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TABLE OF CONTENTS
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W W W. S I P C O N L I N E . N E T
FEATURES 4
VIRTUAL 40TH NATIONAL CONFERENCE EARNS HIGH MARKS
By Bruce Shutan
10
CAPTIVE ACTUARIES IN THE TIME OF THE PANDEMIC
By Karrie Hyatt
ARTICLES 20
BEST PRACTICES FOR UPDATING THE EMPLOYEE HANDBOOK IN A PANDEMIC
32
SIIA PIONEER REFLECTS ON 40 YEARS OF INDUSTRY ACTION
26
ORGAN TRANSPLANT TRENDS CONTINUE TO CHALLENGE SOLVENCY OF COMPANIES’ SELF-INSURED HEALTH PLANS AS FREQUENCY AND COSTS CONTINUE TO GROW, MORE AND MORE ORGANIZATIONS ARE TURNING TO ORGAN TRANSPLANT INSURANCE
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SIIA ENDEAVORS
40
NEWS FROM SIIA MEMBERS
The Self-Insurer (ISSN 10913815) is published monthly by Self-Insurers’ Publishing Corp. (SIPC). Postmaster: Send address changes to The Self-Insurer Editorial and Advertising Office, P.O. Box 1237, Simpsonville, SC 29681,(888) 394-5688
Self-Insurer’s Publishing Corp.
PUBLISHING DIRECTOR Erica Massey, SENIOR EDITOR Gretchen Grote, CONTRIBUTING EDITOR Mike Ferguson, DIRECTOR OF OPERATIONS Justin Miller, DIRECTOR OF ADVERTISING Shane Byars, EDITORIAL ADVISORS Bruce Shutan and Karrie Hyatt, 2018 Self-Insurers’ Publishing Corp. Officers James A. Kinder, CEO/Chairman, Erica M. Massey, President, Lynne Bolduc, Esq. Secretary
DECEMBER 2020 3
F E AT U R E
VIRTUAL 40TH NATIONAL CONFERENCE EARNS HIGH MARKS
I
Written By Bruce Shutan
I
t has been a year like no other, with business travel crawling to a halt and scores of conferences being replaced by virtual events. But silver linings can be found in these uncertain times, and members of the Self-Insurance Institute of America were among the beneficiaries. With nearly 50 educational sessions, SIIA’s virtual 40th Annual National Conference & Expo delivered the most self-insurance and captive insurance content that has ever been included as part of a single event. It also was accessible to all SIIA members without the need for travel and hotel accommodations. The virtual format was a bit hit with 93% of attendees who responded to a postconference survey indicating that they had a positive experience. Several attendees noted that the daily virtual sign in had the look and feel of an inperson event.
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Virtual Conference
Laura Carabello
“The graphics they used for the openings and various events were just spectacular and very compelling,” recalls Laura Carabello,
She also appreciated establishing a rapport with other speakers of her pre-recorded panel discussion. “We all offered a lot of different perspectives,” says, adding that the session moderator was strong, personable and funny.
a principal with CPR Strategic Marketing Communications who has been involved with SIIA for nearly a decade, the past few years of which as a member of SIIA’s International
Kimlinger enjoyed what she calls “rolling conversations” in the conference lounge and participated in a discussion thread through which fellow SIIA Future Leaders members shared helpful resources and perspectives.
“You almost felt like you were walking into a building when you got online with this conference.” Committee.
Craig Clemente, chief operating officer for Specialty Care Management who was both a speaker and attendee, marveled at the show’s live feel. He was most impressed with the distribution of information, ability to have live chats and schedule appointments between sessions. “I thought they did a really good job of carrying as much of the value of a live conference over into the online environment as they could,” says Clemente, a SIIA member for 13 years who has spoken many times at the group’s meetings. As a speaker, Clemente missed the energy and “a feel for what the room is looking for” but found SIIA’s virtual format well-coordinated and user-friendly. “I just thought that there was a lot of continuity and consistency in the way that they presented everything,” he observes.
VIRTUAL CONFERENCE FATIGUE
Clemente also was partial to the lounge feature and weighed in quite a bit in the SIIA Future Leaders discussion thread. “We had a great kind of back-and-forth relative to all the topics of the day,” he recalls. “It was a very organic way to interact with other attendees and have a bit of a think tank and some open dialogue about what we heard from the keynote speaker, especially the first one, because she spoke directly to that subset of Millennials.” “I go to a lot of virtual conferences, and I have to say this one was probably the best,” Carabello says. “There were no hitches to getting registered or involved with various presentations. It just went smooth as silk…That’s almost a miracle in today’s Zoom world.”
Craig Clemente
Dani Kimlinger, Ph.D., CEO of MINES and Associates, was in the enviable position of being a speaker, exhibitor and attendee. A participant in SIIA’s annual national conference since 2013, she had been suffering all year from virtual conference fatigue. However, SIIA’s event far exceeded her expectations. She was impressed with all the preplanning for speakers and exhibitors weeks before the conference in terms of setting a tone, walking everyone through the technology platforms and organizing the event.
She also appreciated not having to choose among interesting presentations that were being held at the same time. As such, she was more inclined to step outside her wheelhouse. “I could attend presentations that may not have been in my realm previously,” she said, citing the captive insurance topic as an example. “I think that was an advantage.”
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Virtual Conference Since the virtual format can be almost invisible to participants, Carabello benefited from it in numerous ways. “You could be like a silent observer,” she says. “I didn’t feel like I had to dress up every day and put on makeup and wear heels and put on a great outfit because nobody saw me… It makes it more relaxed.”
with appropriate service providers, paved the way for proactive outreach that led to more meaningful conversations. “We were able to better target the communication very intentionally,” she reports. A number of groups scheduled post-conference meetings.
The virtual format also helped boost attendee
Carabello says one of her clients, AscellaHealth, a sponsor of the virtual conference, was inundated with meeting requests to learn more about the company’s specialty pharmacy management services.
I didn’t feel as exhausted Dani Kimlinger or fatigued, and I think our team also had a better experience than I think we were all expecting,” Kimlinger observes. stamina. “
Carabello was able to pace herself. “I could take a break, listen to a presentation, go back to work, resume my business, and still feel like I was part of a conference,” she notes. Whereas some Zoom meetings are fractured and poorly staged, Carabello says the SIIA event “felt upbeat as soon as you got online… You had follow-up. You had opportunities to express yourself.”
