Poindexter's Points:
Advanced Plan for Health's
News and Updates

April 2019
In The News
Dr. Barbara Rutkowski and Joy McGee-Cory Featured in The Self-Insurer

 We are thrilled to share that the APH article, Pre-Emptive and Analytics-Based Early Action Can Delay Kidney Dialysis, Reduce Plan Costs and Improve Quality of Life by Barbara Rutkowski & Joy McGee-Cory has been featured in the March edition of The Self-Insurer (an SIPC publication).

The article discusses the effects Kidney Dialysis can have on health and cost outcomes, and the proactive intervention measures APH consistently implements to minimize associated Kidney Disease costs and risks through the art and science of Nurse Navigation in collaboration with Predictive Analysis.
Please click here and visit page 32 to read our article. The full edition may also be downloaded via that link. 
Client Corner
APH’s Social Determinants of Health Task Force
Many innovative thought leaders from across the Advanced Plan for Health client base gathered on March 20th at the corporate offices of Advanced Plan for Health, to take part in a groundbreaking new Task Force to share insight related to Social Determinants of Health and to discuss how it is impacting healthcare costs, quality of service, severity and utilization.

Neil Godbey, Chairman and CEO of Advanced Plan for Health and CEO of The Godbey Group pulled the Task Force together. John Buck, MD, Board of Directors and Founder of Emerus was a co-organizer. Neil and Dr. Buck assembled and led the task force with the aim of developing a plan to discover goals, processes, responsibilities and to delve into who benefits and why.
Together, they hosted Dan Burke , Director-Corporate Benefits at Turner Industries; Creagh Milford , DO, MPH, Chief Medical Officer of Healthcare Highways; Doris Hunt , Executive Director at Children’s Medical Center Health Plan; Brian Connelly , Director of Product Development and Strategy at Gilsbar, Inc., Mike Musci , DO, Chief Medical Officer of New Ocean Health Solutions; Mark Woessner, Vice President at Huntington Insurance Services ; Jennifer Speer , Director of Wellness & Health Risk Management at Higginbotham. APH Staff members participated in the discussion as well, including Data Scientists, Jason Rudy and Matt Lewis; Sue Mutto, RN, MA, Director of Clinical Development and Clinical Informatics and Jennifer Lites, Business Analyst. Ana Handshuh , Vice President of Managed Care Services at Ultimate Health Plans is also a Task Force member.
While Neil shared the effects of mental health on healthcare cost and utilization related to chronic diseases as well as the number of diagnosed and undiagnosed mental health disorders as it relates to antidepressant usage, John encouraged the Task Force members to separate into small groups to discuss the Government and Commercial viewpoints of Medicaid, Medicare and Self and Fully Insured individuals. These breakout groups reviewed the individual behaviors, genetic factors, social circumstances, healthcare and environmental factors that make up Social Determinants of Health (such as economic stability, physical environment, education, employment social economic factors, food / healthy behaviors, community and culture and healthcare utilization). The team then shared the results of the small groups discussion and came up with an action plan on how to properly obtain data to begin further dissecting Social Determinants.

With the motivation from all leaders in attendance, an action plan was created that included what data needs to be obtained. We deeply appreciate the time and insights from these key industry leaders. We are confident that this Social Determinants Task Force will drive significant innovation and positive change in this important focus area.
Recap from the Road
APH was fortunate to have our Denis Cremin be a part of important discussions and sessions at SIIA’s Self-Insured Health Plan Executive Forum in March. One of the key objectives for the conference was to promote improved collaboration in order to grow the self-insurance marketplace in a responsible way. Below is a summary of some key-takeaways that generated buzz at the conference. 

At the conference start, SIIA’s government relations team provided the latest updates on federal and state legislative and regulatory developments affecting the self-insurance marketplace. It was a good way to frame the upcoming conference topics.

