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

April 2018
Recap From The Road

Recap of APH’s Experience at the March Self-Insured Institute of America (SIIA) Self-Insured Health Plan Executive Forum

Denis Cremin, Sr. VP of Sales and Marketing for Advanced Plan for Health (APH) was a delegate at the SIIA Health Plan Executive Forum March 5-7. The event was attended by participants representing Self-Funded Employers, Third Party Administrators (TPAs), Stop-Loss Carriers / MGUs and solution providers. Below are some highlights Denis wanted to share with our readership.

The event covered many topics including – employer insight into drivers of their purchasing decisions, future trends in the TPA marketplace, the adaptational role of the modern broker, the implications of transparency regarding putting a deal together, as well as issues that arise in stop-loss or re-insurance implementations.

A conference highlight was an informative round table moderated by Ron E. Peck Esq. of the Phia Group titled, “ The Good, Bad & Ugly of Reference Based Pricing” .   This was a lively discussion featuring an array of expert perspectives on several reference-based pricing strategies with real-time polling on the pros and cons.

Ron stated that, reference-based pricing can be any one of a number of methodologies for establishing a maximum amount to pay providers for specified goods or services at a commonly known rate that is calculated to provide a reasonable reimbursement for quality goods or services. The rates can be specific to a procedure like appendectomy or hip replacement surgery also known as ‘bundled’ rates; Are based on some framework established by a third party to the health plan and provider (Independent studies, Centers for Medicare and Medicaid Services (CMS), the Red Book, etc.); or Are developed by the plan itself, based on historical charges for those healthcare goods and services.”

Ron covered that many large employer groups and some TPAs have used this approach to reduce healthcare costs. He further mentioned that most network arrangements are based on discounts off of billed charges, however, billed charges have little in common with actual cost. This has led some employers to seek cost -based reimbursements rather than discounts.
If you have any questions for Denis Cremin related to his experience and learnings at this conference, please feel free to reach out to us at
(888) 600-7566 or marketing@mypoindexter.com .
Blog Insights

Here’s an excerpt:

Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So, we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations.

The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.

Mental and substance abuse disorders and their downstream impacts are becoming a growing concern for employers – with costs to employers estimated at $225.8 billion each year . Notably, the financial impact goes beyond absenteeism to include presenteeism as well. Presenteeism, or individuals working with untreated illnesses, is estimated to cost employers $1,601 per person each year according to the same Inc. Magazine article.

Each year, an estimated 16.2 million adults (6.7% of the adult population) in the United States had at least one major depressive episode according to the National Alliance on Mental Illness (NAMI) . NAMI goes on to say that approximately 37% of adults with major depressive episode did not receive treatment.

Many employers are actively looking for better ways to offer their employees support in this area – as they do for overall wellness and chronic conditions such as diabetes and high blood pressure.

According to a recent America’s Health Insurance Plans (AHIP) blog , “Today, with smartphone in hand, telehealth and mobile health tools can connect people to the mental and behavioral health care they need.” AHIP states that health insurers are embracing virtual behavioral health as it makes it easier and more affordable to access behavioral health care, and it improves overall health.

APH, On the Road
Upcoming Tradeshows and Conferences

May 9-11 | Austin, TX

The SouthWest Benefits Conference will be attended by benefits professionals looking to learn more about challenges being faced by others, as well as best practices for addressing them. Topics will include the latest legislative updates, mental health in the workplace, communications that lead to real engagement, the next phase in financial wellness, HSAs and retirement plan strategies, and more.

Currently being rescheduled l Phoenix, AZ
Attendees will gain a new perspective on reducing healthcare costs while improving quality at the industry’s premier event for Utilization and Care Management professionals. In its third year, this innovative conference takes an intensive look at the new problems plans are facing this year, while providing insights and best practices that will enable them to fine-tune Utilization and Care Management initiatives. Leading experts will deliver an original, broad-based picture of how to balance cost containment with improved outcomes.

June 25-26 l Phoenix, AZ
Advanced Plan for Health will be an event sponsor and exhibitor, and we will also be on stage presenting findings of our exciting RISE Association Medicare Advantage Benchmarking study at this event.
The RISE Quality Leadership Summit is the preeminent event for quality-improvement leaders and stakeholders – covering leading-edge quality improvement strategies delivered in an innovative format. Industry pioneers will share the steps they took to boost their quality scores, enriched with insights from healthcare strategists and regulatory officials on how to stay on top of today's rapidly changing environment. This year’s program adds a new track focused on difficult pharmacy-related measures.
If you’d like to learn more about our RISE research project, please reach out to us at marketing@mypoindexter.com . We are currently working with RISE to recruit RISE member M.A. plans to participate.

September 23-26 l Austin, Texas

The SIIA National Conference & Expo is the world’s largest event focused exclusively on the self-insurance / alternative risk transfer marketplace and typically attracts more than 1,700 attendees from around the U.S. and from a growing number of countries around the world.
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.