MATCHING BUYERS WITH SELLERS One huge uncertainty of the virtual format was how it would play out in the exhibit hall. MINES and Associates exhibited at one other virtual conference during the pandemic lockdown, which Kimlinger described as a “terrible” experience that wasn’t worth the investment. About 20 exhibitors simultaneously sat in front of a Zoom call camera to watch for attendees who would initiate a chat, then move into a private breakout session. “It was just a weird process,” she reports. “I had maybe two conversations in the course of three days where people came to me.” Given the complex nature of the behavioral health services her company offers, Kimlinger explains that virtual interactions can be challenging from the standpoint of luring in customers. “It’s not like you’re buying a widget on a website,” she says. “It’s a conversational sale.” Having access to the attendee list beforehand, along with using the conference’s messaging platform for correspondence and a feature that helped match customers
Dave Wilson
COMPELLING KEYNOTERS SIIA Board Chairman and Windsor Strategy Partners CEO David Wilson, a SIIA member for nearly 30 years, thought Kristen Soltis Anderson, a Republican pollster, television personality and writer who previewed the presidential election, was spectacular. “I loved the way that she wouldn’t rise to the bait that [SIIA CEO] Mike [Ferguson] was throwing at her,” he says. Clemente gave high marks to Robert Stevenson, a professional speaker who has been invited to many SIIA conferences over the years, for his thoughtful keynote on adjusting to the pandemic’s virtual world. “We actually
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Virtual Conference had him when we did our SIIA Future Leaders standalone event in Tampa,” he explains. “I think he does a wonderful job.” Among the educational content that resonated most with Clemente were topics involving data and population heath management and the history of SIIA, describing the latter session as “delightful” and recommending it to younger members for deeper industry context. “I thought it’d give a good appreciation for all the work that’s done to where we are now with SIIA,” he adds. Overall, he says there was no shortage of great content for brokers, TPAs, captives and stop-loss carriers. Privy to all of the pre-conference discussions and contingency plans, Wilson describes the end result as “a virtual conference like none I’ve seen.” He says the format change allowed SIIA to focus on educational content and
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provide an opportunity for many more SIIA member firms to participate. Whereas a company with 80 people might have sent only five of them to SIIA’s national conference in the past, he says there was no such restriction with the virtual event whose presentations were later posted on SIIA’s Canoe website and could be viewed at any time. About two years ago, SIIA began recording some of the national conference sessions and posting them on Canoe. While there was a time lag in the past, all virtual content this year was available throughout the event on a special link before migrating to Canoe. In the future, Wilson suspects more virtual sessions will be done. Like many attendees of SIIA’s virtual conference, Clemente had already managed his expectations months in advance. “By the time May hit, it just seemed completely unrealistic that, by October, we were going to either, A, have a vaccine, or B, that it was going to be maybe some version of a hybrid, which I had no idea how they would ever pull that off,” he says. While disappointed that he’d miss out on golf and other fun activities in Phoenix where the live event was supposed to be held, Clemente was pleased that SIIA’s virtual format still delivered on valuable educational content and all “the in-betweenthe-lines stuff” that facilitate business and meaningful interactions.
Bruce Shutan is a Portland, Oregon-based freelance writer who has closely covered the employee benefits industry for more than 30 years.
F E AT U R E
Written By Karrie Hyatt
CAPTIVE ACTUARIES IN THE TIME OF THE PANDEMIC
T T
he COVID-19 pandemic has created unprecedented times for the actuarial field. As a field that relies heavily on historical data, the pandemic has created a new dynamic for actuaries working with captive insurance companies.
When it became evident that COVID-19 would cause a widespread pandemic, George M. Belokas, vice president and actuary with GPW and Associates, Inc., thought, “Like most, my initial reaction to the pandemic was fear for the health and safety of my family, friends, colleagues, and clients. It became more evident that our clients would be negatively impacted when state governments began to mandate business closures and institute ‘stay at home’ orders.”
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Captive Actuaries Robert Walling, principal and consulting actuary with Pinnacle Actuarial Resources, Inc., thought that everything would become a bigger challenge this year. “It hasn’t disappointed. It doesn’t matter if we’re doing pricing studies, reserving studies, or new formation feasibility studies; it doesn’t matter what line of business we’re working on, COVID comes up in the first five minutes in any client discussion.” Al Rhodes, president and senior actuary, SIGMA Actuarial Consulting Group, Inc., had similar thoughts. “Initially my thoughts were focused on all of the challenges related to the management and evaluation of risk. We work for a wide range of clients of various sizes and in various industries. The pandemic does not affect each client the same way and some face new and emerging risks.”
“At the beginning of the pandemic,” Rhodes continued, “SIGMA put together some educational articles for clients about specific analytics that are helpful in determining early trends in unique client data. While immature data may be inconsistent, analytics can still provide valuable insights when analyzing early trends. Claim lag analytics and reviewing loss development trends at more frequent intervals, even quarterly, may be particularly useful.”
For Belokas, “We anticipated the direct impact of business interruption losses resulting from the mandates but it took longer to realize the indirect impacts.
Examples of indirect impacts include the reduction in health insurance utilization when elective procedures were not allowed, the impact of changes in driving habits due to school closures and businesses shifting to a remote workforce, and the liability businesses may incur resulting from their actions (or inactions) to slow or limit the spread of COVID-19. As we enter a new wave of cases, the full impact of the pandemic is not yet known.”
Actuaries deal in historical data. The pandemic created a whole new playing field
“There isn’t a great historical precedence here because of the way it affects differently individual industries and even individual companies within an industry. There is no one COVID-19 benchmark that is going to apply to every nursing home, trucking company, or janitorial service company. There is just not any universal solution that applies to every circumstance an actuary is going to come across.”
with all new data. According to Walling,
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Captive Actuaries As the captive industry is seeing a surge in growth, actuaries are staying busy right through the pandemic. With the hard market, companies are turning to captives to cover traditional risks, as well as new or underdeveloped risks that have been triggered by COVID-19.
“The commercial insurance market is hardening,” said Belokas. “Couple that with the commercial insurance carriers' refusal to cover pandemic losses and the result is a significant increase in interest for captive insurance and other alternative risk management programs. Actuaries in the captive insurance industry are extremely busy assisting in the development of new captive programs and analyzing the impact of COVID-19 and potential future pandemics on existing captive insurance programs.”
emerging risks as well. Specifically, we’ve seen more interest in what is defined as reputational risk or possibly crisis management risk. That’s becoming more of an issue with companies operating through video conferencing and is a great example of something companies didn’t have to worry about at the beginning of the year.”
According to Rhodes, “Many companies are seeking to fund more traditional risks in a captive because pricing is so high compared to prior renewals. We are seeing particular interest in property, automobile and general liability, and directors and officers liability. In the non-traditional risk area, we are continuing to see increases in
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Captive Actuaries through discussion and review of relevant internal data; even if that data does not look like a traditional loss run.”
The company works with client management to get qualitative feedback for anticipated frequency and severity of risks. SIGMA then researches and identifies industry-specific data that is relevant. “Finally, we consider prior market quotes, if available, for a risk. All of these can supplement the more traditional historical data, even if significantly limited.”
LOOKING AT THE DATA
Historical data is limited for many captives even without a pandemic. When data is limited, actuaries have to dig deep into the data that is available.
According to Belokas, “As an actuary in this field, we commonly find ourselves asked to analyze risks with little or no historical data. I find it helpful to begin the analysis by asking a few basic questions. What types of events would trigger a loss under the terms of the policy and how is the amount of loss determined. For example, if a captive wrote a policy covering ‘pandemic business interruption,’ how would the policy define a ‘pandemic’? Would a slow-down in customer activity trigger coverage or does the policy require a mandated closure of the insured business? Answers to these types of questions are critical to understanding a risk and developing a model that appropriately reflects the frequency and severity of a covered loss.”
