Live at the SIIA 2022 Engage Conference, we have our special guest Jeff Kelly, President at Buckingham Self-Funded Solutions. During this visit with host, Sally Pace, Jeff explains how gene therapy crosses over into stop loss. "Gene therapy translating into stop loss is the equivalent of profitability versus loss. As a stop loss carrier retaining a set threshold of risk and these gene therapy drugs coming out with the names that we have all heard, these million dollar price tags and such. I mean these are almost automatic claims to a stop so that these gene therapy drugs and the advanced biosimilar companies bringing in these cancer therapies and J codes, G codes, and every other code that we're about to become aware of. So bringing in cost contain measures stop-loss carriers are already acutely aware of this and they're already putting together solutions. So gene therapy is unfortunately here to stay. It will be evolving throughout the future." Learn more in this episode of The Granite List Live.
Live at the SIIA 2022 Engage Conference, we have our special guest Mary Kay Puckett, Vice President of Employee Benefits at Alliant Insurance Services. She told our host, Sally Pace that friction with TPA partners is healthy. She says, "if there's friction, that's healthier because we represent the clients and we have to make sure that it is always within the client's best interest, whatever the decisions are." Her predictions for the near future include more emphasis on controlling the high dollar drug costs. Also, the focus on transparency helps control costs and make better decisions on health plans as companies consider working with us.
Sally asked Mary Kay about the trend in smaller groups seeking self-funding. Mary Kay says, "
Any group size can be self-funded. You just have to make sure you have the right reinsurance levels." Listen to this full episode of The Granite List Live, "
Live at the SIIA 2022 Engage Conference, we have our special guest Monique Burke, Director of Stop Loss Center of Excellence at OneDigital. She told host Sally Pace that they are seeing a lot of new things in pharmacy services. Employers are now wanting options that the largest employers only used to have. They are looking at self-funding and carving out their pharmacies. Most of the buzz she's hearing is about captives, and repricing direct to the consumer. Sally asked Monique about a success story. Monique told her, "We've been able to lower their rates, same coverage, and actually a better contract by just getting additional quotes. So taking it out to market each year. We've also been able to successfully help clients get their 1 million plan repaid in 48 hours."
Live at the SIIA 2022 Engage Conference, we have our special guest Susan Euteneuer, General Counsel and Chief Compliance Officer at Oxford Risk Management Group. Host Sally Pace asked Susan what people should be looking for when considering a captive. Susan says that first they focus on the formation and operation is in a compliant manner. Oxfod does this by guiding their clients to carefully document their file so there's a lot that goes into make sure the file is built up so that regulators can review it and do a thorough vetting and can approve yoru captive. Oxford is able to offer an AM Best A-Rated insurance product. Susan talked about one of their new programs they started offering in the past year, their Limited Lines Program. She says, "...that is particularly to address these hard market challenges around certain business auto coverages, directors and officers, certain property coverages, really expanding that offering with some great clients and great strategic partners."
The Oxford Risk Management Group is the leading provider of captive insurance services.
Live at the SIIA 2022 Engage Conference, we have our special guest Lindsay Harris, President, and CEO of Healthcare Management Administrators (HMA). They are backed by Cambia Health Solutions giving them access to the blue network across the country. HMA has been a member and partner of SIAA for over 20 years. She attended to focus on learning more about transparency, settlement process and resolution processes to see what is new in these areas that she can take back to benefit their clients.
Sally asked Lindsay her take on where the industry is, she says, " I think our industry's been in a state of flux and change for a long time, and I think that's going to continue. First, I would say I think increasingly what we're seeing is the industry is no longer about pain claims and just being a partner in that regard. Increasingly, we have to do more and engage numbers earlier in their healthcare journey to affect change and helping them to make the best choices in their healthcare. (this is done by) Helping them to find the best places so that they can get the best outcome possible for themselves, as well as really ensure that the plans that we're administering are sustainable financially long term."