A recap of recurring takeaways that came across repeatedly during the conference are:

  • Independent TPAs are serving a niche market
  • TPAs face the same technology platform challenges that healthcare providers faced in EMRs in that they are clunky, require many custom workarounds and rely on superuser vendors
  • The national trend of BUCAHs (Blues, United, Cigna, Aetna, Humana health plans) buying up TPAs
  • High interest in Reference-Based Pricing (RBP)

Some key sentiments and attendee opinions that were expressed relative to BUCAH and independent TPAs’ current roles in the self-funded market are listed below: 

  • Independent TPAs will always have a place in the market as they are more focused on employer needs, financial trust and long-term health plan well-being
  • BUCAHs will continue to lose self-funded business to independent TPAs until they become more flexible and cease to rely on discounts
  • Many independent TPAs are seasoned in RBP, which makes them well-suited to offer this solution to their clients
  • Many attendees shared that it is unrealistic to manage costs in a way that maintains participant satisfaction while simultaneously dealing with decades of promises to providers, disjointed technology and shareholder demands for profits
A highlight of the event was a presentation – “ Making it Work with the Third Wheel - Legacy Vendor Arrangements ,” that was presented by an array of experts who spoke on how to successfully navigate a collaboration challenge TPAs and Consultants recurrently face when they work jointly to setup self-funded health plans. The presenters were: Brian Connelly – Director of Product Development & Strategy, Gilsbar, LLC; Jonathan Logan – President, Logan & Associates of Louisiana, Inc.; Dan Myers – Vice President of Client and Business Development, EBMS; Erin Weenum – Chief Strategist, Employee Benefits, Leavitt Group.

They shared that often, TPAs and Consultants have a long-standing relationship with a provider or vendor they are comfortable working with. The challenge, or point of friction, occurs when one of the two entities has an established third-party vendor that they insist on including in the deal. Thankfully, SIIA provided a platform for these presenters to provide advice on how to overcome such a challenge. A key takeaway was the emphasis on the importance of always maintaining relationships with third-party vendors to ensure they remain strategically aligned with overall objectives, and to have transparency into their coming innovations and plans.
For any questions related to Denis’ experience and learnings at this conference, please feel free to reach out to us at (888) 600-7566 or marketing@mypoindexter.com .
Blog Insights

Since our clients are facing risks and high costs associated with liver injury and chronic kidney disease, we wanted to compile some information pertaining to the impact of over-the-counter (OTC) medications and herbal and dietary supplements (HDS) in these areas. We believe this information will help drive a more proactive approach that better educates and protects employees, members and patients from these often devastating and potentially costly conditions.  Click here to read more.

In observance of National Kidney Month, last month’s health highlight was on Chronic Kidney Disease (CKD) and Dialysis awareness and prevention.

Kidney failure and life-saving dialysis are both a catastrophic health plan expense and life-changing experience that impact health payors and lives alike. Click here to read more.
APH, On the Road
Upcoming Tradeshows and Conferences

The APH team would welcome the opportunity to meet you in person at any of our scheduled tradeshows and conferences. Contact us here , email us at marketing@mypoindexter.com or call (888) 600-7566 to arrange a time to meet with us.
April 16, 2019 | Houston, Texas

APH’s COO, Taylor Godbey will be presenting alongside Turner Industries’, Dan Burke , Director of Corporate Benefits and Memorial Hermann Health System’s, Emily Hightower , Director of Population Health and Wellness. Their presentation is titled – “ Case Study: Turner Industries’ Analytics-Powered Nurse Navigation Care Model” . APH is also a conference sponsor, and will be exhibiting. Please stop by our presentation and booth if you’ll be in attendance. 
May 22-23, 2019 | Galveston, Texas

APH’s Rick Scheel and Steve McBride will be delegates at this event which will feature subject matter experts from all over the country and employer case-studies from those who know how to make managing an employee benefits plan easier and better.
July 15-17, 2019 l Dallas, Texas

APH will be sending a delegate to this HCAA event where the focus will be around challenges and strategies on the forefront of innovative benefits administration. 
September 30 - October 2, 2019 l San Francisco, California

Advanced Plan for Health will have our exhibit booth setup (booth #714), and will be ready for demos of our Poindexter platform. We will also be participating in the conference as delegates. This event is focused exclusively on the self-insurance / captive insurance marketplace and typically attracts more than 1,700 attendees.