For Rhodes and SIGMA, this requires working closely with their client to garner qualitative data that can supplement any quantitative data. “We take several approaches when data is limited. One approach is to focus on risk quantification
When faced with lack of historical data, Walling says that there is no substitute for looking into the data on a more granular basis. “A lot of it is looking at the data in a little more detail. For example, we’re looking at a workers’ comp program over the last year to differentiate between the COVIDrelated workers’ comp claims and the non-COVID claims. What we’re finding is that the workers’ comp claims are much smaller than the typical claim and they tend to have a much shorter duration. Looking at the data on a more granular level allows us to do a better job of isolating the impact that COVID is having.”
Rhodes suggests looking at data on a more frequent basis. Generally, for captives, actuaries look at the year-end data.
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Captive Actuaries Now, as business has been turned upside down for many companies, he suggests looking at the data more often.
“When things are rapidly changing with a client, looking at a certain metrics such as quarter to quarter changes might make more sense. For example, with workers compensation we are looking at a couple of things. Did the client experience a significant drop in payroll due to closed or limited operations? That’s going to affect their losses, so there could be a lot of initial information for us to analyze and then make adjustments to our original estimates.” For Belokas about GPW and Associates, they approached the problem this way, “Because the full extent of the impact of the pandemic is not yet known, we performed a stress testing of the assumptions to estimate the impact under various alternative
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assumptions. For example, we were engaged to analyze a captive insurance program and the risk of reinsurer default resulting from pandemic losses. This engagement required us to review Executive Orders mandating business closures throughout the U.S. and to analyze the business interruption impact of those Executive Orders on insured businesses.”
“I think almost every benchmark that actuaries use is going to be impacted by COVID this year,” said Walling. “It doesn’t matter if it’s long-haul trucking frequencies or workers’ comp loss development patterns, every industry has these weirds drops and surges. Take auto dealers for example, nobody sold any cars during the second quarter but once things started opening up, auto sales surged in the third quarter. The entire auto industry has this weird data where no cars were being shipped, no cars were being bought, so for the transportation and dealer side of the auto industry, all of their revenue data and their payroll data is unusual. For trucking companies, if you were hauling for Amazon, your results look great in the second quarter, but if you were a car hauler you were laying off all your people.”
As Walling’s example shows, every industry was affected differently, and even within the same industry each company had a different experience. This makes it harder to aggregate any data that is coming in. Not being able to look back to the previous five or ten years is pushing captives and risk managers to look to innovation.
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Captive Actuaries “The pandemic may not affect the amount of available data, but it has driven innovative approaches to handling low-data situations,” said Rhodes. “I think one of the ‘benefits’ of the pandemic would be that it is forcing risk managers and analysts to update approaches or methods that have proven to be outdated.”
He continued, “I think some innovation is due to the fact that risk management departments are being forced to use more in-depth analytics. Instead of just doing what they’ve done in the past, focusing on just the risk part of their job, they are going to focus more on metrics, data, and analytics. In the past, we didn’t see many smaller risk management departments employ analytics in a dedicated manner. The pandemic is forcing them to become more innovative in this aspect.”
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WHAT THE FUTURE HOLDS
With the limited data available from the beginning of the pandemic, actuaries can now start to compile data for future events. According to Belokas,
“Analyzing the impact to clients that had pandemic coverage during March and April 2020 provided us an opportunity to observe the impact and will help in analyzing the exposure to future pandemics. However, we must be careful to recognize that future illnesses and the reactions from businesses and governmental authorities are unlikely to be exactly like COVID-19. Any estimate of future losses needs to recognize this uncertainty.”
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For current financial ratings of underwriting companies by independent rating agencies, visit our corporate website at www.sunlife.com. For more information about Sun Life products, visit www.sunlife.com/us. Stop-Loss policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states except New York, under Policy Form Series 07-SL REV 7-12. In New York, Stop-Loss policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations. © 2019 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. BRAD-6503k SLPC 29427 02/19 (exp. 02/21)
Captive Actuaries
“A lot of companies out there have year-end policies— January to December— so the upcoming year-end renewals will likely be difficult on the insured side. We are going to have some clients that look very different from the beginning of the year and some clients that will look virtually the same. For clients whose operations have been impacted, it will be challenging to price for next year.” According to Rhodes,
Captives flourish when there is uncertainty in the insurance market and they will continue to grow as commercial carriers become more conservative in their policies.
“I expect commercial insurance carriers will continue to narrow language to specifically exclude pandemic-related losses,” said Belokas. “Captives have a proven history of protecting businesses from losses not well handled in the commercial insurance marketplace. Pandemic-related losses clearly fit this category and I anticipate most or all captives will write (or continue to renew) coverage for pandemicrelated losses at the next renewal.” A more immediate concern for actuaries is that pricing policies and renewals are going to be difficult over the next two years.
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Walling has a similar view, “I think we’re going to see a lot of conservative estimates at year-end because the last thing anyone wants to do is take an overly optimistic view. We simply don’t know if or when there will be a vaccine for COVID-19. We don’t know if there is going to be another bubble over the holidays. We keep seeing these regional outbreaks. We honestly don’t know how close we are to the end of this.”
Captive Actuaries
2021 will continue to see unusual data sets and depending on how COVID-19 continues to spread, businesses will likely see more unusual behavior in the marketplace. Rhodes said, “All of the data from 2020 and 2021 is going to be unusual. It could be longer than 18 months from now before the data gets sorted. It really depends on how quickly companies, and the economy, can get back to business as usual.”
He added that many of his clients are hopeful. “What we’re hearing from clients who had a slow-down—whether they had to furlough employees or had reduced sales—they do think things are going to pick up.”
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Still, with no end in sight for the pandemic, actuaries will continue to look to new ways to do their work. As Walling said, “For an actuary, a moving target is the hardest one to hit, so actuaries rely the idea that the way the next year is going to play out can be predicted on the last five or the last ten. There is nothing in the last ten that would have predicted this.”
Karrie Hyatt is a freelance writer who has been involved in the captive industry for more than ten years. More information about her work can be found at: www. karriehyatt.com.
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BEST PRACTICES FOR UPDATING THE EMPLOYEE HANDBOOK IN A PANDEMIC Written by Philip Qualo, J.D.
F
or many employers, the start of the holiday season usually brings forth the time of year to brush the dust off of the employee handbook and determine what changes are desired, and required, for the upcoming year. Although employers have generally been quick to adopt and enforce policies addressing COVID-19, the rapidly changing guidance and onslaught of personal and professional restrictions necessitate swift revisions as best practices and requirements continue to change from day to day. In general, employers should review and revise their employee handbooks at least annually to account for changes in local, state, and federal laws and workplace safety requirements. After an unprecedented year that unleashed a pandemic on the world, however, employers and their compliance teams are scanning their employee handbooks, scratching their heads, and wondering where to begin.
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In order to avoid the challenge of updating and re-distributing an employee handbook multiple times within a single year, it may be helpful to limit specific references to COVID-19. For example, I chose to use terms such as “Public Health Emergency” and “Pandemic” where possible. If COVID-19 has taught us anything, it is that life is unpredictable. Now that we have collectively experienced and continue to endure this pandemic, we now know that public health emergencies and pandemics can happen to us… yes, even to us. In finalizing our own employee handbook for a hopefully better 2021, I thought it would be helpful to share some lessons I learned on updating an employee handbook in challenging times.
