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

May 2018
In The News

We are very pleased to share that APH was featured in Employee Benefits News (EBN) with an article that prominently features how Poindexter’s predictive analytics provide critical visibility into areas of high cost and risk with kidney disease and dialysis. We are passionate about this topic, as well as other areas of insight we are identifying for our clients via the Poindexter advanced and predictive analytics platform. The earlier we are able to provide visibility into areas of high risk and cost, the earlier our clients are able to offer support and intervention.

Below is the article title, an excerpt and link:

By Phil Albinus - Employee Benefits News - Published April 10, 2018

When an employee of Hill Country Memorial Hospital developed chronic kidney disease, the not-for-profit hospital in Fredericksburg, Texas faced a whopping bill. Not only was an employee facing a lifetime of dialysis treatments three times a week, missed work hours and increased medical care, the 80-bed hospital had maxed out its $1 million premium for its employee health plan.

“It cost us quite a bit,” recalls Becky Laughlin, the current benefits manager, who was the benefits coordinator at Hill Country Memorial Hospital when the incident occurred.

After the episode, the HR and benefits team looked for a solution. They found one in data management provider Advanced Plan for Health, which oversees its employee medical care expenses generated by its third-party employee benefit administrator Web TPA. Using its Poindexter program, APH oversees the hospital’s employee medical expenses, looks for patterns of cost overruns, pharmaceutical pricing and possible drug seeking behavior, overuse of emergency room and urgent care facilities. It generates reports that are sent to employers on a weekly, monthly or quarterly basis .

To continue reading click here .
Blog Insights
APH is honored to share that Rex Wallace , Principle of Rex Wallace Consulting , was a guest blog contributor for our second April blog. Below is an excerpt of the piece. 

On April 2nd, The Centers for Medicare and Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The entire document is a behemoth which includes important information about CY2019 for Medicare Advantage plans across a variety of topics. This paper will focus solely on the impact on Star Ratings.

The release of the Final Call Letter is one of a series of key milestone dates leading up to October 11, 2018, when CMS releases Star Ratings for each Medicare Advantage organization to the public.

To continue reading click here .
Rex Wallace is Principal at  Rex Wallace Consulting, LLC .

His firm is dedicated to helping Medicare Advantage plans improve Star Ratings. Prior to founding Rex Wallace Consulting, Rex held Consumer Experience and Star Ratings leadership roles at Cambia Health Solutions and Universal American. He is an esteemed expert in the Medicare space.
Our first April blog highlighted a topic of concern for many who are managing those in their population with diabetes. Here is an excerpt.

All entities managing health plans – self-insured employers, health plans, brokers and more – need to take note of the impact of diabetes on the health of their members and the financial bottom line of their health plans. Particular focus needs to be put on the recent changes to care guidelines for diabetic control as they aim to improve diabetic care – but differ – which is causing confusion.

In 2018, the American Diabetes Association (ADA) made significant changes by incorporating various individualized factors, adding cardiovascular drugs for those with hypertension or heart disease, modifying the HbA1c goals for diabetics with certain characteristics, and providing consideration to children and pregnant women.

To continue reading click here .
Featured Research

As mentioned previously, Advanced Plan for Health (APH) and The RISE Association (Resource Initiative & Society for Education) have launched a Medicare Advantage Plan Benchmarking Analysis research project.

Below is a snippet of a recent press-release regarding the research project:

This Medicare Advantage Plan Benchmarking Analysis will shed light into areas of commonality and outliers and will also include benchmarking. APH and RISE intend the research findings and recommendations to serve as a guide for areas of focus for continuous improvement. The full research findings will be blinded, and no participating plan will be identified. Participating plans will, however, receive a full report of their individual findings, benchmarks and recommendations.

Research participation is open to RISE member Medicare Advantage plans at no cost. RISE membership is also at no cost to Medicare Advantage plans.

Healthcare data analytics experts from Advanced Plan for Health (APH) and RISE Board members will look for commonality as well as outliers across the data sets, will present findings as well as recommendations and best practices at the RISE Quality Leadership Summit at the end of June, in Phoenix, Arizona. Results will also be available on the RISE website.

To continue reading click here .
We are in the final phase of working with RISE to recruit RISE member M.A. plans to participate. If you’d like to learn more about the research, please reach out to us at marketing@mypoindexter.com  
APH, On the Road
Upcoming Tradeshows and Conferences

May and June | NE Region U.S.
Corporate Synergies’ The Current Events are full day forums of exceptional Health & Welfare Benefits and Business Insurance speakers, whose insights will help attendees gain control over industry situations that are top of mind. The Forums’ faculty will deliver solid, actionable information that HR & Finance professionals can execute on today.

The Advanced Plan for Health team is honored to be participating in these Corporate Synergies Group events. We will be featured in their Benefits Tech Café, and at the May 9 and May 17 events, our Rick Scheel and Denis Cremin will be presenting best practices and a client case study – Advanced & Predictive Data Analytics: Driving Results for Employers . Registration is currently open for the events, and more details may be found here .

  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.

June 14-15 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.

July 16-18 l Minneapolis, MN

The HCAA TPA 2018 Summit focuses on the information and process needs of benefit administrators and the self-funded industry. It additionally offers break-out sessions for attendees in Leadership, Sales/Marketing, Operations and Emerging Leaders paths. 

September 23-25 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.