AU News
3/8/2010

TABLE OF CONTENTS

General & Company News

ING Employee Benefits Introduces CAP IT^SM Program To Manage and Stabilize Stop Loss Cost

HealthNow New York Announces HealthNow Administrative Services (HNAS)

AMPS Introduces PEPM Program with Guaranteed ROI and Payer Indemnification

Eldorado's Alliance with PMCS Enables Payers & Providers to Enhance Benefits & Savings

Emdeon Introduces Mobile Application for Healthcare Claim Reporting Software

Novia CareClinics Raises $1 Million for On-site Clinics

Walgreen Combines Pharmacy, Health, Wellness Units

INTERLINK Adds Henry Ford Hospital to 'Centers of Excellence'

Claimsnet.com Reports Fiscal Year 2009 Results Showing 6% Growth in Annual Revenue

People News

MedSolutions Names Alan Henry, MD, as Chief Medical Officer of Premerus

CIGNA LifeSOURCE Adds Patty Hunt as Account Manager

Allviant Appoints Worksite Wellness and Health Promotion Expert Steve Giardini to Advisory Board

Market Trends, Studies, Books & Opinions

Medical Tourism Can Generate 20% to 80% Savings for Self-Funded Employers

Health Reform Insights &Talking Points - Dem vs Dem

Legal, Legislative & Regulatory News

DOL's Employee Benefits Security Administration (EBSA) Announces $1.36 Billion in Penalties, Recoveries and More -- Targeting Techniques and Criteria

Medical News

Aspirin Does Not Reduce Cardiovascular Events for Individuals with Low Ankle Brachial Index

Resources

Standard Stop-Loss Employer Disclosure Form Endorsed

Upcoming Conferences

Editorial Notes, Disclaimers & Disclosures

General & Company News

ING Employee Benefits Introduces CAP IT^SM Program To Manage and Stabilize Stop Loss Cost

MyHealthGuide Source: ING, 3/2/2010, www.ing-usa.com

The majority of benefit managers rank finding a solution for the ever increasing costs of medical insurance as a top priority. Self funding continues to be a popular alternative for plan sponsors to meet their employees' health care needs and realize the many advantages it brings.

ING Employee Benefits has developed CAP IT^SM, a program aimed at helping manage and stabilize the cost of Stop Loss insurance. To be eligible for this offer, clients need to package their Stop Loss with Basic and/or Supplemental Term Life Insurance. Clients will receive the benefit of packaging both these coverages with an industry leading carrier with more than 100 years of combined experience in these lines of coverage. In exchange for packaging, clients will receive a pre-set renewal rate cap on their Stop Loss coverage and no new lasers. The rate cap is determined at the inception of the policy based on the Specific Stop Loss deductible and lifetime maximum. 

"One of the main concerns for employers that purchase Specific Stop Loss is that they will be subject to very large renewal rate increases," said Mark McCarville, VP & Actuary at ING Employee Benefits. "Or worse, they'll have an ongoing critically ill claimant who could severely impact their benefit insurance fund. CAP IT mitigates this concern with very competitive renewal caps, ranging from 24-35%, and our promise to not add new lasers at renewal."

If you would like additional information about CAP IT, please contact Kristin Bordwell at (612) 372-5319 or kristin.bordwell@us.ing.com.

About ING Employee Benefits

For more than 80 years, ING Employee Benefits has offered traditional group insurance benefits as well as voluntary insurance products and retirement programs, all conveniently delivered at the worksite including Stop Loss, Group Annual Term Life, and more.  Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY).  Visit www.ing-usa.com/us/businesses/employeebenefits/index.htm.

About ING

ING is a global financial institution of Dutch origin offering banking, investments, life insurance, and retirement services to over 85 million residential, corporate and institutional clients in more than 40 countries. With a diverse workforce of about 115,000 people, ING is dedicated to setting the standard in helping our clients manage their financial future.  

In the U.S., the ING (NYSE: ING) family of companies offers a comprehensive array of financial services to retail and institutional clients, which includes life insurance, retirement plans, mutual funds, managed accounts, alternative investments, direct banking, institutional investment management, annuities, employee benefits, and financial planning. ING holds top-tier rankings in key U.S. markets and serves nearly 30 million customers across the nation. Visit www.ing.com/us.

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HealthNow New York Announces HealthNow Administrative Services (HNAS)

MyHealthGuide Source: HealthNow New York, Inc., 3/2/2010, www.hnas.com and www.healthnowny.com

BUFFALO, NY -- HealthNow New York, Inc., one of the Northeast's leading health insurance and employee benefits companies, has announced a national expansion through a newly-formed subsidiary, HealthNow Administrative Services (HNAS).

The subsidiary is an administrative and outsourcing services company specializing in self-funded benefit plans targeting mid to large employer groups (100 to 1,000-plus employees), brokers, and agents. Additionally, HNAS' will partner with smaller third party administrators, providing the man power, claims operations and technology infrastructure they need to remain competitive in today's marketplace.

The focus of HNAS responds to the struggling economy and the strong trend of employers searching for options beyond traditional insurance. Employer groups want the flexibility to tailor benefit plans to directly meet their needs and their employees' needs, while having more control of the costs. These organizations are willing to self-insure and underwriting the risk while outsourcing the back office operations of managing claims processing, provider networks, utilization review or membership functions. Self-insured enrollments grew, across the insurance industry, from 44% in 1999 to 57% in 2009. As of December 2008, self-insured membership was a significant portion of membership in nine of the top 10 health plans.

"At HealthNow New York, we continue to seek and drive sustainable growth initiatives while exploring options to position this organization for its long-term future," said Alphonso O'Neil-White, president & CEO of HealthNow New York Inc. "Many internal and external forces are changing the shape of this industry. Those organizations who not only adapt but continually look to ways to reinvent themselves will survive. HNAS is one element to our continued evolution."

While HNAS will continue to foster current broker and client relations across the Northeastern U.S., specifically in the New England and Mid-Atlantic regions, HNAS has begun marketing employee benefit products and services across the country.

While its home base will be King of Prussia, Pa., a sales and client administration office has been established in Dallas, Texas targeting the southwest. HNAS sales forces are now located in Phoenix, Ariz., and Boston, Mass., to assist in nationwide service.

HNAS complements HealthNow's existing brokerage strength secured through its 2006 acquisition of Brokerage Concepts Inc. (BCI). BCI will continue to serve as a leading group benefit and individual brokerage firm, operating regionally and headquartered in King of Prussia, Pa., with offices located in the northeast corridor.

"HealthNow has made a substantial commitment to HNAS with clear goals for both its short and long-term future," said Lawrence Thompson, HealthNow senior vice president of Large/ Administrative Services Only Accounts. "We are investing in people, infrastructure and technology to enable the organization to compete head-to-head on a national level. We anticipate that the majority of HealthNow's new membership growth in 2010 will be attributed to the success and leverage of HNAS."

According to Thompson, indicators show the self-insured segment will continue its significant growth in 2010 as health care costs keep on rising, taxes continue to increase, revenue and investments decrease and employers are forced to lower their costs. Employee benefits costs run second to compensation expense.