AVOID NON-STATIC COVID-19 PROVISIONS As updating an employee handbook multiple times within a fiscal year can be an administratively burdensome task, a best practice is to ensure all policies included or updated in the handbook are relevant, as well as static, for the duration of the applicable fiscal year. This has been simple in most years, however, in response to the COVID-19 pandemic, the federal government passed a series of comprehensive laws, with rapidly approaching expiration dates, aimed at protecting American workers by regulating group health plans and imposing new leave paid entitlements on covered employers, such as the Families First Coronavirus Response Act (FFCRA). In addition to the FFCRA, state and local laws guidance continue to be updated at an unpredictable frequency that often necessitates a quick and temporary change to workplace rules in order to comply safety requirements. For employers that sponsor self-funded plans, it is also important to keep in mind that for any newly enacted leave entitlements that continue coverage, the applicable Plan Document should be amended to reflect this continuation of coverage and communicated to the stop-loss carrier so ensure no gaps in coverage.
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As such, including language in an employee handbook referencing an employer’s responsibility to contain a public health emergency or pandemic would apply to COVID-19 and other critical health crisis that poses a threat to workplace safety. For policies with an approaching expiration date, or that are likely to change frequently based on changing guidance, it may be helpful to generally reference them in the employee handbook and detail them in a separate platform or notice that can be updated and re-distributed with ease. For example, we use an intranet platform to house our most up to date COVID-19 policies. This allows for quick enhancements of relevant policies and immediate notification to employees. Although any platform accessible to all employees may be appropriate, an employer should take the additional step of distributing, announcing, or where
applicable, requiring sign-off for each and every change to document compliance with notification requirements. In this case, I expanded the handbook to include language that referenced the “Direct Threat Exception” to Americans with Disabilities Act (ADA) limitations to explain my employer’s ability to temperature check and inquire about health status. In this provision, I chose to leave out the term “COVID-19” because the direct threat exception would likely apply to any other declared public health emergency that may arise. The temperature check policies, on the other hand, may not be applicable in a different type of pandemic.
SO YOU’RE SAYING NOT TO INCLUDE ANY COVID-19 LANGUAGE? Employee handbooks are more than just a collection of policies for most employers, they are a snapshot of that year, a yearbook of sorts. Although some memories are better left … not remembered…employers may one day want to reminisce on challenging year. On the other hand, as COVID-19 is likely not going anywhere as soon as we hoped for, it may be a good idea to include some static references to COVID-19.
So I would not recommend pretending COVID-19 does not exist when it comes to the employee handbook. For example, in our own employee handbook, I developed a paragraph that describes COVID-19, briefly, and details our companies commitment to follow all state, local, federal and Centers for Disease Control (CDC) guidance. As this guidance is subject to change, and has from day to day since the start, I did not include specific references to our face mask policy. Is this important? – absolutely. Is the handbook, however, the best place to house a policy that may be outdated by the time it is distributed? – probably not.
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In summary, there are rarely two employee handbooks that are entirely alike in this world. There are not many rules surrounding what needs to go in one, or what needs to go out. For the most part, employee handbooks are not even legally required. It is, however, a strongly recommended best practice for an employer to maintain one and ensure appropriate policies as determined by their specific compliance needs. Therefore, employers are free to include any and every COVID-19 policy and language they desire. In minimizing the non-static language, however, employers can detail compliance with applicable rules and spare a lot of time, effort, and employee confusion on reconcithe most current workplace safety guidance.
Philip Qualo, J.D., joined the The Phia Group, LLC in June 2018. In his current role as a Compliance and Regulatory Affairs Consultant. Philip provides consulting services to employers, third-party administrators, brokers, and vendors on an array of topics focused on human resource and employee health benefit plan compliance. He proactively monitors the legal and regulatory environment to identify legal, regulatory and compliance-related gaps and advises internal and external stakeholders on areas of risks. He earned his J.D. from Villanova University School of Law and his B.A. in both Philosophy and English from Loyola University Maryland. Philip’s professional experience has ranged from practicing employment law, specializing in disability litigation, to managing federal grants and advocating for underserved communities on behalf of National Alliance on Mental Illness (NAMI).
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ORGAN TRANSPLANT TRENDS CONTINUE TO CHALLENGE SOLVENCY OF COMPANIES’ SELFINSURED HEALTH PLANS As frequency and costs continue to grow, more and more organizations are turning to organ transplant insurance. Written By John Richert, RN BSN MSM
FREQUENCY AND COST TRENDS According to the United Network for Organ Sharing (UNOS), a record-breaking number of 39,719 solid organ transplants were performed in the United States in 2019 -- a 9% increase from 2018 and the ninth year in a row a record has been set. Bone marrow and stem cell transplants performed worldwide and in the United States are tracked by the Center for International Blood & Marrow Transplant Research (CIBMTR). CIBMTR reports that the number of transplants continues to increase in the 4% range annually. Persistence Market Research reported in 2019 that the global bone marrow transplant market is expected to exceed $12 billion by the end of 2028.The growth is expected to be at a CAGR (Compound Annual Growth Rate) of 3.6% for the forecast between 2018 and 2028. North America will continue to lead the growth, followed by Europe. Together, the two will account for over 80% of global demand. It reflects the rising frequency of using bone marrow transplants to treat certain cancers. Between 2016 and 2020 (estimated), the combined number of autologous and allogeneic transplants performed in the U.S. increased 11%.
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Costs also continue to increase for transplants year-over-year. Examples from Milliman’s 2020 triennial report show allogeneic bone marrow transplants with an average estimated billed charge of over $1 million, double lung transplants at $1.3 million and heart transplants at $1.6 million. With other health care costs already increasing across the board, the need for employer groups to budget for one or more potential transplants at upwards of $1 million per transplant adds to the health plan’s burden. This is particularly difficult for small to medium size employer group health plans. If one or more transplants occurred in a single year, a company’s self-funded health plan and even the company itself could face a severe financial burden if no method or risk transfer was available.
POSSIBLE SOLUTION Historically, stop loss insurance provided a solution to mitigate the potentially catastrophic cost of organ transplants, as well as other high-cost medical events. But as the cost and frequency of organ transplants have risen, stop loss carriers are more often applying a higher specific deductible (“laser”) to known transplant potentials. The proliferation of lasers for organ transplants has increased the relevance of fully insured group organ and tissue transplant policies for self-funded health plans. These policies give self-funded health plans the ability to carve out transplant risk in response to lasers, through a predictable per employee per month (PEPM) premium. This budget stabilization approach to funding transplant risk, coupled with the fact that most stop loss carriers discount premium when an organ transplant policy exists, makes this approach to managing transplant risk a valuable tool for self-funded health plans.
