Jesse Larrison

Attention Stop Loss Underwriters & Clinicians: The choice is yours this renewal season. Are you still relying on traditional methods to review every single file this renewal season? Are you planning to spend hours formatting spreadsheets and then even more time reading line by line until your eyes hurt? What are the chances that you miss something major like a pending transplant or gene therapy after spending 12 hours reading the small font on a 30,000-row Excel file? There is a better way. It's not too late to implement AMS (Advanced Medical Strategies) Profiler for this renewal season. With Profiler, you no longer have to spend hours formatting and merging files. Imagine having every unique file format look the exact same after just ~5 minutes. Then, imagine being able to zip through a massive file in just a few hours (or less) without the fear of missing something major. Want to actually enjoy this upcoming renewal season? The choice is yours. #HealthInsurance #Underwriting #StopLoss #Healthcare #PredictiveAnalytics #BigData #DataAnalytics #Insurance #Innovation

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This is a common question I receive when speaking with Medicare payers. When it comes to routine vision coverage, what is the difference between Full Service versus Exam + Allowance coverage offerings? Please check out VSP's blog on this question. The blog not only clarifies the coverage differences, but how it impacts a member experience. https://lnkd.in/g6URCYHc

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Risk adjustment plays a critical role in the operations and profitability of ACA health plans. Therefore, health plans' ability to accurately capture and recapture HCCs is critical to financial success. HCC recapture rates is one window into the performance of a health plans' risk adjustment performance. This study provides HCC and RxC recapture rates for participating health plans and the study-wide benchmarks at key drill downs such as year, region, and metal tier. Featured Authors: Matt Sauter & Chia Yi Chin #ACA #RiskAdjustment #HCCs #HCC #RecaptureRates #RiskTransfers

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There's tons of buzz in the risk adjustment world about AI, Machine Learning, NLP, (insert buzzword here... the blockchain is probably involved somehow too) etc. models that seek to find potentially missed HCCs within your population. These models can be pretty cool, but we've found that before health plans invest a ton in fancy suspecting algorithms, they can often get a much bigger ROI from just using the data they have in front of them: if someone had a chronic condition last year, they probably still have it this year, and something as rudimentary as an XLOOKUP in an Excel sheet can find these opportunities. You can always count on the folks at Wakely to bring brilliant insights about the ACA market and risk adjustment - they've got unparalleled relationships within the ACA market that gives them a unique view into the challenges and opportunities. This paper found that the plans who were better at recapturing HCCs year over year saw a $20 PMPM improvement vs those plans who were not as proficient at recapturing HCCs - for a plan with just 10,000 members, that's over $2M a year in opportunity. What are you doing to maximize these opportunities right in front of you?

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The Q1 2024 staffing results for the Senior Living and LTC industry are out and the positive staffing trend continues as we have experienced growth for twenty-six consecutive months and have roughly 297,000 more team members employed than when hitting the staffing floor in January 2022. Even with this positive momentum, there are still 119,600 less team members employed within nursing and residential care than when COVID began to impact our communities in February 2020. AssuredPartners will continue to analyze this data as we enhance our strategies to further drive future positive momentum.

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The results of our RFP process are in – and BlueCross BlueShield of Tennessee has chosen Parkridge Health System as the provider partner alongside Erlanger for Blue Network S in Chattanooga. We're excited about bringing Parkridge facilities into Network S, given both their breadth of services and convenient proximity to more members throughout the area. We’re confident they'll deliver the high-quality care our Network S members deserve at prices they can afford. Our provider network team spent weeks analyzing bids from CHI Memorial and Parkridge, considering quality, patient experience, and affordability, among other key metrics. While neither bid would allow us to lower premiums, Parkridge’s bid came in significantly lower than CHI Memorial’s best and final offer and provides a much-needed path to slow future premium increases for our members. We do know the doctor/patient relationship is very important to many of our members, especially for our Network S members who see a CHI Memorial doctor today. Our plan is to have a contract with the CHI Memorial physicians regardless of our Network S RFP decision. If that plan does not work out, we’re committed to paying current rates to CHI Memorial doctors as well as applying in-network benefits to members. We think that’s our best option to provide peace of mind to our members. We know that it’s not a perfect plan. CommonSpirit could balance bill our members. We don’t feel like they need to because their current rates are very competitive. But that’s what we’re willing to do and we’ll do that indefinitely. Get all the details on this decision at BCBSTnetworkupdates.com

