Archive for March 4th, 2013

Another Carrier Touts Self-Funding

Monday, March 4th, 2013
Date: March 4, 2013 12:28:24 PM CST
To: undisclosed-recipients:; Subject: BIG NEWS: Assurant locking in renewals until Dec. 2014 and Self Funded now Available!
Last year there was BIG news at Assurant Health with the addition of the Aetna Signature Administrators network and this year there are several changes that will be extremely positive as we move forward in the year.  We will still have the Aetna network which gives your clients access to over a million providers. This year and beyond we will continue to focus on you, The Agent.  Take a look below at these Business Building Enhancements for 2013 from Assurant Health!  1. Beginning with 4/1 effective dates, rates and plans will not come up for renewal until December 2014 ( as long as the group doesn’t make a plan change).  So new groups that are effective April 1,2013, don’t have to worry about a rate increase or making a plan changed until December 2014. 2. We will NOW underwrite using HB 2015 information. As long as we have ALL of the requested information we will rate the case.  If we don’t like the result we can always submit full applications to have a full underwriting review in hope of a better rating. 3. We will be introducing our small group self funded plan to the market in the second quarter! This is a great option for groups concerned with an increase in rates in 2014. Since self funded falls under ERISA guidelines, it is not subject to the same health care reform rules and we can keep rates low (subject to underwriting).  This is currently being offered to group with 15 lives or more. 4. Our ancillary products are now available via an online web link that I can have set up for you on your website. Your clients can go in and buy a great product… accident, cancer, heart/stroke, dental, etc… and you will be paid the commission which starts at a minimum of 35% and goes up to 55% depending on plan choice. 5. We now have a new Occupational Accident Product that includes Employer Liability coverage!!  This is a great alternative to workers compensation coverage, which is easy to quote, easy to issue and easy to sell! It offers 15% first year and renewal compensation. These are just a few of the exciting things we are doing NOW as we continue to be the AGENT Centered company we’ve always been and our commitment to the small group market remains steadfast. If you would like to discuss any of these enhancements please give me a call.  I look forward to writing some business with you this year. [attachment “Proposal Request Form.xls” deleted by Jennifer Ranker/HEALTH/ASSURANT/US]
***Please note new phone number and address****
Jenny Ranker Irwin Small Group Sales Specialist Assurant Health 9990 Richmond Ave, Suite 375 Houston, Texas 77042 T 800.444.7322 ext 5869 F 414-299-1301
Earn up to 70% commission with Assurant Supplement Products.  Register or Log in to to start selling today!

Will Fee-For-Service Become Obsolete?

Monday, March 4th, 2013
National Commission on Physician Payment Reform Recommends Five-Year Transition Plan Away From    Fee-for-Service:
CPR will tell us how far we have to go on March 26th


Dear Colleague:The United States spends an unprecedented $8,000 per person on health care each year – more than any other nation. These costs are unsustainable. One of the single greatest factors driving health care costs is how we pay physicians – and it is fundamentally flawed. We cannot control runaway medical spending without changing how providers are paid. That’s why I formed Catalyst for Payment Reform and why I joined the National Commission on Physician Payment Reform.
A new Report from the Commission released today recommends that we move away from fee-for-service, where doctors are paid for each service they provide. Fee-for-service offers skewed incentives that promote fragmented care and encourage doctors to provide more – and more costly care – regardless of the benefit to patients.
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The Commission’s recommendations provide a blueprint for phasing out fee-for-service and transitioning to a more value-oriented, mixed payment model over a 5-year period. The recommendations are well aligned with CPR’s goal of achieving 20 percent of payments tied to value by 2020.On March 26th, Catalyst for Payment Reform will release a first-of-its-kind National Scorecard on Payment Reform, measuring what portion of private sector payments are currently tied to value versus fee-for-service. The Scorecard will give us a sense of how far we have come and how far we have to go to realize our goal. I hope you can join us in person or via webinar.Sincerely,

Suzanne Delbanco

From A Physician:

From a professional perspective, I resent not being paid for the expertise and time that I bring to the table, and that my services are being treated much like an assembly line worker.  Yes, I’m an old fart, and it’s hard for me to change, but that’s how professionals are paid in our society – based on complexity, time spent, and risks of the procedures we do.  Think about lawyers, engineers, architects, etc.  It’s piece work.  Is it efficient?  I would argue that it is.  What is not efficient is the unfricking-believable complex system we have of being reimbursed.  If I see you, send you a bill, and you pay it, it’s no different than any other service that is provided in this country every day.

Keep in mind that the other main method of payment is a flat fee basis (ala HMO full risk model) that transfers the insurance company’s risk to physicians who, by and large, are woefully inadequate at managing that risk – that’s simply not what we do.   And it has been proven to incentivize physicians to under utilize services that are reasonably necessary and appropriate due to financial incentives the other way.  I know insurers and employers like this b/c it cuts down on care and money spent, but it is not what is in the best interests of patients.  The problem began when we let 3rd party payers get between physicians and patients.  I know we’re not going back at this point.  But I’m not ready to concede that FFS is gone.  It will have a place in a substantial part of medical practice in the future – just not for everyone.  People with the financial wherewithal to pay a premium for convenience will continue to seek out those physicians who can offer them that service, and provide good medical care – all for a fee.  It may be a chicken or a pot of beans, but at least I won’t have to deal with fricking BCBS, and all those pointy headed bureaucrats that add nothing to the equation, but suck the life out of the system.

So, this self proclaimed “National Commission” is full of shit.  They can kiss my ass.

I feel better now.

From a TPA:

“The problem began when we let 3rd party payers get between physicians and patients.”

I seem to remember the providers pushing this not the payors. Any time providers want to go back to collecting from members I am reading to go. Won’t miss those 1099 love letters from the IRS for a second.