Fourth Quarter 2016I May Be Fat But You May Be Ugly and I Can Always Diet | Executive Forum 2017 is Fast

Approaching | Take Advantage of Our Subject Matter Connectors | Save The Date for TPA Summit2017 | New CSFS Designees | 2017 Sponsorship Opportunities Await | Get Social with HCAA

I May Be Fat But You May Be Ugly and I Can Always Diet

By Steve Rasnick HCAA President

I honestly donrsquot remember where I first saw this saying but it reallymoved me ndash well beyond the fact that itrsquos either hilarious or veryoffensive If you feel that itrsquos the latter please forgive me becausethat is not my intent

I liked the saying so much that I had it emblazoned on a few teeshirts which I always wore when exercising or walking the beachThe reaction of anyone that saw me was remarkable Most thought itwas funny and some may have thought it was rude but either waypeople thought about the message People ndash who would not

otherwise look twice at an overweight balding old man ndash laughed and often commentedeither to me or amongst themselves Those that understood the message understood thatall of us really do have choices many of which we make every day What do I wear todaywhat do I eat today supersize it do I smoke or drink do I drink and drive do I take mymedication do I abuse drugs will I be kind or nasty and others too numerous to list Allare personal choices many of which impact our health and ultimately the cost of ourhealthcare How was that as a segue into discussing health costs prevention wellnessbehavior modification and the value proposition of a TPA

There is no question that health coverage costs continue to increase at a very alarmingrate and that we are as a nation rapidly approaching the point where healthcare may nolonger be affordable for the averageshysized employer and absolutely not affordable for smallemployers But why We live in America the greatest nation in the world Why should anyAmerican ever be without access to the best healthcare and robust health coverage to helpwith the cost There is only one reason in my opinion ndash Itrsquos just too darn costly andheretofore employers jumped from carrier to carrier to find lower rates or cost shift toemployees or worse yet both But isnrsquot that treating the symptom rather than the illness

The reason that health coverage is too expensive is caused in part by how much profit aninsurer makes the cost of medical malpractice insurance defensive medicine the totallack of price transparency permeating the entire medical delivery system and much moreHowever these are just symptoms and the root cause of the problem is just not thatcomplicated Itrsquos due to the general deterioration of the health of Americans starting withparents and the terrible choices and examples that we continue to make regarding ourown health wellness and prevention What kind of message are we sending to ourchildren Our legacy is a generation of obese children afflicted with the preventablechronic diseases that can only continue to increase healthcare costs Irrespective ofwhether healthcare is funded through the private sector or public sector the present modelis unsustainable The problem may be the cost but the solution is in dealing with the causein a more effective manner

Those of you who know me must wonder ndash at age 72 why is Steve preaching aboutwellness I take so many medications that I glow in the dark and when I jump on my WiiFit it politely greets me as ldquofat boyrdquo and begs for forgiveness as I punish the board doingexercises not intended for an overweight but no longer obese individual Worse yet thegovernment added insult to injury Years ago when I finally received my Medicare Part ldquoArdquocard something that I had seemingly worked my entire life to earn my sex was indicatedas female It came with a letter from Social Security stating ldquoMs Rasnickrdquo we are here tohelp yourdquo but that is another story

My company pays claims on behalf of employers who choose to partially selfshyinsure theiremployee benefit plans In 2015 we paid almost $650 million to local and regionalhealthcare providers and over the past 19 years we have paid almost $3 billion inhealthcare claims so we have a pretty good idea as to utilization patterns providerpractice patterns and general healthcare trends Itrsquos not very pretty

Almost 90 of all claims dollars paid are spent on only 10 of plan participantsJust imagine how much we could reduce our overall healthcare costs if we couldavoid even a small portion of these claims through improved wellness andpreventionThe largest claims are due to the consequences of poorly treated or untreatedchronic diseases which were preventable (primarily obesity and diabetes related)59 of next yearrsquos highshycost population will come from this yearrsquos presumablyhealthy population71 cents of every healthcare dollar is spent on treating conditions that are lifestyleshyrelated and potentially reducible by behavioral changesMost conditions were negatively impacted by the patient not receiving the righttreatment at the right time from the right physician doing the right thingsMost treatment is episodic and a large percentage of our covered population doesnot participate in a consistent chronic disease management treatment program Wespeculate that this is due to a laissezshyfaire attitude on the part of the patient poorlydesigned benefit plans and a reduced number of primary care physicians