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The Inflation Reduction Act introduced several changes to Medicare Part D starting in 2025, emphasizing federal negotiation of prescription drug prices and requiring drug manufacturers to pay rebates, while adjustments to Part D out-of-pocket maximums and creditable coverage determinations are expected to impact employer-sponsored plans significantly. Learn more: https://ow.ly/nPgz50RraC8

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https://lnkd.in/ehEuEF-6 A new study reports that employer-based insurance rose from 55% of the market in 2015 to 60% in 2021. As #employers continue to shoulder rising #healthcare costs, health innovators have the opportunity to create solutions that benefit both employers and the greater health system. For some, value-based care #benefits show great promise as a sustainable solution. Learn more at:  https://lnkd.in/gzxVD4uK

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🏛️💼 Anticipating 2025: Medicare is poised for significant transformations, especially concerning Part D prescription plans. With proposed changes aimed at reducing consumer spending on medications, insurance companies are bracing for increased financial responsibilities. This shift comes as the industry grapples with cost containment in the wake of pandemic-driven expenditure rebounds. How will these changes affect the healthcare landscape? Professionals, share your insights on navigating these upcoming challenges. . . . #Medicare2025 #Medicare #Employeebenefits #Medicarecoverage #HRInnovation #HRChallenges #HR #DoctorsChoiceusa #Healthcare

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Episode 2 of #CoffeeTalk is LIVE! Just wrapped up a discussion in Nashville about the importance of short-term care insurance. Did you know about the nuances of Medicare outpatient observation status? Let's talk solutions! Share your thoughts in the comments below. #seniorcare #shortterm

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Heads Up! There are upcoming changes in the staffing domain for the July 31st Care Compare refresh that could impact the star ratings of your nursing homes. This article provides more information about the updates, including the modifications to staffing turnover measures. #MarshMMA #seniorliving #CMS

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Despite congressional efforts to increase transparency and limit drug pricing, pharmacy spending is still on the rise. This is due to factors such as drug prices, utilization, and emerging therapies. As a result, employers may find it challenging to limit the impact of rising prescription costs on their premiums. However, there are alternatives to consider. #pharmacy #drugpricing #healthcare #employers #alternatives #EmployeeBenefits #Insurance

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Nearly all HPL policies require physician providers to be scheduled for coverage to extend. On the other hand, most mid-level staff are automatically extended coverage under an HPL policy – with the typical exception of independently contracted mid-level staff. We interviewed numerous HPL underwriters in order to provide you with an understanding of why that is as well as the potential impact of this HPL coverage peculiarity. HPL: What About Those Independently Contracted Mid-Level Providers??? https://hubs.ly/Q02CwQYW0

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It is interesting to see how vertical integration continues to advance in Healthcare each year.

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CMS announced the 2025 maximum broker commissions for Medicare Advantage and Medicare Part D plans. Discover how much you can earn writing MA and PDP business for the 2025 coverage year in this episode! 🎧 https://buff.ly/3W6vff0 . . . . . #ASG #ASGPodcast #AgentSurvivalGuide #Insurance #InsurancePodcast #InsuranceAgency #InsuranceAgent #RitterIM #RitterInsuranceMarketing

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Remaining Second Quarter Deadlines and Reminders 2024 June 01  -  Submit prescription/medical plan cost reporting to CMS (RxDC)   PCORI Fees Due by July 31, 2024 Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2024 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI). Further Consolidated Appropriations Act, 2020, extended to plan years ending on or before September 30, 2029 The amount of PCORI fees due by employer sponsors and insurers is based upon the number of covered lives under each “applicable self-insured health plan” and “specified health insurance policy” (as defined by regulations) and the plan or policy year end date. This year, employers will pay the fee for plan years ending in 2023. -         For plan years that ended between January 1, 2023 and September 31, 2023, the fee is $3.00 per covered life and is due by July 31, 2024 -         For plans years that ended between October 1, 2023 and December 31, 2023, the fee is $3.22 per covered life and is due by July 31, 2024 NOTE: The insurance carrier is responsible for paying the PCORI fee on behalf of a fully insured plan. The employer is responsible for paying the fee on behalf of a self-insured plan, including an HRA. In general, most health FSAs are not subject to the PCORI fee.   Source: https://lnkd.in/e6nuQgxT [irs.gov]

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The Inflation Reduction Act introduced several changes to Medicare Part D starting in 2025, emphasizing federal negotiation of prescription drug prices and requiring drug manufacturers to pay rebates, while adjustments to Part D out-of-pocket maximums and creditable coverage determinations are expected to impact employer-sponsored plans significantly. Learn more: https://ow.ly/yv0z50Rz6P3

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