "Most of the decisions that determine 2010 plan costs were made in an environment of great uncertainty as employers awaited the conclusion of the reform debate. Many of this year's cost drivers, including the share of employer and employee cost increases, reflect historical trends." "The economic environment, and particularly the high rate of unemployment, also has implications for healthcare costs," said MMI co-author Chris Girod, Milliman principal and consulting actuary. "When employees are laid off, there are also cost ramifications for the remaining employees." Medical costs for a family are determined by the number, type, and cost of healthcare services that they utilize and the amounts that the employee's health plan pays medical providers for these services. Utilization of medical services for a particular family varies significantly based on the family's ages, geographic area, health status, and other factors. The difference between the least-expensive and most-expensive cities in our study is 37%. Among the 14 metropolitan areas Milliman annually studies, three cities--Miami, New York, and Chicago--now exceed the $20,000 per-family mark. Phoenix is the least-expensive city in this study with a per-family cost of $16,071. About Milliman's MMI The MMI is based on Milliman's analysis of historical claim data and understanding of trends in utilization and cost. The complete Milliman Medical Index is available at www.milliman.com, or by calling Lorraine Mayne at 801.924.1390 or Jeremy Engdahl-Johnson at 646.473.3021. About Milliman Milliman is among the world's largest independent actuarial and consulting firms. Founded in Seattle in 1947 as Milliman & Robertson. the company currently has 52 offices in key locations worldwide. Milliman employs more than 2.400 people. The firm has consulting practices in healthcare. employee benefits. property & casualty insurance, life insurance and financial services. Milliman serves the full spectrum of business, financial, government, union. education and nonprofit organizations. Visit www.milliman.com. Legal, Legislative & Regulatory News SIIA Meets With DOL Officials Regarding Self-Insurance Study MyHealthGuide Source: Self-Insurance Institute of America, Inc. (SIIA), 6/2/2010, www.SIIA.org Washington, DC -- A SIIA delegation met yesterday in Washington, DC with Phyllis Borzi, assistant secretary of labor and other key DOL officials to discuss the development of a report on self-insured group health plans mandated by the recently-passed Patient Protection and Affordable Care Act. The objective of the meeting was to secure an opportunity for SIIA to consult with the DOL regarding the development of the report to ensure that self-insurance plans are accurately portrayed. Ms. Borzi indicated that SIIA's assistance could be useful. "We are very pleased that the DOL was receptive to our offer of assistance and we look forward to working with them over the coming weeks and months," said SIIA Chief Operating Officer Mike Ferguson. The meeting was prompted by the requirement of the PPACA that the DOL must access information about self-insurance from the Annual Return/Report of Employee Benefit Plan - Form 5500. The initial report is scheduled to be released in March of 2011. "Data included in this report is extremely narrow and does not provide a complete picture of the financial stability of many self-insured plans," Ferguson said. "We were encouraged that DOL personnel agreed that without broadening its view, the report could suffer from significant gaps in key information and paint an inaccurate portrait of self-insurance." Additional member communications on this subject will follow on an ongoing basis. SIIA is also working to assure the accuracy of another report - this by the Department of Health and Human Services (HHS) - that will survey the group health benefits market and compare self-insurance with other forms of coverage. Yesterday's meeting illustrates the critical role SIIA continues to play in representing the interests of its members as the health care regulatory environment continues to evolve. About SIIA The Self-Insurance Institute of America, Inc. (SIIA) is a dynamic, member-based association dedicated to protecting and promoting the business interests of companies involved in the self-insurance/alternative risk transfer (ART) industry, both domestically and internationally. Visit www.SIIA.org. Texas Supreme Court Denies Review of Stop-Loss Case MyHealthGuide Source: StreetInsider.com, 6/2/2010, StreetInsider Article AUSTIN, TX -- The Texas Supreme Court has declined to review a case involving the amount some hospitals marked up workers' compensation-related bills under rules in effect until 2008. "Texas employers realized a great victory today," Mary Barrow Nichols, general counsel and senior vice president for Texas Mutual, said. "A small number of hospitals were marking up a $4,000 item to $40,000 or more, or they'd turn a two-day admission into a $120,000 bill. These inflated charges could have cost the system hundreds of millions of dollars and continued to affect the workers' compensation premiums of every Texas employer." The interpretation issue in this case between Texas Mutual and Vista Medical Center affects any remaining fee disputes under the stop-loss exception to the now-repealed rule. Hospitals that treat workers' compensation patients in Texas are reimbursed under the state's workers' compensation in-patient fee schedule. The 1997 fee schedule, which was repealed in 2008, included a stop-loss exception. Under the stop-loss exception, hospitals could be paid more than the fee schedule if they met certain criteria. The dispute between Texas Mutual and Vista centered on those criteria. Texas Mutual argued that the stop-loss exception should be applied to admissions involving charges of more than $40,000 and "unusually extensive services." Vista countered that the exception applied to all admissions for which they charged more than $40,000. The 353rd Judicial District Court of Travis County ruled for Vista. Texas Mutual appealed to the Austin Court of Appeals, which reversed the lower court. Vista then asked the Supreme Court to review the case. About Texas Mutual Insurance Company Austin-based Texas Mutual Insurance Company is the state's leading provider of workers' compensation insurance, with approximately 29% of the market. Since 1991, the company has provided a stable, competitively priced source of workers' comp insurance for all Texas employers. Preventing workplace accidents and minimizing their consequences is a major part of Texas Mutual's mission. Visit www.texasmutual.com.