"As a subsidiary of HealthNow New York, HNAS has access to resources and the capacity to provide superior administrative and outsourcing services that deliver integrated and creative benefit solutions," Thompson said. "HNAS combines strength, knowledge and expertise with plan flexibility to provide brokers and clients across the U.S. with a seamless, comprehensive resource for planning and implementing group benefit products and administrative services."

About HealthNow New York Inc.

HealthNow New York is one of New York State's leading health care companies serving members across upstate New York. Headquartered in Buffalo, NY, HealthNow does business as BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, HealthNow New York, Brokerage Concepts Inc. and HealthNow Administrative Services. In 2008, company revenues grew to more than $2.27 billion.  

As a subsidiary of HealthNow New York, Inc., HealthNow Administrative Services provides administrative and outsourcing services, while delivering innovative strategies to meet any group benefit plan objective.  Visit www.hnas.com.

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AMPS Introduces PEPM Program with Guaranteed ROI and Payer Indemnification

MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 3/4/2010, www.advancedpricing.com

Atlanta, GA -- Advanced Medical Pricing Solutions (AMPS) recently introduced a new per-employee/per-month (PE/PM) pricing program whereby they provide a guaranteed return on investment to employer groups of their TPA/payer clients. AMPS, a privately held company, is working with clients across the U.S. to achieve accurate billing by hospitals for healthcare services provided.

"AMPS is a cost containment company and a PE/PM pricing model lends itself just as readily to our efforts as the typical percentage-of-savings model," said Mike Dendy, CEO/President of AMPS. "Because of our physician driven audit and review model and our indemnification benefit, we feel confident enough in our outcomes to guarantee an outstanding return on investment to the employer group clients who work with our TPAs," continued Dendy.

AMPS audits are managed exclusively by licensed medical doctors who perform a line-by-line analysis of every claim submitted for review. AMPS announced in fall 2009 that the company added indemnification that protects all members of the payer group from loss due to AMPS'  audit and review efforts.

"We have consistently found errors in 89% of the medical bills we have reviewed and we have achieved an 18% + average billing reduction over the last four years. This accomplishment is remarkable relative to our industry because the great majority of the claims we review are in- network billings," said Dendy. "Payers are beginning to realize that the clauses in PPO  contracts that suggest that a bill can't be audited are both self serving and potentially illegal when hospital billings represent such a huge percentage of any payers cost mix. Further, recent court rulings are pointing to the fact that payers have a fiduciary obligation to protect a plan's assets and no one can rightfully assert that such has taken place without a rigorous review of hospital bills."

A story on ABC Good Morning America on April 7, 2009 defined the scope of the medical billing issue, stating that 80% of all medical bills have errors. The origins of these errors include: mismatches - drugs that appear on a medical bill, even though they weren't listed in the medical records; double charges - the same procedure billed twice, though it occurred only once in the patient's care program; and, inflated charges: charging exorbitant fees for modestly priced items, which could be everything from aspirin to a prosthesis.

A measurement of the scale of the medical billing problem is the announcement by the New York State Comptroller, Thomas DiNapoli, in December 2008 regarding medical bill overpayments. DiNapoli came out with a statement that the system New York has been using isn't working. The Comptroller's office had recently overseen an audit of the system and turned up $1.8 billion in overpayments. That is only one state.

About AMPS

Founded in 1995, AMPS now has offices in Atlanta, GA; Chattanooga , TN; and Phoenix, AR. AMPS' reviews have yielded an average cost savings on adjusted hospital claims of 19.55% (over and above PPO discounts). With an average size of claim reviewed of $51,365, this has yielded an average additional dollar reduction of $10,041 per claim. AMPS average success (hit) rate on claims greater than $15,000 reviewed is 90.5%.

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. 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).  Call Jim Delaney, COO, in Atlanta, GA at 678-528-3041 and visit www.advancedpricing.com.

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Eldorado's Alliance with PMCS Enables Payers & Providers to Enhance Benefits & Savings

MyHealthGuide Source: Eldorado Computing, Inc. (ELDORADO), 3/2/2010, www.eldoinc.com,  www.eldocomp.com and www.pmcsonline.com

Phoenix, AZ -- Eldorado Computing, Inc., an MphasiS Company and a leading provider of health benefit and claims management platforms, announced the integration of its Javelina and HEALTHpac platforms with Preferred Medical Claim Solutions' (PMCS) Preferred Data Interchange (PDI) system. This integration will provide Eldorado's health plan, third party administrator (TPA), insurance carrier, self-insured clients and their members the ability to reduce the cost of "out of network" healthcare services.

"Traditionally, approximately 10-20% of medical claim dollars fall outside the primary care network," stated Paul F. Caliendo, President and Chief Executive Officer of PMCS. The integration with Javelina, Eldorado's innovative, next generation, browser-based platform, as well as its HEALTHpac system, automatically identifies and then sends "out of network" claims to PMCS during the adjudication process. "All upfront costs have been absorbed by PMCS and Eldorado. In 2009 PMCS' success rate exceeded 72% of the claim dollars we received, and we reduced our clients' allowable billed charges by over 15%," continued Mr. Caliendo.

PMCS' Advance Funded Provider (AFP) program has the built in technology to permit PMCS to process, negotiate and remit the provider settlement on a timely basis, enabling Eldorado's clients to enhance their cost containment capabilities without altering their funding cycles. The program can also be instrumental in improving customer satisfaction and increasing member loyalty.

"We are pleased to offer our clients added cost containment value through our technology integration and alliance with PMCS," stated Tom Castleberry, Vice Chairman of ELDORADO.

About PMCS

Based in Scottsdale, AZ, Preferred Medical Claim Solutions (PMCS) assists all Payers, including insurance carriers, self-funded employers, patients, associations and members in reducing their cost of healthcare. PMCS partners with Third Party Administrators (TPAs), Administrative Services Only (ASOs) and Health Maintenance Organizations (HMOs) in the prompt settlement of medical bills with medical providers on a national basis. By utilizing our state-of-the-art custom electronic data interchanges and our direct provider agreements, PMCS' services are proven to efficiently reduce paperwork, eliminate disputes and reduce the cost of healthcare.  Visit www.pmcsonline.com.

About ELDORADO

Based in Phoenix, Ariz., Eldorado (Eldorado Computing, Inc.) specializes in health insurance application development, business process outsourcing (BPO) services, IT engineering and operational consulting. The company serves the full spectrum of organizations nationally and internationally engaged in managing health benefit plans including third party administrators (TPAs), health plans, employers and self-insured organizations. Together, Eldorado customers manage 5 million lives and handle 35 million claims annually. For more information, contact 602.604.3100 and visit www.eldoinc.com and www.eldocomp.com.

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Emdeon Introduces Mobile Application for Healthcare Claim Reporting Software

MyHealthGuide Source: Emdeon, Inc. (NYSE: EM), 3/1/2010, www.emdeon.com

NASHVILLE, TN -- Emdeon Inc., a leading provider of healthcare revenue and payment cycle management solutions, announced the introduction of a mobile application for its award winning medical claim management platform Emdeon Vision^SM. The Emdeon Vision Mobile application offers healthcare providers an on-the-go snapshot of their claims and related cash flow and is compatible with the iPhone®, Android™, Windows Mobile®, Palm® and many other "smart" portable devices.