Case study Without organ transplant insurance: A stop loss policyholder of 209 employees with a $439,000 premium, a $100,000 deductible, plus a potential liver transplant lasered at $800,000. The plan’s internal budget for the laser is $318.00 PEPM. With organ transplant insurance: An organ transplant policyholder of 209 employees with a $33,000 premium, a $100,000 stop loss deductible, plus a potential liver transplant. The stop loss carrier provides a (4.5%) discount, ($19,755) for having an organ transplant policy. The cost of organ transplant insurance is $5.28 PEPM. This illustration above demonstrates the potential financial benefit of carving out transplant risk. When comparing group transplant insurance policies, the plan sponsor should consider the following in their purchasing decision:
· Compare the coverages for: o first dollar or deductible per transplant claimant
o claims payment
direct to providers or reimbursement to policyholder for paid claims
o lifetimes maximums,
travel/lodging/meals reimbursement, covered transplant services
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· Does the policy include transplant medical management service? o Medical Director/Reviewer, Case Management and Utilization
Review Nurses registered or licensed in states where required
o Organizational URAC accreditation and/or registered as a UR Agent in states where required
· Will the transplant carrier cover transplant claims when pre-authorization or pre-notification did not occur, including transplantation when notified after the fact?
Price is a considerable factor in the purchasing decision. However, reviewing these considerations prior to purchase will ensure the plan sponsor receives the best value from their organ transplant policy and that members have a supportive customer service experience in the event they need the benefit.
Plan sponsors should also be confident that the carrier has the expertise with and knowledge of the latest developments in organ transplants.
RECENT TRENDS IMPACTING TRANSPLANTATION Many factors impact transplantation including regulatory, technological advances, health insurance and the availability of donor organs. The following are some of the more-recent developments around transplantation.
COVID-19 Once the pandemic became more widespread, according to reporting by The Lancet, including statistics from the United Network For Organ Sharing, deceased donor solid organ transplantation took a sharp dip in frequency for March and April 2020. As hospitals and more specifically transplant programs put safety measures into place, deceased donor organ transplantation frequency began to return to expected numbers. Living donor solid organ transplantation continues to track less than in 2019.
This is likely due to the virus, local/ regional protocols and the hesitancy of potential living donors in the current environment. Bone marrow and stem cell transplants did not take the similar dip and remain at expected frequency levels. There have been several successful lung transplants performed in Wuhan,
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NMP for donor lungs increased from 1.7% in 2015 to 6.3% by 2019; for livers, the increase was from 0.1% in 2016 to 1.4% in 2018. NMP for hearts has fluctuated from 1.5% in 2016 to just less than 1% in 2018. The added cost to organ procurement for the use of NMP could be at least $100,000.
CLOSING THOUGHTS Human organ and tissue transplantation will continue to evolve. While new therapies such as CAR T cell, immune and genetic therapies may eventually replace or augment bone marrow transplant as the treatment of choice, certain diseases may continue to be best treated with bone marrow transplants.
China, the epicentre of the outbreak, on patients whose lungs were devastated by the virus. There was also a U.S. citizen who had a successful lung transplant due to the damage done by the virus. It’s difficult to determine what long-term impacts the virus will have on organ function, particularly on the lungs. This will be a potential situation to monitor as the virus continues to unfold.
OPIOID EPIDEMIC IMPACT ON TRANSPLANTATION Of the 70,000 drug-related deaths in the U.S. in 2017, 68% were due to opioid overdose. Deaths from the opioid crisis have increased the availability of donor organs with hearts and lungs currently being used by transplant programs. A study published in the Annals of Thoracic Surgery showed that opioid hearts accounted for 1.2% of transplants in 2000 and 10.8% by 2017. Opioid lungs accounted for 2% of transplants between 2000-2007 and 7% between 2010-2017. The studies also noted there were equal outcomes for recipients of opioid hearts and lungs as those receiving non-opioid organs. Over time, it is possible that other opioid organs may be utilized.
USE OF NORMOTHERMIC MACHINE PERFUSION Normothermic Machine Perfusion (NMP) is a technology to preserve and/or enhance the viability of a solid organ for transplantation. Compared to the long-used organ preservation technique of static cold storage between organ retrieval and transplantation, NMP reduces ischemic injury, risk of organ dysfunction and other post-transplant complications in recipients.
Solid organ transplantation will continue to evolve with continued research and development in xenotransplant, mechanical and hybrid devices. In these cases, transplantation will continue into the foreseeable future increasing in cost and frequency.
John Richert, RN BSN MSM, Vice President Lead Underwriter, has 30 years of experience in developing and managing organ transplant insurance, including medical management, network development, claims and underwriting. John can be contacted at john.richert@ us.qbe.com for more information about QBE’s solution for Organ Transplant or go to https://www.qbe.com/us/ specialty/accident-health/products/organ-transplant.
This article is for general informational purposes only and should not be construed as legal, commercial or other professional advice. Any case studies herein are only hypothetical. Actual coverage is subject to the language of the policies as issued.
NMP holds promise for improved preservation, better assessment and reconditioning of organs before transplants. NMP will help expand the donor pool by allowing the use of organs that once would have been declined for use.
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SIIA PIONEER REFLECTS ON 40 YEARS OF INDUSTRY ACTION
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Written By Bruce Shutan
F
orty years after the Self-Insurance Institute of America was founded, no one has as much institutional memory about the industry than Jim Kinder. Since starting in the insurance industry in 1964, he worked for a TPA that managed 501(c)(9) trusts and later became SIIA’s first CEO. Since retiring from the organization, he is now chairman and CEO of Kinder & Associates as well as president of the Kinder Family Foundation. His daughter, Erica Massey, is SIIA’s executive vice president. Kinder recalled the group’s evolution in a chat with SIIA CEO Mike Ferguson at the virtual 40th Annual National Conference & Expo.
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Trinidad Navarro
Insurance Commissioner
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He said the goal in establishing SIIA was to represent risk takers, excess carriers and plan administers in the face of government efforts to regulate the self-insurance component of risk transfer and protect ERISA.
Jim Kinder
One powerful tool in SIIA’s arsenal is a national annual conference. The first such event was in New Orleans in 1981 where a mere five members helped lure 151 attendees to occupy 150 prepaid hotel rooms.
Four years later, SIIA developed a strong legislative presence in Washington, D.C., with the help of George Pantos, a principal in the law firm of Vedder Price. Kinder described him as “stronger than nine acres of garlic. He was committed to the cause.” The fledgling group’s first decade focused on health care, gradually expanding into the entire alternate risk transfer business, including workers’ compensation, property and casualty, and captive insurance programs. Kinder is pleased with the level of balance among these areas of representation across the organization. In addressing many highlights over the past few decades, Kinder remembered meeting President George W. Bush at a Greenville, S.C. fundraiser with Jerry Castelloe who was then with CoreSource. “We were able to bend his ear for all of about 13 seconds on association health plans,” he said, noting how AHPs began showing up in his speeches afterward.
Another fond – and funny – memory involved William F. Buckley, a blueblooded intellectual, lifelong Republican, author and editor of The New Republic who keynoted a SIIA conference one year at a hotel that was also hosting a Ringling Brothers and Barnum & Bailey Circus.