DOL Urges U.S. Supreme Court to
Not Review ERISA / Golden Gate Restaurant Case
Case: Golden Gate Restaurant Association v. City and County of San Francisco, California, et al. In October 2009, the U.S. Supreme Court delayed action on employer fees in San Francisco's groundbreaking health care program to seek advice from the Obama administration.
Obama's administration has been noticeably quiet during the legal fight over San
Francisco's program, but has now urges the Supreme Court to not review the ERISA
case which requires companies with more than 20 employees to provide health insurance
benefits or pay fees that cover the employees' health care at city hospitals and
clinics. DOL Advises, 'Premature to Proceed' ...In light of the new federal legislation, the Department of Labor has concluded that, at present, it would be premature to proceed with regulatory action. In the unlikely event that additional state or local governments choose to enact health care spending requirements like the [San Francisco program], the Department might reconsider whether the preemption issue has sufficient ongoing significance to warrant administrative action to address it. . . . The preemption issue does not warrant this Court's review at this time for the same reasons that the Department of Labor has determined not to take regulatory action on the issue at this time." ...The preemption issue does not warrant this Courts review at this time for the same reasons that the Department of Labor has determined not to take regulatory action on the issue at this time.
... the new federal health care legislation contains numerous provisions designed
to promote broader access to health care coverage. Those provisions include an employer
shared responsibility provision that imposes assessments on employers with 50 or
more fulltime equivalent employees that do not provide health insurance to their
employees if any full-time employee receives a premium tax credit in new health
insurance exchanges.
Increased Response and Survival in Ovarian Cancer Patients New Treatment, Cost Savings Ranged 10% to 62% MyHealthGuide Source:
Nashville, TN -- DiaTech Oncology announced the American Society of Cancer Oncology (ASCO) has published the results of a comprehensive study to determine the effectiveness of the Microculture Kinetic (MiCK) assay for apoptosis in predicting increased response and survival rates for ovarian cancer patients. In the MiCK assay, the tumor cells of an individual patient are exposed to multiple doses of several chemotherapeutic drugs either as single drugs or in combinations. A sophisticated algorithm is used to monitor and compute the amounts of apoptosis caused by each of the drugs to establish a drug sensitivity profile of the patient's tumor cells. Knowledge of a patient's drug sensitivity profile allows the treating oncologists to prescribe chemotherapy that would be the most effective against the tumor cells of that patient.
The study followed 48,927 employees and 3.5 years claims data on all patients with
diagnoses of CA lung, breast, colon or ovary. Analysis of average Rx costs was made
based upon total CT usage, Rx of selected PTs including therapeutic drug administration
(admin), CT admin, supportive care (SC) drugs, CT drugs, biotherapy (BT) drugs,
growth factors, home infusion costs, and cost of the MiCK assay.