Emdeon Vision for Claim Management is a web-based program that enables end-to-end visibility of healthcare claims from the point of submission to Emdeon through payer adjudication as well as fifteen months of historical claims data. It can be used in a standalone mode but may also be integrated with a number of leading physician office systems. Emdeon Vision for Claim Management is a simple yet powerful tool for day-to-day accounts receivable monitoring, error corrections and claim tracking. Interactive dashboard reporting also helps office staff and management analyze their claim rejections, including the top reasons for rejections.

Emdeon Vision Mobile is an extension of the web-based program and offers healthcare providers a quick glimpse into the claim management side of their practice from their portable handheld device. Physicians can identify trends or potential issues while monitoring their practice remotely via the mobile application.

"The Emdeon Vision Mobile application allows physicians to understand the potential issues or trends that might arise during the revenue cycle," said Philip Hardin, executive vice president of provider services for Emdeon. "We are proud to offer this convenient addition to Emdeon Vision to help healthcare providers monitor trends with payers, investigate high volume of rejection rates or inquire about claims requiring additional work."

About Emdeon

Emdeon is a leading provider of revenue and payment cycle management solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, its customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. Visit www.emdeon.com.

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MyHealthGuide Source:  MedCityNews, 2/22/2010, MedCityNews Article

INDIANAPOLIS, IN -- Novia CareClinics LLC has raised $1 million in debt for its on-site, employer-affiliated health clinics, according to a Securities and Exchange Commission filing.

The company says it operates 18 clinics for 16 employers and is in the process of opening up six new clinics for six different employers. Clients include Symmetry Medical Inc., a Warsaw, Ind.-based manufacturer of orthopedics devices and the government of Fishers, an Indianapolis suburb.

Client companies pay Novia a monthly per-employee charge, plus actual costs for clinic staffing, generic prescription drugs, lab tests and replacement supplies. Employees don't pay for the services or prescriptions obtained from the clinic.

A client company's employees and their dependents are typically eligible to obtain services at Novia's clinics, though the client company may choose to make others eligible, such as retirees or part-time workers. Novia says its clinics help employers lower costs by paying less for basic health services and improving employees' health.

Novia CareClinics was founded in 2005 and reported annual revenue between $1 million and $5 million, according to the regulatory document.

The company received a $1 million equity investment in June, according to another regulatory document.

About Novia CareClinics

Novia CareClinics, LLC is an Indiana limited liability company organized to conduct the business of creating and managing employer sponsored on-site clinics providing primary care health services to employees, their families, or others as designated by a sponsoring employer.  Visit www.noviacareclinics.com.

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Walgreen Combines Pharmacy, Health, Wellness Units

MyHealthGuide Source: Joanne Wojcik, 3/1/2010, Business Insurance Article

DEERFIELD, IL -- Walgreen Co. is restructuring its health care division sales force to provide employers, managed care organizations, pharmacy benefit managers and governmental clients one-stop shopping.

Under the realignment, Walgreen's health services division, which includes its pharmacy benefit manager services, specialty pharmacy services, medical campus pharmacies, long-term care pharmacy and home care services, will be combined with its pharmacy services division, which encompasses its retail operations.

The product offerings of the two divisions now will be made available through a single sales force operating as the pharmacy, health and wellness solutions division, which includes worksite and retail clinic operations.

The Deerfield, Ill.-based company also said Stanley B. Blaylock, Walgreen's senior vp and president of Walgreens Health Services, has decided to leave the company in April after a transition period.

Mr. Blaylock was a co-founder and CEO of Medmark Specialty Pharmacy Solutions before Walgreen acquired it in 2006. He plans to pursue new entrepreneurial opportunities in the health care field, the company said in a statement.

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INTERLINK Adds Henry Ford Hospital to 'Centers of Excellence'

MyHealthGuide Source: INTERLINK, 3/2/2010, www.interlinkhealth.com

Hillsboro, OR -- INTERLINK's Quality Assurance and Contracting Teams are pleased to announce the addition of the Henry Ford Hospital as a provider in full standing in the INTERLINK Transplant Network. This relationship completes INTERLINK's current contracting initiative for the large 14 state Central Region of the United States. INTERLINK announced the completion of the NE Region three weeks ago, and with two new contracts effective in March and April, regional completion announcements for both the Western and Atlantic Regions are planned in the near future.

"With the large number of INTERLINK clients and transplant activity occurring within the Central Region, finalizing our strategy and ensuring we had the right mix of centers and programs available was critical to our success" said John Van Dyke, INTERLINK's CEO. INTERLINK's average billed transplant charges for some of the most common transplant types dropped again in 2009 and they attribute this success to their relentless pursuit of the good outcome transplant program. The liver program at Henry Ford Hospital has been in existence for 21 years and serves as a primary transplant program in the area providing 1,082 liver transplants in total and about 100 annually.

"It is counter-intuitive to think that the addition of one center and one program could complete an entire regional strategy, but from this point forward, INTERLINK contracting will be making program level changes in this region as determined appropriate by our Quality Assurance Committee" according to Scott Ray, INTERLINK's Senior Vice President overseeing network contracting. To view INTERLINK's complete network click here or to view the composition of INTERLINK's Central Region strategy click here.

About INTERLINK Health Services, Inc.

INTERLINK is a privately held corporation based in Hillsboro, Oregon. INTERLINK was formed in 1995 and severed its first 8 years as a marketing and client service organization for another national Centers of Excellence network. In 2003 INTERLINK began creating its own a quality based transplant network for its clients, which is now near complete. INTERLINK is known for its regimental approach to quality assurance for transplant care, its unmatched claims processing and industry leading education programs. INTERLINK is the transplant network for over 20,000,000 members nationally and considered a leader in the niche transplant Centers of Excellent network industry.  Call 800-599-9119 and visit www.interlinkhealth.com.

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Claimsnet.com Reports Fiscal Year 2009 Results Showing 6% Growth in Annual Revenue

MyHealthGuide Source: Claimsnet.com (OTCBB: CLAI.OB), 3/4/2010, www.Claimsnet.com

DALLAS -- Claimsnet.com inc., a leading provider of Internet-based business-to-business solutions for the healthcare industry, reported its results for fiscal year 2009 and fourth quarter of 2009, which ended December 31, 2009.

Financial Highlights

• For the year ended December 31, 2009, the Company reported revenues of $2,207,000, a 6% increase from the $2,080,000 reported for fiscal 2008.
• Cost of revenues for the 2009 fiscal year were $1,680,000 compared to $1,640,000 for the 2008 fiscal year, a 2% increase. Selling, general and administrative expenses of $854,000 were reported for 2009 compared to the $985,000 reported in fiscal 2008, a decrease of 13%.
• The Company reported a gross profit of $527,000 for fiscal year 2009, compared with a gross profit of $440,000 for fiscal year 2008, representing a 20% increase.
• The loss from operations for fiscal 2009 was $327,000 compared to $545,000 reported in fiscal 2008, representing a 40% decrease. The net loss for fiscal year 2009 was $364,000, or $0.01 per share, compared to $650,000, or $0.02 per share, in the prior year, representing a 44% decrease.

