While we all start to sit down, our broker tries to put us at ease by cracking a few jokes. No matter how funny the humor, it doesn’t overshadow reinsurance renewal time for our self-insured plan.
The process starts with an overview of how many self-insured claimants hit specific level, came close, or how near we were to our aggregate attachment point.
We also review any significant diagnosed conditions that might exist and also examine the total amount of premium spent versus reimbursement. We review the numbers and a blues ballad starts blowing in the wind.
It’s the same old deal, the same old sad song. “Your catastrophic claim went over half a million” is like an out-of-tune violin. Or, perhaps the cadence of “You had four specific claims this year” will bring a tear to my eye. Even better and more popular, let’s all sing a bar from the familiar song “I know you didn’t have any claims, but the industry overall has been hit hard.”
You know what I want out of reinsurance? I want a whole freaking symphony of sounds that makes my heart sing with praise. I want the reinsurer to be a partner. Crazy idea? I don’t think so.
The way the industry is structured now, employers don’t communicate directly with the reinsurer. Why is that? Why, when they review a bid, can’t they offer tips, ideas, and ways to reduce risk for both of us? Why is it that they — the underwriting specialists — can’t tell me which disease management partners they’ve found who have decreased expenses for other employer groups?
I’ve discovered that many reinsurers want to be more involved with the employer but can’t. I wished my reinsurer would say, “Wow, you have value-based designs in place, you get a discount!”
I bet that if they had more frequent updates on my claim data, and saw an organ transplant coming, they’d be happy to suggest some transplant programs to offset our costs. Why doesn’t the reinsurance market provide a consultative approach and add value to the employer? I want them to sing in my choir.
I remember an out-of-network hospital claim that called in for pre-authorization to my Administrative Services Only (ASO) provider and was approved. But then, the claimant was just forgotten. No follow-up, no case management.
The member stayed there over two weeks. Even better, they released the bill payment at 100% with no attempt to negotiate it down.
When I asked my ASO (who also handled our reinsurance), why we both had to bear the burden of this expensive claim, their lyrics consisted of excuses, citation of policies, and overall lack of procedures.
Even when the reinsurance is bundled by the same provider, it still doesn’t work to protect mutual interests. Not on the Top 40 Hit List with me.
It’s time for a whole new reinsurance overture — a true partnership that monitors my risk, rewards me for wellness initiatives, and provides me with resources. Then, at renewal time the music will be a slick saxophone that calms my soul. Let’s start composing a new reinsurance rhythm! Are you ready to sing?
Guest blogger Karrie Andes, SPHR, is a frequent speaker on self-insurance, a freelance writer and HR professional in Kansas City. She can be reached at karrieandes@sbcglobal.net.
Already Registered?
If you have already registered to Employee Benefit Views, please use the form below to login. When completed you will immediately be directed to post a comment.
Not Registered?
You must be registered to post a comment. Click here to register.
7 Comment(s)
Posted by: karrieandes | March 11, 2010 9:06 AM
I am happy to see some posts here from brokers and TPAs that get involved and offer more value to their clients. I actually would expect that my broker or TPA make sure I have carve outs such as DM, CM, transplant, cancer care networks, home health, etc. And I also expect the good old fashioned "tussle" with the reinsurer to negotiate a good rate based on my plan design. But, what I want is not only a broker or TPA being a partner, I want the reinsurer to be a partner as well, and that requires an industry change. Let's say that the stoploss reinsurer has 1,000 clients, with a whole variety of providers. If the reinsurers were able to get the data dumps they need, they could then provide the employer, broker, or TPA suggestions. Brokers and TPAs don't take the risk. The reinsurer and the employer do, and that is why I want them to be more involved. Can you imagine what type of data mining abilities a reinsurer could have if they had access to the plan data of all their policies?
There are stoploss providers out there that want to communicate directly with the employer, but they have been able to break through the barriers in the market. That's just the way the industry is, and I think that needs to change. As one poster put it, maybe I am just singing to the choir...oh well, I like a good tune now and then!
Report this Comment
Posted by: gellery | March 11, 2010 7:12 AM
I totally agree with all of the other brokers who have responded; you need a better TPA and Broker. Other brokers and TPA would have assisted you with these issues and many other TPA's would have negotiated for lower payment on your out of state claim. Engaging employees with the health care delivery process is essential to reducing health care costs. Demand more from your providers (TPA, Broker, Wellness Provider) and require everyone to met on a regular basis to review claims experience and ongoing claims.
Report this Comment
Posted by: MSL | March 9, 2010 4:10 PM
You're singing to the choir sister... The reality is that the only two parties at the table that are "at risk" are the stop loss carrier and the self funded group. I'm on the stop loss side and my many years of providing spec and agg have taught me a few things including: ASO's are reluctant to bring stop loss to the renewal concert because of reluctance that any ideas and concept delivered will rub against provider contracting and control (ASO's are in the provider business before they are in the TPA business). Furthermore, traditional TPA's are reluctant to bring us stop loss folks along b/c of fear that any ideas and concept delivered will expose any shortcoming or strategy the TPA failed to deliver in their ultra competitive space. A solution is rooted in a deeper stop loss / consultant value proposition that encourages (the non threatened) broker to bring along stop loss. With this approach - we have done more client direct stop loss renewals in the last 5 years than the prior 10 combined.
Report this Comment
Posted by: Gary W | March 9, 2010 3:58 PM
I am ready to sing Karrie. We are building a choir of "wellness minded" employers with 50 to 450 employees who collectively want to improve their employee's "health" lifestyle. Not all employers qualify. Healthier lifestyles improves employee health risks resulting in fewer health claims over time. Unfortunately the current generation of children is not that healthy and will be the first generation that will not live as long as their parents.
Engaging employees with financial incentives and ongoing education is vital for success. I was one of the early HSA advocates, but HSA success is doomed if the employer does not offer financial incentives to employees.
Employers who have had enough of insurance company rate increases, can grasp our vision to lower health insurance costs.
Gary L. Whiddon, CFP President Health Plans Online, Inc. www.HealthPlansOnline.com/rx/bn
Report this Comment
Posted by: Jeffrey M | March 9, 2010 3:39 PM
You need a good TPA! ASO says it all "admin services ONLY". What you are asking for is not outrageous and indeed is available today. We work with our carriers throughout the plan year, and many of them get direct feeds of data from us and the UR providers so that management of claims becomes an ongoing collaboration. And our carriers are happy to suggest ways our clients can help themselves save money through plan design, disease mgt and other innovations.
Your experience with that out-of-network claim shouldn't have happened - there's no way to sugar coat it. Somebody wasn't watching the barn door until the horse was gone.
I have been in the business 32 years now, 27 as a TPA. I won't list my contact info here, but I love to talk to informed HR people like you. You get it!
Report this Comment
Posted by: robert f | March 9, 2010 3:20 PM
I would demand that my broker ask the reinsurer what suggestions they might have to reduce risk and premiums. Most Brokers only care about renewing the case and getting out of the office to renew other cases. As a Broker myself I always look at other options for my clients. You should always demand more from your Broker as they are being paid to do just that. Don't take no for an answer
Report this Comment
Posted by: Shammon | March 9, 2010 2:49 PM
I so agree! Heard those same songs over and over myself.
Report this Comment
Add Your Comments...