“We were following the elephants around to go into the banquet hall,” Kinder recalled, “and his one comment was, ‘when you guys throw a party, you really throw a party.’” He predicted that a ballooning federal deficit, coupled with legislative action in recent years and the pandemic’s devastating impact, could trigger “some very interesting taxation issues that have a major material effect to items like self-insurance, captive insurance or risk
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retention groups.” Asked what advice he’d give to the next generation of leaders in the self-insurance industry, Kinder encouraged active participation in SIIA and networking with one another. “Surround yourself with people smarter than you,” he said. “I think you still have the best of the best coming to the meetings, and that does set them apart, because they’re active.”
“The industry is a lot more complex than it was in the older days,” he continued. “Methods of communication are different. Nobody sees anybody, nobody knows anybody. It’s all this electronic stuff, which I think has its place. But sitting down, having a beer with somebody, or a Coke or coffee, and just looking eye to eye and talking to people
makes all the difference in the world, in my book, and I think it accelerates your learning curve.” Bruce Shutan is a Portland, Oregon-based freelance writer who has closely covered the employee benefits industry for more than 30 years.
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ENDEAVORS
SIIA ENDEAVORS MULTIPLE EDUCATIONAL AND CONNECTION OPPORTUNITIES PLANNED FOR THE NEW YEAR – MARK YOUR CALENDARS NOW
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ith 2020 soon coming to a close, the Self-Insurance Institute of America, Inc. (SIIA) is taking this opportunity to preview its 2021 event calendar to help you plan your participation. Unfortunately, ongoing COVID-19 concerns make it impractical to confirm traditional in-person events at this time. Given this reality, we can report now that the following in-person SIIA events produced in previous years will not be held in 2021:
-Self-Insured Health Plan Executive Forum -Self-Insured Workers’ Compensation Forum -International Conference -Mentor Connection Forum
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ENDEAVORS We do recognize, however, that there is significant interest among members to be able connect in-person. In this regard, two contingency plans will be considered for 2021.
Government Relations Webinar Update Series - Second Tuesday of the Month
First, should public health conditions improve sufficiently, SIIA is considering a scaled down and reformatted in-person event that could be held in early June. Additional details will only be announced should a decision be made to proceed.
With a new Administration and new Congress in Washington, DC, 2021 promises to be a very active year with regard to legislative/regulatory developments affecting the companies involved in the self-insurance/captive insurance marketplace. To keep members informed about what they need to know, SIIA’s government relations team will be holding a monthly webinar series from January through June.
SIIA is also making tentative plans to incorporate some in-person components as part of next year’s National Conference & Expo, currently scheduled for October 3-5, 2021 in Austin, TX. Please read more about the plans for this event in the next section.
Connect From Anywhere (CFA) Opportunities – 2021 The association is pleased to announce several Connect from Anywhere (CFA) events – SIIA’s re-branded and improved version of “virtual” events – for the upcoming year. Preliminary information is provided below with more details to follow in the coming months. Please note that we are not soliciting speaker applications at this time.
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ENDEAVORS CFA Members Only Networking Forum Series -The last Thursday of each month from January through June – 5:00 p.m. to 7:00 p.m. While we wait for public health conditions to improve enough to allow for the in-person networking functions that so many SIIA members value, the association is pleased to announce monthly CFA members’ only networking forums to be held from January through June to facilitate important connections via the Zoom video platform. The casual, after hours, format will allow for participants to be randomly rotated among multiple small group video chat rooms to maximize connection opportunities.
Medical Travel CFA Seminar Series February/March/April 2021 (Specific dates TBA) SIIA is developing a CFA seminar series to specifically highlight medical travel destinations – both domestic and international – that provide low-cost/high quality health care treatment services for self-insured employers.
This will provide selfinsured payers and advisors information to get head start on identifying potential provider partners while we wait for travel to return to normal.
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SIIA Future Leaders CFA Summit - April 20-22, 2021 (2.5 hours per day) The self-insurance industry has started to witness a significant generational change, with an increasing number of its long-time leaders transitioning into retirement. Coming up the ranks behind them are many talented younger members who will lead our industry in the years and decades ahead.
SIIA is encouraging this transition through its SIIA Future Leaders (SFL) initiative. The highlight of this initiative in 2021 will be a SIIA Future Leaders CFA Summit that is being designed to help prepare these younger members (under 40) for the challenges and opportunities ahead of them.
Direct Contracting CFA Executive Forum - May 18-20, 2021 (2.5 hours per day) Direct contracting arrangements between health care payers and providers have become the subject of increased interest in recent years. To help accelerate the growth of this market segment, SIIA has pulled together several of the brightest minds representing leading payers, advisors and providers to develop detailed “best practices” recommendations that will be shared as part of a Direct Contract CFA Executive Forum to be produced in 2021.
ENDEAVORS Hot Topic Webinar Series - Various dates from January through June, 2021 SIIA has taken several of the hottest topics from recent educational programs that will be produced via a live format with enhanced content. They will be scheduled on various dates from January through June.
CFA Mentor Connection Forum - June 17-18, 2021 Produced exclusively by SIIA, this event connects younger SIIA members (under age 40) with several of the most successful self-insurance/captive insurance industry executives in small group “Zoom Rooms.”
As mentioned previously, if public health conditions improve sufficiently later next year, SIIA will supplement the CFA format with in-person components to allow for an additional option for those who would like to participate in that way. Watch for announcements likely later next spring.
In the Meantime SIIA wants to take this opportunity to thank its members for their support and patience during a very tumultuous 2020. If your company is not a member, we invite you to join at this time so that you can take advantage of highly discounted registration fees and/or complimentary registrations for our 2021 events, among other benefits.
For immediate assistance, please contact Jennifer Ivy at jivy@siia.org. Should your company be interested in sponsoring any of the 2021 events listed above, please contact Justin Miller at jmiller@siia.org.
We wish everyone a safe and enjoyable holiday season and look forward to connecting with you in the new year from wherever you are. This format provides attendees unique access to those who can provide important career advancement advice, including how they can be more valuable to their employers. The program also facilitates interaction among attendees to help them build their professional networks.
CFA National Conference & Expo October 3-5, 2021 SIIA’s 2020 Virtual National Conference was widely considered a big success, with 93% of participants reporting that they had a positive experience according to a post-event survey. We expect that it will be an even better CFA event for 2021.
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NEWS
NEWS FROM SIIA MEMBERS 2020 DECEMBER MEMBER NEWS SIIA Diamond, Gold & Silver Member News SIIA Diamond, Gold, and Silver member companies are leaders in the self-insurance/captive insurance marketplace. Provided below are news highlights from these upgraded members. News items should be submitted to membernews@siia.org. All submissions are subject to editing for brevity. Information about upgraded memberships can be accessed online at www.siia.org. For immediate assistance, please contact Jennifer Ivy at jivy@siia.org. If you would like to learn more about the benefits of SIIA’s premium memberships, please contact Jennifer Ivy at jivy@siia.org. 40
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NEWS DIAMOND MEMBERS SYMETRA ADDS COVID-19 DEDUCTIBLE SAVINGS ENDORSEMENT TO STOP LOSS COVERAGE
BELLEVUE, WA — Recognizing the many challenges employers are facing as a result of COVID-19, Symetra Life Insurance Company, a leading stop loss carrier for more than 40 years, has introduced a COVID-19 deductible savings endorsement. Designed to help reduce the impact of COVID-19 claims on self-funded plans, this no-cost endorsement is being offered with all Symetra stop loss policies with effective dates from Jan. 1–March 31, 2021 in approved states. “Today’s benefits landscape is already challenging for employers with self-funded health plans. We are pleased to offer our deductible savings endorsement which was written with simplicity in mind to avoid adding to the administrative strain so many of our customers are facing in these uncertain times,” said Jeremy Freestone, senior vice president, Stop Loss. The Symetra COVID-19 deductible savings endorsement has just two eligibility requirements: (1) The primary diagnosis must be COVID-19, and (2) the claim must include inpatient hospitalization related to the COVID-19 diagnosis.