"Our financial results for fiscal year 2009 and especially the last two quarters reflected the progress of the Company as we concentrated on cost reductions and efficient customer service in a difficult economic environment. We remain fully focused on this strategy of efficiency and margin growth for the Company with a goal of reaching profitability in fiscal year 2010," commented Don Crosbie, chief executive officer of Claimsnet.

"In fiscal year 2009, transaction volume increased by 18% to a total of 11,800,000 transactions compared to fiscal year 2008. This growth is the result of maintaining long term customer relationships, expanding our customer base, and offering additional services to all of our customers. Our total number of direct payer customers now exceeds 65, along with a growing number of direct provider connections.

An added benefit to our customers is the more than 35 connections that have been developed with other claims clearinghouses in our industry. These relationships allow more transactions to be maintained in an electronic format, rather that being printed to paper, and we continue to add more of these connections as we expand our business relationships."

About Claimsnet.com

Claimsnet.com inc. is a leading provider of Internet-based claim processing solutions for the healthcare payer industry, including distinctive, advanced ASP technology. Headquartered in Dallas, Claimsnet offers systems that are distinguished by ease of use, customer care, security and measurable cost advantages.  Contact Don Crosbie at (972) 458-1701 Ext. 112, dcrosbie@claimsnet.com and visit www.claimsnet.com.

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People News

MedSolutions Names Alan Henry, MD, as Chief Medical Officer of Premerus

MyHealthGuide Source: MedSolutions, 3/4/2010, www.medsolutions.com

Nationally recognized breast imaging expert to lead company's diagnostic accuracy efforts

FRANKLIN, TN -- MedSolutions, a leading provider of medical cost management services, has appointed Alan Henry, MD chief medical officer of the company's Premerus^SM Diagnostic Accuracy program. Premerus is the nation's first diagnostic platform that leverages proprietary technology to connect patients with certified expert diagnosticians, thereby improving quality and affordability of care through increased diagnostic accuracy that reduces medical risks and downstream costs associated with misguided tests, treatments and procedures.

A founding member of the American Society of Breast Surgeons, Dr. Henry is a nationally recognized expert on breast imaging and surgery. He has served as president of Breast Care Specialists of Virginia since 1996. Earlier in his medical career, he developed the Carilion Breast Care Center in Roanoke, Va., the region's first hospital-based center, where he also served as medical director. Board certified by the American Board of Surgery with a specialty certification in breast ultrasound, he has conducted significant research in sentinel lymph node biopsy and was one of the first physicians in the nation to adapt image-guided breast biopsy.

In addition to his clinical expertise, Dr. Henry has considerable experience in healthcare policy, strategic business planning and management. He is a principle in 2-View, LLC, a medical device company, and founded Opus Clinical Research, a contract research organization specializing in breast cancer research studies in 2004. A graduate of Dartmouth College, Dr. Henry earned his MBA from Virginia Tech's Pamplin College of Business and his medical degree from the Medical College of Georgia. He is a former president and board member of the American Society of Breast Surgeons, a member of the American College of Surgeons, and a member of the American College of Radiology's stereotactic breast biopsy credentialing committee.

"We are delighted to welcome Dr. Henry to our management team," said Curt Thorne, chief executive officer of MedSolutions. "As a practicing surgeon with significant subspecialty expertise, his insight and experience will be a tremendous asset to our efforts to enhance patient safety and reduce cost by connecting patients with the most appropriate diagnostic experts."

Premerus uses proprietary workflow technology to identify and route scans to a certified expert radiologist with experience in a particular specialty. This use of certified expert radiology specialists differs from current practice where, frequently, generalists perform the initial reading and diagnosis.

Research affirms that a physician's degree of specialization and volume of experience reading certain types of scans dramatically increase the probability of accurate diagnosis. According to a mammography study published in Radiology, radiology specialists have a 30% lower recall rate than general radiologists, meaning specialists need significantly fewer additional tests to confirm screening mammography findings.[1] In addition, these specialists had a 75% greater cancer detection rate than that of general radiologists, as well as finding 75% more stage 0-1 cancers. A follow up study in the Journal of the National Cancer Institute confirmed this finding, noting that it was the degree of specialization and the volume of experience that increased diagnostic accuracy rates.[2]

"A woman diagnosed with Stage 0 breast cancer has a near 100% chance of surviving her cancer, while delayed diagnosis has dramatically lower survival. The consequences of delayed and misdiagnosis on patients, families, and treating physicians themselves is devastating, and in many cases is preventable," said Dr. Henry. "I am excited about the opportunity that Premerus creates to help solve the significant problem of diagnostic error by supporting treating physicians in delivering a timely, accurate diagnosis for their patients."

About MedSolutions

Using independently validated savings methodologies, MedSolutions specializes in intelligent cost management of medical services for commercial, Medicare and Medicaid payors. The company maintains management contracts for 27 million individuals nationwide. Using robust data, predictive intelligence technology and clinical expertise, the company's innovative solutions extend beyond radiology management to other areas of medical specialty, including oncology, cardiac imaging, sleep, ultrasound, emergency room imaging and Premerus^SM Diagnostic Accuracy. MedSolutions has been recognized three consecutive years for its call center operations by the prestigious J.D. Power and Associates Award. Visit www.MedSolutions.com.

Premerus^SM Diagnostic Accuracy

Premerus^SM is a groundbreaking solution from MedSolutions that addresses the significant problem of error in the diagnostic process. Premerus^SM increases accuracy in the interpretation of diagnostic imaging studies to eliminate the risk of unnecessary and misguided treatments and improve the quality and cost of patient care. Premerus^SM is the nation's first diagnostic platform that delivers access to the specialty expertise of some of America's leading diagnostic physicians. Using proprietary technology to match individual cases with the proven skill and improved accuracy of diagnostic specialists, Premerus^SM efficiently routes clinical data and images to leading diagnosticians for expeditious review. The unparalleled quality of Premerus^SM is built on the patent pending Certified Premerus^SM Expert process, which aligns and rigorously certifies diagnostic physicians within their specific area of expertise, thereby assuring an accurate initial diagnosis that leads to higher quality, more efficacious care. Visit www.medsolutions.com/premerus.

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CIGNA LifeSOURCE Adds Patty Hunt as Account Manager

MyHealthGuide Source: CIGNA LifeSOURCE, 3/1/2010, www.cignalifesource.com

CIGNA LifeSOURCE Transplant Network, is pleased to announce that Patty A. Hunt has joined the team as account manager. Hunt will primarily be responsible for conducting new client implementations and account management, and will serve as a liaison between customers (companies such as reinsureres, stop loss carriers, health plans, third party administrators and others that lease access to the transplant network) and the CIGNA LifeSOURCE operations team.

Hunt has more than 15 years of account management and sales experience and extensive experience in the transplant network industry. Prior to joining CIGNA LifeSOURCE, Hunt held sales management and sales executive positions with LifeTrac Network and account management and account executive positions with Allianz Life Insurance of North America. 