"The impressive and statistically significant survival and response data in this study show that the DiaTech MiCK assay can be an effective tool for oncologists in determining the best chemotherapy treatment for a cancer patient," said Dr. Emery Salom, Chief Dept of OB/GYN Palmetto General Hospital, Assistant Professor Florida International University, Herbert Wertheim College of Medicine. "It is also important to note the data provided guidance on generic drug use and single vs combination therapies," said Dr. Cary Presant, Medical Director DiaTech Oncology, Professor of Medicine, University of Southern California, "This is good news for ovarian cancer patients and is clearly a major step to provide more effective personalized care, and often less expensive and less toxic treatment of cancer patients." "We are able to arm the physician with effective tools capable of eliminating a patient's cancer cells or keeping tumor cells under effective control. This technology helps physicians prolong their patient's life. Other studies we have completed clearly demonstrate the MiCK assay works in all cancers and we are in discussion with several large insurers to obtain reimbursement approvals and make sure this technology becomes available to patients", said Garry Latimer, DiaTech CEO and Founder. About DiaTech Oncology DiaTech Oncology is a privately held clinical pathology laboratory working to help oncologists and their patients deal with the devastating effects of cancer. DiaTech utilizes a patented technology called the Microculture Kinetic (MiCK) assay. The MiCK assay is the only test available that measures the chemotherapeutic drug effect for a specific patient, both kinetically and accurately. Call 866-556-5356, email info@diatech-oncology.com and visit www.diatech-oncology.com. Standard Stop-Loss Employer Disclosure Form Endorsed MyHealthGuide Source: Self-Insurance Institute of America (SIIA, www.SIIA.org), Society of Professional Benefit Administrators (SPBA, www.SPBATPA.org), Recurring article Self-Insurance Institute of America ( www.SIIA.org ) and Society of Professional Benefit Administrators ( www.SPBATPA.org ) have endorsed a standardized stop-loss disclosure form, which also includes ICD-9 codes. The documents are intended to help facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting. Stop-Loss Carriers and MGUs Adopt the Standardized Form The list below represents an estimated $3.3 Billion in Stop-Loss premium. Assuming a medical self-funded community Stop-Loss market of $4 Billion, then over 80% of the market has adopted the form. If you are a Stop-Loss carrier or MGU that has adopted the standard disclosure form, please let us know at Info@MyHealthGuide.com.
Latest Survey Results Recommending Adoption Respondents from the self-funded community have voted 86% in favor of adoption of the standard form for Stop-Loss disclosure. For all survey results, see www.MyHealthGuide.com/disclosures.htm. Standard Form Adoption May Not Mean Standardization While surveyed members (n=112) from the self-funded community voted 86% in favor of adoption of the standard form for Stop-Loss disclosure and a majority of the Stop-Loss market has adopted the form, complete st standardization is still a goal. LaRea Albert of Health First TPA (Tyler, TX ) complains, "The Standard Stop-Loss Employer Disclosure Form is not standard, we are getting a different standard from various MGUs and carriers." Another colleague at Health First, said, "Each Stop-Loss source requires enough 'extras' that Health First concludes the form should not be called, "Standard."
"These comments show that, at least down at the operating level, many underwriters and their managers 'do not get it'!
If the form is 'approved', but insist on the unique information carrier by carrier, then that's not accepting the standard, " says John Lord, Vice President-Specialty Zurich Specialty Health, and a member of the Industry Study Group which developed the Standard Disclosure
Form. "Clearly we have work to do to get the message out to all the right people." The following draft documents may be downloaded and viewed at www.myhealthguide.com/disclosures.htm.
About Employer Disclosure The Employer Disclosure, required by most Stop-Loss carriers and MGUs, has grown in sophistication and use. Today, most Stop-Loss sources require an employer disclosure before a new or renewal quote is offered. Ideally, the Employer Disclosure lists all known high cost claims, claims that have exceed a given dollar threshold, or patient/employees with certain diagnoses. Failure to disclose these individuals can later lead to claim denials. For the past several years, an industry study group has worked on "standardizing" the reporting process with the objective that all insurers would come to accept the reporting system/form as an industry standard.
June 7-9, 2010
June 7-9, 2010
June 8-9, 2010
June 9-11, 2010
June 10-11, 2010
June 15, 2010
June 15-16, June 15-16, 2010
July 20-21, 2010
June 22, 2010
June 28-30, 2010
June
30, 2010
July 19-21, 2010
July 20-21, 2010 July 21-23, 2010 TPA University presented by The Health Care Administrators Association (HCAA). Three-day annual event offers in-depth discussion and analysis of key industry issues offers the most comprehensive view of a single trend or issue within third party administration. Keynotes are the most informative in the industry and networking opportunities are ranked high among members. Westin Tabor Center, Denver, CO. Information and registration: http://hcaa.org/tpauniversity.html.
August 16-19, 2010
September 13-14, 2010
September 13-14, 2010
September 15-16, 2010
September 20-22, 2010
October 6-8, 2010
October 12-15, 2010
October 17-20, 2010
October 20-22, 2010
October 25-26, 2010 November 8-11, 2010iWEDI 2010 Fall Conference. Hyatt Regency Reston, Reston, Virginia. www.wedi.orgwww.wedi.org
November 14-17, 2010
January 31-February 1, 2011 Editorial Notes, Disclaimers & Disclosures
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