Once these requirements are met, the specific deductible for that claimant is reduced by $3,000. Symetra has worked closely with its stop loss policyholders and benefits brokers since the pandemic’s advent, implementing several policy accommodations including accepting COVID-19 diagnostic testing and treatment as “covered expenses” without a mid-year amendment to the employer’s plan document; continuing coverage for claims from employees and eligible dependents that no longer meet eligibility requirements; and extending the premium grace period. For more information on Symetra’s COVID-19 response for stop loss policyholders, click here. About Symetra Symetra Life Insurance Company is a subsidiary of Symetra Financial Corporation, a diversified financial services company based in Bellevue, Washington. In business since 1957, Symetra provides employee benefits, annuities and life insurance through a national network of benefit consultants, financial institutions, and independent financial professionals and insurance producers. Visit www.symetra.com.
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NEWS GOLD MEMBERS ADVANCED MEDICAL PRICING SOLUTIONS (AMPS) AND CANCER TREATMENT CENTERS OF AMERICA PARTNER (CTCA) TO OFFER COST-EFFECTIVE CANCER CARE
ATLANTA – Advanced Medical Pricing Solutions (AMPS), a pioneer in cost management for the self-insurance industry, has signed an agreement with Cancer Treatment Centers of America (CTCA) to provide its Clients and Members access to better cancer care. Employers want to provide employees with better options for care, but often do not know where to start. The addition of CTCA as a preferred Oncology Provider will allow AMPS Clients to offer their employees access to unparalleled cancer care at a significantly reduced price. Both organizations share the passion and value of offering exceptional care that is effective and affordable.
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“As a nationally accredited and recognized leader in quality and patient satisfaction, CTCA is proud to partner with forward-thinking organizations like AMPS, as its preferred oncology provider, to ensure its network has direct access to our world-renowned model of care delivered in a cost effective manner,” said CTCA Chief Strategy Officer, Linde Finsrud Wilson. Offering Employer Groups Access to Proactive and Affordable Cancer Care AMPS is committed to providing access to cost effective solutions to patients who need cancer care. With this partnership, employer groups contracted with AMPS can now offer their employees direct access to high-quality cancer care with “fair for all” rates.
NEWS
“We are excited to partner with CTCA,” said Kirk Fallbacher, CEO of AMPS. “It is clear consumers are looking for better managed care and ways to reduce healthcare costs. This partnership will expand patient options to meet individual healthcare needs while also lessening medical expenses.” About Advanced Medical Pricing Solutions (AMPS) Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers, TPAs, and reinsurers. AMPS mission is to help clients attain their goals of reducing healthcare costs while keeping members satisfied with quality healthcare benefits. AMPS leverages 15 years of experience in auditing and pricing medical claims to deliver "fair for all" pricing both pre-care and post-care. AMPS offers innovative dashboards and analytics to provide clients with insights based on Plan performance. Contact Amanda Hertig, Marketing, at ahertig@ advancedpricing.com and visit www.advancedpricing.com.
About Cancer Treatment Centers of America Cancer Treatment Centers of America® (CTCA) is a national oncology network of hospitals and outpatient care centers offering an integrated approach that combines surgery, radiation, chemotherapy, immunotherapy, and advancements in precision medicine with supportive therapies to manage side effects and enhance quality of life during treatment and into survivorship. CTCA® publishes treatment results annually including patient experience, length of life, quality of life, patient safety and quality of care. CTCA also offers qualified patients a range of clinical trials that may reveal new treatment options supported by scientific and investigational research. CTCA patient satisfaction scores consistently rank among the highest for all cancer care providers in the country. Visit cancercenter.com.
HPI NAMES ELIZABETH STONEMAN NATIONAL SALES EXECUTIVE Westborough, MA – Powered by a surge in national growth, HPI has tapped Elizabeth Stoneman as their new National Sales Executive. Elizabeth will fuel HPI’s market development and maximize their distribution channel across the country. She brings over 10 years of sales experience in the industry and is an expert on strategic development, relationship management and self-funding. “The addition of Elizabeth to our team is an exciting milestone for HPI,” said Drew Rozmiarek, Senior Vice President of National Sales and Emerging Markets.
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NEWS
“Elizabeth will play a critical role in our future success. When hiring for this position, I was looking for someone with tremendous all-around knowledge of self-funding, RBP sales experience and a strong reputation in the industry. Elizabeth checked all of those boxes and then some. She brings a fresh point of view on our continued growth strategies, has a stellar reputation in the market and came highly recommended from many trusted industry leaders.”
About HPI
Stoneman most recently served as Regional Sales Director at Trustmark, for which her responsibilities included new business acquisition, consultative functions and serving as the subject matter expert on Reference Based Pricing. Previously, she held a sales coordinator role at Humana.
SILVER MEMBERS
“I’m thrilled to be joining a team known for its creative strategies,” said Stoneman. “HPI is growing nationally and has a reputation for longstanding, successful relationships. I look forward to contributing to its expansion and can’t wait to see what the future holds.”
Willett is an experienced sales professional with more than 18 years of experience in the insurance industry.
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HPI redefines what is possible with self-funded health plans. As a leading national third-party administrator, they partner with health plan brokers and employers to provide innovative self-funding strategies and customized plans tailored to each client’s needs and population. HPI’s solutions give employers greater cost transparency and control, while elevating the member experience. It is their flexible approach, entrepreneurial spirit and commitment to quality, technology, and service that enable them to deliver premium value to their customers. Contact Su Doyle, VP of Strategic Marketing, at sdoyle@healthplansinc.com and visit www.hpiTPA. com.
CUSTOM DESIGN BENEFITS ADDS COLUMBUS TERRITORY SALES MANAGER, DAVID WILLETT
Cincinnati, OH – Custom Design Benefits (CDB), the area’s largest independent Third Party Administrator, is pleased to announce the hire of David Willett as Sales Manager in the Columbus, Ohio territory.