Hunt holds a managed health care professional designation from America's Health Insurance Plans and is a licensed agent for accident and health insurance. She is based at CIGNA's Eden Prairie, Minnesota office, working with customers nationwide.

About CIGNA LifeSOURCE

CIGNA LifeSOURCE contracts with more than 400 organ and tissue transplant programs at more than 115 independent transplant centers that are nationally recognized for their clinical outcomes.  Visit www.cignalifesource.com.

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Allviant Appoints Worksite Wellness and Health Promotion Expert Steve Giardini to Advisory Board

MyHealthGuide Source: Allviant Corporation, 3/2/2010, www.allviant.com

SCOTTSDALE, AZ -- Allviant Corporation announced that it appointed health lifestyle expert Steve Giardini, the worksite wellness and health promotion program coordinator for the city of Scottsdale, to its advisory board. Giardini has 23 years of experience leading, managing and developing health and wellness programs for municipal employees, including 2,600 people employed by Scottsdale.

"Steve's deep knowledge and expertise give him a unique perspective that will help strengthen the strategy, vision and development of Allviant's CarePass™ technology for employers and consumers," said Lilian Myers, Allviant's CEO. "We are thrilled to welcome Steve to the board and look forward to his contributions in advancing our continued growth and to moving the healthcare industry toward a system that encourages prevention, wellness, and health management to provide consumers greater control and convenience over their care."

Giardini has led Scottsdale's worksite wellness and health promotion program since 2005. Prior to that Steve served 17 years as the Fire Service Health & Wellness Coordinator for the City of Mesa. There he develop, planned and implemented firefighter specific health, fitness and wellness programs. A member of the Wellness Council of America, International Association for Worksite Health Promotion, and American College of Sports Medicine. Giardini holds an undergraduate degree in business administration from the University of Phoenix.

"I am honored to join the advisory board of one of the industry's leading innovators and consumer-centric companies," said Giardini. "I look forward to working with other board members and Allviant's management to transform and improve healthcare for consumers."

CarePass enables consumers to control their personal health service communications and transactions by aggregating and delivering context-relevant information securely-via phone, e-mail, or text messaging-depending on their preference.

About Allviant Corporation

Allviant Corporation is the developer of CarePass,a technology-enabled service that gives healthcare consumers a new method of access, convenience and control by connecting existing information systems and administrative data though a personally-defined set of communication methods. The opposite of customer relationship management (CRM), this service relationship management technology empowers the customer to determine when and how they want to interact with service providers across their unique array of healthcare relationships. Visit www.allviant.com and follow us on Twitter or Facebook.

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Market Trends, Studies, Books & Opinions

Medical Tourism Can Generate 20% to 80% Savings for Self-Funded Employers

MyHealthGuide Source: Reducing Healthcare Costs for Employers, published by Thompson Publishing Group, written by Marla Durben Hirsch. Copyright 2010.  www.Thompson.com

Medical tourism, originally the domain of uninsured consumers willing to travel for cheaper medical care, is becoming a popular option among employers/plan sponsors, which have noticed the substantial cost savings and want in on the action.

There is growing interest by self-funded and fully insured employers in offering medical tourism as an option in their benefit packages. In medical tourism, patients go overseas for hip replacements, angioplasty and other non-emergency procedures. The patients often combine the treatment with a vacation, then return home for follow-up care.

Cost savings range from 20% to 80%, according to Renee-Marie Stephano, president of the Medical Tourism Association in West Palm Beach, Fla. (See chart below.) "It's a large value, and often the foreign surgeon was trained in the U.S. and is just as, if not more, experienced in the procedure," she explains. For instance, hip resurfacing has been performed in other countries for years; it has only recently been approved in the United States.

Substantial Growth Anticipated

Insurance-covered medical tourism isn't new, but it's becoming more prominent as the industry matures and employers are less afraid of antagonizing local providers by publicly offering it, according to Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions, Washington, D.C., which recently released a study on medical tourism.

According to "Medical Tourism: Update and Implications" published October 2009, several trends are fueling the demand for medical tourism, including:

• increased demand for outpatient surgery;
• more coverage/demand for dental surgery;
• acceptance by employers and health plans targeting commercial populations;
• sophistication of medical tourism operations;
• globalization of the U.S. workforce;
• access to low-cost transportation; and
• Support by foreign governments.

Factoring in further increases in health care costs over the next decade, Keckley anticipates medical tourism will grow 35% a year. U.S. citizens left the United States for about $1 billion in health services in 2008, he adds.

The Deloitte study notes that the recession and the hope of health reform slowed medical tourism's growth in 2008 and 2009, but if health reform founders, growth could resume. "[Now that health reform has sputtered], we currently have nothing to look forward to reduce costs," says Stephano.

With savings so substantial, employers and plans can offer employees incentives for using the option, such as a cash bonus or waiver of copayments, and still realize thousands of dollars in health plan savings, Stephano indicates. Other incentives include hotel and meal expenses, passport and visa expenses, transportation expenses and translation expenses, notes attorney Howard Bye, with Stoel Rives, Seattle.

"Offering this option also reduces employee absenteeism and improves employee retention. It's goodwill," Stephano points out. "And it's a great opportunity for an employer to be competitive in the marketplace," she adds.

Employers Take Notice, Add Option

While medical tourism has garnered attention from self-funded employers, fully insured and group health plans aren't ignoring the trend. Deloitte's study reports that several insurers such as Anthem Blue Cross and Blue Shield (WellPoint), Health Net of California, Blue Cross Blue Shield of South Carolina, and UnitedHealth have added medical tourism products or launched pilot programs.

"Blue Cross Blue Shield is traditionally conservative. It shows that insurers are figuring this out pretty quickly. It's a no-brainer. The price points are so dramatic," notes Peter Hayes, formerly with Hannaford Brothers and now CEO of consulting firm HC Solutions in Scarborough, Maine.

"Different plans are responding, and promoting it. A 30% to 70% reduction should be reason enough to look at [medical tourism]. And since so much of our workforce is shifting [and has immigrated] from other places, traveling for a procedure is part of their return home and visit with family," Keckley explains.

Add-on Creates Double Win for Company

Portland, Maine-based supermarket chain Hannaford Brothers reaped an unexpected bonus by adding medical tourism to its health repertoire. Hayes added the option to Hannaford's self-insured benefit package after the company incurred a $1 million hit on a hip replacement that went sour, forcing the company to increase deductibles for its 27,000 employees to $2,500 a year. "If your average income is $30,000, the $2,500 in out-of-pocket was a lot," he notes.

Hayes originally asked the local health systems for a discount on certain procedures, but was flatly refused. He then polled the employees, many of whom have never traveled out of the state of Maine, and discovered 90% of them would consider going overseas for treatment. He arranged for and launched a medical tourism partnership program with a health system in Singapore in the beginning of 2009 that would cost one-third than what it would cost for the same procedures done locally; Hannaford waived employees' out-of-pocket costs if they took advantage of the option, and paid for a travel companion to accompany the patient.

Option Opened Local Doors

There was an unexpected side benefit: Two local health systems that had rejected Hayes' request for a discount contacted him and offered to match the discount provided by Singapore. Hayes accepted the offers. Apparently adding medical tourism to an employer's benefits package can create leverage to get better rates locally, points out Bye, who has seen this occur elsewhere.

