As
seen in AHIP Coverage...
Managing
Catastrophic Claims
By Charles
Crispin
Catastrophic claims, defined here as medical claims of $1 million
or more, were rare a decade ago. While still not a typical occurrence,
they are surfacing with greater frequency. In fact, it is no
longer unusual to see claims of $2 million or more incurred by
a single member.
A recent study by one reinsurance organization found that the
number of $1 million-plus claims in its pool of reinsured members
has tripled in the past three years. In a 1999 study by another
reinsurance company, 2 million covered lives generated only two
claims greater than $1 million. In 2006, however, the company
projects that 1 million covered lives will generate 10 such claims.
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As
seen in National Underwriter Life & Health...
Medicare
Advantage: As Enrollment Grows, So Do Risks For Plans
The new, revamped
Medicare Advantage program has proven surprisingly popular
with the public—and with plan sponsors. As of July
1, 2006, nearly 7 million Americans had signed up for an
MA plan and 20 million had enrolled in the separate Part
D drug benefit. The number of individual health plans participating
in the MA program has also increased this year. Acc ording
to a recent Kaiser Family Foundation report, as of July 1,
there are 512 separate MA plans, up from 292 in July 2005.
As the number of beneficiaries and the number
of plans grow, the potential rewards and risks for each plan
also grow. Many new contractors are smaller, regional health
plans, competing in a market that is dominated by large, publicly
traded plans.
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As
seen in Business Insurance...
Managed
care companies seek help, advice from reinsurers
A rapidly
changing market for managed care companies is altering the
relationship between medical reinsurers, reinsurance brokers
and their clients.
As managed
care companies deal with opportunities such as a reinvigorated
Medicare market, they will need more help and advice from their
reinsurance partners about how to make the best of those opportunities,
reinsurers and brokers say.
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As
seen in Senior Care Management...
Medicare
capitation poised for major comeback in 2005
By all estimates,
Medicare Advantage is poised for an enrollment explosion in 2005,
and capitated physician and hospital organizations should immediately
start reassessing their risk contracting management systems, two
experts tell Senior Care Management.
“We
are in a very strong managed care cycle now. It is significant,
especially with Medicare,” says
Charles Crispin, president of Evergreen Re, a Stuart, FL-based
reinsurance brokerage and consulting company. “With all
the new benefits brought into Medicare, we will see payers like
Humana and others put the metal down, and there will be a large
migration into managed care.”
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As
seen on AAHP.org...
Strategies
for Managing Risk in an Era of Rapid Change
By Charles Crispin
The nation's
changing health care landscape is forcing health plans and health
insurers to newly confront the old business adage of "no
risk, no reward." With the recent passage of the Medicare
reform bill and the growing popularity of consumer-choice products,
many companies are considering entering new markets and launching
new products.
Plans embarking
on these new marketing opportunities naturally want to maximize
the possibility of reward while minimizing the risk. The calculation
of risk has long been a core business activity for health plans
and health insurance companies. Now executives must go beyond
simply computing risk or accounting for it in underwriting tables,
they must actively manage its component factors.
.
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As seen in Drug Cost Management Report...
Evergreen
Re Says Its PBM Audit Service Cuts Drug Spending
Health care
reinsurance and medical risk brokerage firm Evergreen Re is offering
an auditing service to evaluate health plans' and employers' PBMs
that it says can generate between 3% and 5% savings on pharmacy
spend off the cuff. The service was developed as a "best
in class" approach to utilizing various types of pharmacy
cost analysis products, according to the company.
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As seen in National Underwriter...
New
Risks, Tighter Reinsurance Terms Pose Risk for Self-Funded Plans
For many
employers, the era of self-insuring health care benefits has quickly
turned into the era of managed risk.
Rising health
care expenses, fueled by new technologies, treatments and increasing
utilization, have created new, potentially damaging risks. The
continued risk in health care costs and ongoing changes in reinsurance
underwriting capacity and pricing are making future benefits cost
projections all the more difficult for employers.
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As
seen in Capitation Rates & Data...
Give
your reinsurance policy a thorough check up
The nature
of risk management has changed dramatically over the past few
years, with the reinsurance trend rate leapfrogging the overall
medical trend, according to Charles Crispin, president in the
Stuart, FL, office of Evergreen Re, a managed care consulting
firm and reinsurance brokerage. An overall loosening of referral
and management controls by health plans has led to increased utilization,
which is likely to continue. Providers, especially hospitals,
have leveraged their negotiating strength to seek -- and, in many
cases, receive -- higher contractual reimbursements. The aging
of the U.S. population has heightened the incidence of certain
diseases that most frequently occur in older adults, such as Alzheimer's,
Parkinson's, and many cancers.
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Health
Plan Advisor - February 2003
By
Reden & Anders, Ltd.
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As
seen in The Wall Street Journal...
Sorry, Only Half of That Surgery Is Covered
By Amy Dockser Marcus
Undercoverage
has become more pervasive as sophisticated new medical procedures
become more commonplace. Charles Crispin, chief executive officer
of Evergreen Re Inc., a health-care consultant in Stuart, Fla.,
says he has noticed more restrictive policies recently as companies
struggle to protect themselves from catastrophic claims. He points
to one client that provided coverage for a hemophiliac teenager
whose drug bill was over $16,000 a month. "It all comes back
to the company's ability to finance it," says Mr. Crispin.
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the full Wall Street Journal Article
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As
seen in HealthLeaders...
Payback Time
By Bonar Menninger
Practical
lessons in managed-care contracting usually don't come cheap.
Terry Hargadon, CEO of Long Island Health Network in Melville,
N.Y., recalls one of his former employers that developed a new
heart program but overlooked on important detail: The hospital
neglected to renegotiate payor contracts to insure adequate coverage
of the service.
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Branching
Out with Self-Funded Health Care
By Chuck Newton, Evergreen Re
HR executives
preparing to deal with the costs of health care benefits may feel
like they're being led to the chopping block as analysts estimate
annual increases ranging from 16 percent to 20 percent this year.
With no relief in sight and pharmacy costs tailing right behind
health care costs, HR executives are turning - or returning -
to self-funded benefits programs.
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