Prior to joining CDB, Willett worked with third party administrators and insurance carriers, earning him expertise in group health, dental, vision, disability and life insurance products. Willett brings a commitment to finding the right solution for a group with him to every client. “I’m excited to join the Custom Design Benefits team,” said Willett. “I’m ready to bring CDB’s innovative cost-effective solutions to the Columbus market and help employers find the right self-funded benefits plan for their group.” In his role as Sales Manager, Willett will oversee CDB’s continued expansion into the Columbus market. As a long-time member of the National Association of Healthcare Underwriters and the Columbus Association of Healthcare Underwriters, Willett understands the market and what groups need to offer competitive and comprehensive health benefits. “We are thrilled to have Dave here with us,” said Julie Mueller, President and CEO of CDB. “Dave’s familiarity with the industry and especially the Columbus market give us a lot of confidence in his ability to fuel our growth within this area and find the solutions that clients need.”
NEWS About Custom Design Benefits Custom Design Benefits (CDB), is a dynamic, service-oriented organization specializing in the administration of self-funded health benefits, compliance services such as FMLA, COBRA, and consumer driven services. Founded in 1991, Custom Design Benefits is the area’s largest independent Third Party Administrator servicing brokers and employers in Ohio, Kentucky and Indiana and is recognized as a national leader in the development and implementation of reference-based pricing plans. Additionally, Custom Design Benefits is one of the top 25 women-owned businesses in Cincinnati. Visit www. CustomDesignBenefits.com or email us at CustomDesignBenefits@ CustomDesignBenefits.com.
MAESTRO HEALTH ADDS LEADERSHIP KIM HOWE,
FRANCK BRICE AND JOE MEYER CHICAGO - Maestro Health, a techenabled third-party administrator (TPA) for employee health and benefits, officially announced the appointments of Kim Howe as Senior Vice President of Human Resources, Franck Brice as Chief Development Officer and Joe Meyer as Senior Vice President of Sales and Marketing. With decades of experience in the healthcare and insurance industries, their combined leadership will help Maestro Health expand to new markets and accelerate growth within the health and benefits space.
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Howe comes to Maestro Health with three decades of human resources and operations experience in the health and benefits space. As SVP of Human Resources, she has worked to enhance Maestro Health's employee benefits offerings, diversity, equity and inclusion initiatives, performance management program and employee onboarding. Prior to Maestro Health, Howe served over 13 years at AXA Equitable. She started as the Director of HR Operations & Payroll and transitioned to a Senior Director role overseeing finance transformation and strategic initiatives, including Equitable's eventual IPO.
"It's been a busy year for the human resources team at Maestro Health," Howe said. "We've listened to employees and provided them with the tools, processes and programs they need to be successful in their roles. More importantly, we're prioritizing our employees' overall wellbeing, including their physical, mental, financial and social health, just like the clients we serve." Brice joins Maestro Health from AXA where he led AXA Next's U.S. Health program. In that role, he designed and deployed a global operating model, launched algorithm-based insurance products, created a global health and wellness platform and optimized fraud detection using artificial intelligence. At Maestro Health, Brice is responsible for furthering Maestro Health's mission to lower costs and improve health outcomes for clients. "I've always been passionate about helping organizations innovate through technology to solve business problems," Brice said. "Joining forces with Maestro Health in a more direct role was a logical next step for both me and AXA. As Chief Development Officer, I can help draw stronger connections between Maestro Health and other AXA Next units, resulting in better outcomes for our clients." In Meyer's role as SVP of Sales and Marketing, he is responsible for leading all sales and marketing functions and go-to-market strategies in support of Maestro Health's new brand identity in the market. He's spent 20 years in the health plan space, holding leadership roles at Cigna, MedCost, Blue Cross/Blue Shield of North Carolina and Atrium Health. Throughout his career, Meyer has built a strong track record of revenue growth and market innovation with a keen focus on serving the needs of clients.
NEWS
"Having worked on both the provider and payer side, I've witnessed firsthand how the U.S. healthcare system has failed to serve the needs of employers and the patients trying to utilize the system," Meyer said. "It's clear employers and their trusted advisors need more from their health plans, like innovative and transparent self-funded benefits solutions driven by strong cost and clinical care management programs. I look forward to using my industry expertise and strong relationships to drive revenue growth and extend Maestro Health's reach across the market." About Maestro Health™ Maestro Health works with employers and their trusted advisors to administer self-funded health plans. By blending administrative services, clinical care management and cost management, we help employers optimize their benefit plans to drive better outcomes at a lower cost. When partnering with Maestro Health, employers can save money on healthcare and focus on what really matters—their people. Visit maestrohealth.com.
Do you aspire to be a published author? We would like to invite you to share your insight and submit an article to The Self-Insurer! SIIA’s official magazine is distributed in a digital and print format to reach 10,000 readers all over the world. The Self-Insurer has been delivering information to top-level executives in the self-insurance industry since 1984. Articles or guideline inquires can be submitted to Editor Gretchen Grote at ggrote@ sipconline.net The Self-Insurer also has advertising opportunties available. Please contact Shane Byars at sbyars@ sipconline.net for advertising information.
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THE SELF-INSURER
SIIA 2020 BOARD OF DIRECTORS & COMMITTEE CHAIR ROSTER
CHAIRMAN OF THE BOARD*
DIRECTORS
COMMITTEE CHAIRS
David Wilson President Windsor Strategy Partners, LLC Princeton, NJ
Kari L. Niblack, JD, SPHR CEO ACS Benefit Services Winston-Salem
PRESIDENT/CEO
Jeffrey K. Simpson Attorney Womble Bond & Dickinson (US) LLP Wilmington, DE
CAPTIVE INSURANCE COMMITTEE John R. Capasso, CPA, CGMA, PFS President & CEO Captive Planning Associates, LLC Medford, NJ
CHAIRMAN ELECT*
Peter Robinson Managing Principal EPIC Reinsurance San Francisco, CA
Mike Ferguson SIIA Simpsonville, SC Robert Tierney President StarLine Osterville, MA
TREASURER AND CORPORATE SECRETARY*
Gerald Gates President Stop Loss Insurance Services AmWins Worcester, MA *Also serves as Director
SIEF BOARD OF DIRECTORS Nigel Wallbank Chairman Heidi Leenay President
Thomas Belding President Professional Reinsurance Marketing Services Edmond, OK Laura Hirsch Co-CEO Aither Health Carrollton, TX Lisa Moody President & CEO Renalogic Phoenix, AZ
GOVERNMENT RELATIONS COMMITTEE Steven B. Suter President & CEO Healthcare Management Admtrs., Inc. Bellevue, WA CHAIR, INTERNATIONAL COMMITTEE Liz D. Mariner Ford Senior Vice President Re-Solutions, a Risk Strategies Company Minneapolis, MN CHAIR, SIIA FUTURE LEADERS COMMITTEE Brady Bizarro Director, Healthcare Attorney The Phia Group, LLC CHAIR, TPA BEST PRACTICES TASK FORCE Jerry Castelloe Principal Castelloe Partners, LLC CHAIR, WORKERS’ COMP COMMITTEE Shelly Brotzge Regional Underwriter, Group Self-Insurance Midwest Employers Casualty
Freda Bacon Director Les Boughner Director Alex Giordano Director
DECEMBER 2020
49
SIIA NEW MEMBERS DECEMBER 2020
REGULAR CORPORATE MEMBERS Jaiver Ojeda Co-Founder Provide International Logistics Solutions LLC Las Vegas, NV
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50
THE SELF-INSURER
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