"I got everything I wanted. It changed the affordability for employer and employee," says Hayes. No employee has yet made it to Singapore, although Hayes expects that employees will.

Downsides to Medical Tourism

Of course, there are some drawbacks to receiving treatment overseas. For instance, there may be fewer patient protections, such as the ability to bring a lawsuit for medical malpractice or privacy laws comparable to the federal Health Insurance Portability and Accountability Act, (HIPAA). There may be language issues or unanticipated political unrest in a foreign country, and some medical conditions are not appropriate for or can worsen during travel. Some American providers are also hesitant or unwilling to provide the follow-up care after the patient returns home.

Nonetheless, it's an attractive option for many employers. "This is big, and it's practical. It's the perfect confluence of consumer demand for value, technology and greater transparency. It's not going away," says Keckley.

Instituting a Successful Medical Tourism Benefit Program

To consider adding a medical tourism benefits option to your health benefits package, employers/plan sponsors should consider the following:

1. Make sure you use reputable partners. Some consultants, also called "facilitators" who broker these relationships are very sophisticated; others are "just travel agents in drag," Keckley says. Many but not all foreign hospitals have been accredited by the globally recognized international arm of the Joint Commission. "You have to do your due diligence," Hayes recommends. "There are some fly-by-night packages, so look at quality and credentialing, not just price," he adds.
    
2. Look at plan design. Determine which procedures will be covered, whether the program will be limited to employees only, how it will dovetail with utilization review requirements and other design issues, says Bye.
    
3. Align your program with your risk comfort level. If your company is more risk-adverse, partner with hospitals in countries that are stable and have legal systems and patient protections similar to those in the United States, says Hayes. Or use a foreign country closer to home, such as Mexico, Barbados or Costa Rica.
    
4. Make sure the program won't violate any current contracts. If you have an exclusive contract with a provider network, double check that adding this option won't cause trouble. If it does, you may still be able to amend the contract, says Bye.
    
5. Consider following the AMA's guidelines. Medical tourism is a rather unregulated industry; however, the American Medical Association (AMA) published the AMA Guidelines for Patients Travelling Overseas for Medical Care in 2008 to provide suggested structure for these programs. For instance, the AMA recommends that medical tourism be voluntary, not mandatory, since some employees will not want to venture far from home for their medical care. The program is more likely to be accepted and harder to challenge if it's voluntary, notes Bye.
    
6. Make sure the benefit plan structure meets applicable U.S. law. A plan sponsor may ask the foreign hospital to agree to keep patient records confidential based on American law, to avoid possible HIPAA violations. The employer should also check to see how some of the benefits offered may be seen as income by the IRS, and make correct income tax reporting and withholding determinations, says Bye. For example, benefits for prescription drugs that are legal in a foreign country but which aren't legal in the United States are taxable to the employee, he points out.
    
7. Create/update new policies as necessary. You'll need program disclosure and  participation agreements to be signed by the employee and travel companion, including acknowledgment of the risks of travel in general, the possibility that legal recourse may be reduced, that the patient is otherwise fit to travel and potential tax consequences. You may also need to update leave of absence policies, since patient-employees may be off work for a longer period of time, says Bye.
    
8. Watch for hidden speed bumps. For example, Blue Ridge Paper Products in Canton, N.C., in 2006 halted plans to send an employee overseas for surgery after his union objected, notes Bye.

Medical Tourism Sample Surgery Cost Chart

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Legal, Legislative & Regulatory News

DOL's Employee Benefits Security Administration (EBSA) Announces $1.36 Billion in Penalties, Recoveries and More -- Targeting Techniques and Criteria

MyHealthGuide Source: U.S. Dept of Labor, 3/2010

• DOL News Release
• DOL Detail Results
• DOL Targets Certain Plans; Targeting Criteria

Washington -- The U. S. Department of Labor's Employee Benefits Security Administration (EBSA) announced monetary results of $1.36 billion in fiscal year 2009 for retirement, health, and other employee benefits plans governed by the Employee Retirement Income Security Act (ERISA).

EBSA closed 3,669 civil investigations in FY 2009. In over 72% of those cases, the agency found violations and obtained correction. Criminal offenses involving employee benefit plans led to indictment of 115 individuals.

EBSA Assistant Secretary Phyllis C. Borzi said, "These results reflect a strong, fair and aggressive program to protect the benefits of American workers, retirees and their families. We believe our civil enforcement program demonstrates the success of using targeted investigations."

The agency also recovered $124.5 million for workers and their families through informal resolution of individual complaints. In addition, handled 365,457 inquiries from the public and conducted more than 1,500 education and outreach events that reached workers, employers, plan officials and Congressional members.

Civil Investigation Statistics Demonstrate Success In Targeting

In FY 2009, EBSA closed 3,669 civil investigations, with 2,833 (77.21%) resulting in monetary results for plans or other corrective action.

EBSA often pursues voluntary compliance as a means to correct violations and restore losses to employee benefit plans. However, in cases where voluntary compliance efforts have failed, or which involve issues for which voluntary compliance is not appropriate, EBSA forwards a recommendation to the Solicitor of Labor that litigation be initiated. In FY 2009, 204 cases were referred for litigation. Together, EBSA and the Solicitor of Labor determine which cases are appropriate for litigation, considering the ability to obtain meaningful relief through litigation, cost of litigation, viability of other enforcement options, and agency enforcement priorities. EBSA cases referred to the Solicitor's office for litigation are often resolved, with monetary payments, short of litigation. Nationwide in FY 2009, litigation was filed in 107 civil cases.

Targeting And Limited Reviews

The EBSA uses targeting techniques in the handling of limited review cases (Program 53). Targeting is the process whereby the limited investigative resources of EBSA are directed toward those plans and service providers with the highest potential for abuse, consistent with agency goals, objectives and priorities. Limited review cases are expedited inquiries into one or more specific facets of a plan or service provider's operation in order to determine quickly whether a violation exists and further investigation is merited or whether the matter should be closed.

Targeting Criteria

1. Computer generated compilations of selected employee benefit plans or service providers derived from reports filed with EBSA.
    
2. Information derived from detailed review and analysis of annual reports, supporting financial statements, schedules, exemption application files, ERISA section 502 complaints, and other internal EBSA sources.
    
3. Information concerning employee benefit plans or service providers derived from other governmental agencies such as the IRS, the SEC, and state insurance agencies.
    
4. Information concerning employee benefit plans or service providers derived from non-governmental sources such as newspapers, industry journals and magazines, or leads from knowledgeable parties.
    
5. Information received as a result of complaints from participants, fiduciaries, informants, or other sources in the community, other than allegations of acts against a participant or beneficiary for exercising any right to which he/she is entitled under the provisions of an employee benefit plan, or interfering with the attainment of any right to which the participant may become entitled, which should be handled as described in Chapter 43.

Methods for Using Sources to Identify Limited Review Targets

1. An entire compilation of employee benefit plans or service providers can be targeted for limited review without further refinement of the initial compilation. Generally, this method will be used when the compilation itself is small. For example, an RO may request a printout from the National Office of all exemption applications granted, denied or withdrawn for plans having at least fifty (50) participants located within that RO's jurisdiction. Such a compilation would probably be small in number and, generally, would not require any additional analysis to afford a reasonably good basis for limited review cases.
    
2. More sizeable compilations can be refined through the use of "inquiry letters" (Figure 1) whereby certain additional information is obtained from employee benefit plan officials prior to opening a limited review case. Such inquiry letters, however, should be used with caution and only in a manner consistent with the guidelines in paragraph 4 below. Each RO using inquiry letters will review responses to such letters in order to determine which employee benefit plans appear to merit further review, either by opening a limited review case or through the use of additional case development efforts.
    
3. Telephonic contacts may also be used to assist in refining compilations in order to select specific cases for limited review. Such contacts may be used to further refine large compilations after receipt and analysis of "inquiry letters."

About EBSA

Through its enforcement of the Employee Retirement Income Security Act (ERISA), the Employee Benefits Security Administration (EBSA) is responsible for ensuring the integrity of the private employee benefit plan system in the United States. EBSA's oversight authority extends to nearly 695,000 retirement plans, 2.8 million health plans, and a similar number of other welfare benefit plans, such as those providing life or disability insurance. These plans cover about 150 million workers and their dependents and include assets near $5 trillion.

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Medical News

Aspirin Does Not Reduce Cardiovascular Events for Individuals with Low Ankle Brachial Index

MyHealthGuide Source: Journal of the American Medical Association, Vol. 303 No. 9, 3/3/2010, JAMA Abstract

Among individuals without clinical cardiovascular disease but identified with a low Ankle Brachial Index (ABI), taking aspirin does not reduce cardiovascular events according to a study published in the Journal of the American Medical Association.

A low ankle brachial index (ABI) indicates atherosclerosis and an increased risk of cardiovascular and cerebrovascular events. Screening for a low ABI can identify an asymptomatic higher risk group potentially amenable to preventive treatments.

The study followed 28,980 men and women aged 50 to 75 years living in central Scotland, free of clinical cardiovascular disease, between April 1998 to October 2008.  Of those, 3,350 with a low ABI (0.95) were entered into the trial, which was powered to detect a 25% proportional risk reduction in events.  Interventions Once daily 100 mg aspirin (enteric coated) or placebo.  Patients had follow-up of an average of 8.2 years.

Study findings

• There was no statistically significant difference found between the group who took aspirin and those who took a placebo.
• However, hemorrhaging requiring admission to hospital occurred in 34 participants (2.5 per 1000 person-years) in the aspirin group compared to 20 (1.5 per 1000 person-years) in the placebo group.

About Ankle-Brachial Index (ABI)

Source: Mayo Clinic

The ankle-brachial index test is a quick, non-invasive way to assess your risk for peripheral artery disease, a condition in which the arteries in your legs and ankles are narrowed. People with peripheral artery disease are at a higher risk of heart attack, stroke and poor circulation.

The ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm. A low ankle-brachial index number can indicate narrowing or blockage of the arteries in your legs, leading to circulatory problems, heart disease or stroke.

ABI Result Range

• No blockage (1.0 to 1.3). An ankle-brachial index number in this range suggests that you probably don't have peripheral artery disease. But if you have certain risk factors, such as diabetes, smoking or a family history of PAD, tell your doctor so that he or she can continue to monitor your risk.
   
• Mild blockage (0.8 to 0.99). If your ankle-brachial index number is less than 1.0, you may have some narrowing of the arteries in your ankle. People with an ankle-brachial index of 0.9 or lower may have the beginnings of peripheral artery disease. Your doctor may then monitor your condition more closely.
   
• Moderate blockage (0.5 to .79). An ankle-brachial index number in this range indicates more significant blockage of your ankle arteries. You may have noticed some pain in your legs or buttocks when you exercise.
   
• Severe blockage (less than 0.5). If your ankle-brachial index number is in this range, your ankle arteries are significantly blocked and you may have pain in your legs even while resting. An ankle-brachial index of less than 0.5 suggests severe peripheral artery disease.

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Resources

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.

• BEST Re on behalf of US FIRE & BEST LIFE

• Cairnstone Re

• HCC Life

• HMA MGU, LLC, MGU

• Independence Holding Company (Standard Security Life Insurance Company of New York, Madison National Life and Independence American Insurance Company)

• Intermediary Insurance Services, Inc. (IISI), MGU on behalf of QBE Insurance Company and American National Life Insurance Company of Texas

• J. Allan Hall & Associates, Inc., MGU on behalf of their underwriting facility, Lloyd's of London

• Medical Excess

• Medical Risk Managers, MGU

• National Benefit Resources, MGU on behalf of UnitedHealth Group insurance companies

• R. E. Moulton, Inc. / American United Life Insurance Company (OneAmerica Companies)

• RMTS, LLC, MGU on behalf of their carriers Nationwide Life Insurance Company, Gerber Life Insurance Company, and Trustmark Insurance Company (as filed)

• Spectrum Underwriters, MGU

• Star Line Group, MGU on behalf of QBE Insurance Company, Nationwide Life Insurance Company and Lloyd's of London.

• Stop-Loss Concepts, Inc., MGU on behalf of their carriers, Gerber Life Insurance Company and QBE Insurance Company.

• Swiss Re Commercial Insurance

• Zurich North America

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 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."

Disclosure Form, Codes, White Paper, Available

The following draft documents may be downloaded and viewed at www.myhealthguide.com/disclosures.htm. 

• Standard Disclosure Form & Codes (with instructions) Word Format

• Standard Disclosure Form & Codes (with instructions) Acrobat PDF Format

• Stop-Loss/Reinsurance Disclosure & Reporting "White Paper" (updated 9/1/2006)

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.

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Upcoming Conferences

March 8 - 10, 2010
Fifth National Pay for Performance Summit presented by Integrated Healthcare Association and Harvard Health Policy Review and Health Affairs. Hyatt Regency, San Francisco, CA.  www.PFPSummit.com

March 10-12, 2010
24th Annual Legislative/Regulatory Conference presented by Self-Insurance Institute of America, Inc.  Confirmed speakers:

• Senator Ben Nelson (D-NE): "Health Reform View by a Former Insurance Commissioner"

• Rep. Jason Altmire (D-PA): "'Blue Dogs' Influence on Legislation"

• Rep. Michael Burgess (R-TX): "Perspectives on Healthcare Reform"

• Rep. John Kline (R-MN), Senior Republican of the House Health, Education, Labor and Pensions (HELP) Committee

• Gary Lefkowitz, Senior Employee Benefit Plan Specialist, U.S. Department of Labor:
  "Self-Insurance/ART and Employee Benefits"

• Panel discussion on actions by the National Association of Insurance Commissioners affecting self-insurance/ART:

  • Tom Hampton, Sonnenschein Nath & Rosenthal, LLP, former Commissioner of the Department of Insurance, Securities and Banking, District of Columbia

  • Julie McPeak, Attorney, Burr Forman

  • Wes Bissett, President, The Bellemore Group

Attendees will have the opportunity to meet with their elected representatives as part of SIIA's popular "Walk on the Hill" event.  Marriott Metro Center Hotel. Washington, DC. Sponsorship information: Justin Miller at 800-851-7789 or jmiller@siia.org.  www.SIIA.org

March 26, 2010
ON-SITE Clinics presented by The La Penna Group, Inc. This is a Forum on the status and future of the On-site Industry restricted to employers that have on-site clinics presently and who wish to network with others concerning the present issues and future challenges that these unique operations address.  No vendors - no advertisers - no outside consultants.   Contact Michael La Penna, Principal, The La Penna Group, Inc., (800) 527-3662 and mlapenna@lapenna.com.  www.lapenna.com

April 6-8, 2010
TPA & MGU/Excess Insurer Executive Forum presented by Self-Insurance Institute of America, Inc.  This event is designed for senior level executives representing health care third party administrators and MGU/stop-loss insurance carriers. New this time will be a conference golf tournament on the morning of April 6. Charleston Place Hotel. Charleston, SC. Sponsorship information: Justin Miller at 800-851-7789 or jmiller@siia.org. www.SIIA.org

April 12-13, 2010
MCIA Spring Summit presented by Montana Captive Insurance Association, Inc. (MCIA), Helena, MT.  Information and registration: www.mtcaptives.org/i4a/pages/index.cfm?pageid=3441

April 13-15, 2010
Global Healthcare & Medical Tourism Conference Korea 2010 presented by a joint initiative between the Medical Tourism Association (MTA), Korean Health Industry Development Institute (KHIDI).  Up To 800 Attendees.  US Health Insurance Companies and Insurance Providers Invited.  Industry Players From Over 25 countries.  Seoul, Korea.  Information and Registration: www.asiamedicaltourismcongress.com

April 14-16, 2010
SPBA Spring 2010 Meeting - Members Only presented by Society of Professional Benefit Administrators. Washington DC.  www.SPBATPA.org

April 25-28, 2010
CHT Annual National Client Conference presented by Consumer Health Technologies, Inc. The Green Valley Ranch Resort and Spa in Las Vegas, Nevada. www.consumerhealthtech.com.

April 25-29, 2010
RIMS Annual Conference. Boston Convention Center. www.RIMS.org

April 26-28, 2010
Advances in the Management of Oncology Patients presented by OptumHealth. A symposium for health care professionals to provide an in-depth exploration of the recent advances in cancer prevention, treatment and care, as well as the management of treatment-related complications.. Conference information: 800-847-2050 or education@optumhealth.com. See http://attendesource.com/profile/web/index.cfm?PKwebID=0x10356da5d&varPage=home

May 10-11, 2010
TPA College of Knowledge presented by Texas Association of Benefit Administrators (TABA) , Omni Hotel Downtown Austin, TX.     www.tpbaa.com

May 11-13, 2010
Self-Insured Workers' Compensation Executive Forum presented by Self-Insurance Institute of America, Inc.  This event attracts senior executives involved with self-insured workers' compensation programs, including group self-insured workers' compensation funds (SIGs). Windsor Court Hotel. New Orleans, LA. Sponsorship information: Justin Miller at 800-851-7789 or jmiller@siia.org. www.SIIA.org

May 12-14, 2010
21st Annual Northshore International Insurance Services Medical Excess Claims Conference.  Salem, Massachusetts, at the historic Hawthorne Hotel on . Invitation only. Contact Adria L. Garneau, CEBS at agarneau@niis.com. Information: www.niis.com.

June 7-9, 2010
London Self-Insurance/ART Conference presented by Self-Insurance Institute of America, Inc.  Speaker and program highlights: Ori Karev, CEO of United Health Care International, will talk about how self-insured group health plans should be structured for companies with employees in multiple countries from a provider/insurer perspective.  John Latter, Head of Multinational Insurance Population for Zurich Financial Services Group will cover tax and compliance issues related to the use of locally filed insurance policies and rates outside of the United States.  Captives and reinsurance for employee benefits.  Corporate risk aggregated from multiple countries dedicated to understanding actuarial assumptions in managing blocks of global risks. Tour Lloyd's headquarters in London.  Sponsorship information contact Justin Miller at 800-851-7789 or jmiller@siia.org. Visit www.siia.org/London

June 7-9, 2010
National Accountable Care Organization (ACO) Summit presented by Harvard Health Policy Review and Health Affairs.  A Hybrid Conference and Internet Event. The Leading Forum on the Accountable Care Organizations (ACOs) and Related Delivery System and Payment Reform.
Ritz-Carlton Hotel, Washington, DC. www.ACOSummit.com

June 10-11, 2010
"A Revolutionary Passion for Savings" presented by The Phia Group, LLC, honoring its 10th Anniversary.  Latest cost containment strategies and services available to the health insurance industry today. All attendees will discover efficient and innovative ways to prosper in the ever changing health care environment. Leading industry experts discuss revolutionary cost saving techniques that plan administrators can implement immediately.  Historic Omni Parker House.  See  www.phiagroup.com/news/111209_forum2010.htm.  Registration:  Bethany Hoffman, Marketing Executive, at 781-535-5608, bhoffman@phiagroup.com and visit www.phiagroup.com.

June 28-30, 2010
Society of Actuaries 2010 Spring Health Meeting. Orlando, FL.  www.soa.org

July 19-21, 2010
MCIA Fifth Annual Conference presented by Montana Captive Insurance Association, Inc. (MCIA), Whitefish, MT.  Montana Insurance Commissioner Monica Lindeen as well as all of the state's key captive regulators plan to be there to help educate attendees about what the domicile has to offer.  Companies interested in sponsorship opportunities should contact Justin Miller at 866/388-6242, jmiller@mtcaptives.org. Information and registration: www.mtcaptives.org/i4a/pages/index.cfm?pageid=3354

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.

Sept 13-14, 2010
TABA 2010 Fall Conference presented by Texas Association of Benefit Administrators (TABA), Marriott Sugarland Town Square Sugarland, TX. www.tpbaa.com

October 6-8, 2010
SPBA Fall 2010 Meeting - Members Only presented by Society of Professional Benefit Administrators. Phoenix, AZ. www.SPBATPA.org

October 12-15, 2010
30th Annual National Educational Conference & Expo presented by Self-Insurance Institute of America, Inc.  This is the world's largest business conference/trade show dedicated exclusively to the self-insurance/alternative risk transfer industry. The event features more than 50 educational sessions and a trade show with about 150 companies showcasing their products and services.  Sheraton Chicago Hotel & Towers. Chicago, IL.  Sponsorship information: Justin Miller at 800-851-7789 or jmiller@siia.org. www.SIIA.org

October 17-20, 2010
Society of Actuaries 2010 Annual Meeting. New York City. www.soa.org

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Editorial Notes, Disclaimers & Disclosures

• Articles are edited for length and clarity.

• Articles are selected based on relevance and diversity.

• No content in this Newsletter should be construed as legal advice.  All legal questions should be directed to your own personal or corporate legal resource.

• Internet links are tested at the time of publication.  However, links change or expire often.

• Articles do not necessarily reflect views held by the Publisher.

• Disclosure: MyHealthGuide is associated with CareHere, LLC^® and LabInsight^®.

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