So what can we do to more effectively deal with the true cause of our increasing healthcoverage costs Itrsquos really not rocket science We need to promote a change in our internalwork cultures and to realign our benefit plans to encourage wellness and prevention and topromote behavioral modification Moreover we need to find a way to reward participantswho are successful and to equitably hold others accountable for their failure to improvetheir lifestyles The goals of reward and accountability are not mutually exclusive

All of the above statistics came from our Population Health Software where we identifygaps in care and develop employer programs that engage participants in wellness throughthe development of creative reward programs Our nurses actively engage participantswith the sole goal of seeing that all participants receive the right treatment at the righttime from the right provider who is doing the right thing and more often than not we aresuccessful Itrsquos software that is similar to software used by most TPAs

HCAA is all about TPAs and selfshyfunding so how does all of the rhetoric about wellnessand prevention relate to TPAs and selfshyfunding Itrsquos really quite simple You cannotmanage that which you are unable to measure Have you ever seen or heard of a BUCA(BluesUnitedCignaAetna) that makes available the same type of information tocustomers or agents Of course not and employers that jump from carrier to carrier eachyear and never consider a TPA are just treating the symptom and not the illness

Is it possible that the BUCAs do not have sophisticated Population Health Software We allknow that they have it so why donrsquot they normally make that information availableBecause transparency is not their friend as it shifts the ldquopowerrdquo to the plan They treateveryone like a mushroom because it helps them spread their risk

This message is all about choices Uninformed employers can continue to ignore selfshyfunding and each year shop for the lowest insured rate Uninformed participants will stillldquosupersize itrdquo And some TPAs will continue to differentiate themselves based solely uponhow well they pay claims and ignore their real value proposition ndash their powerful dataanalytics tools plan design flexibility and virtually unlimited transparency

So I ask why not a TPA

Executive Forum 2017 is Fast Approaching

The 2017 Executive Forum will be here before we know it Donrsquot miss out on yourchance to save with our discounted registration rates available only for a limitedtime And be sure to book your room at the conference hotel in support of ourorganization for the best group rates REGISTER HERE

The conference is set to be an exciting gathering just weeks after our new president takesoffice ndash wersquoll have much to discuss as we examine the impact the new administration andother evolving industry pressures bring to the selfshyfunding ecosystem Hear from an expertlineup of speakers on important topics such as

ldquoArt Assassination and America How Transparency Disrupts an Industry andChanges a Nationrdquo Presented by Martin A Makary MD MPH ndash Professor of SurgeryJohns Hopkins University School of Medicine

During the 2008 financial crisis ldquotoo big to failrdquo became a familiarphrase in the US financial system Now the US healthshycare system isheading down the same path with record numbers of hospital mergersand acquisitions let alone the looming BUCA ones Dr Makary willdescribe the trends and disruptors changing health care Newpayment models and radical ways of measuring value for the first timeare gameshychangers to prepare for His speech will describe theheritage of health insurance and the players looking to change itsinterface with patients and hospitals

Take Advantage of Our Subject Matter Connectors

During HCAAs 2016 Strategic Planning process our Board discussed the need to identifyand to make known the vast expertise in the HCAA membership Consistent with HCAAsfocus on the Value of Connectionrdquo these experts known as Subject Matter Connectorswill be available to engage with HCAA members to help with specific questions or toprovide suggestions when a member requires direction based on topics inherent to thirdparty administrators and benefit administrative services

Subject Matter Connector Leads which consist of members of the HCAA Board ofDirectors will build connector teams through the identification of individual HCAA membersthat have extensive experience and knowledge The Leads will direct members to Affiliateor TPA resources within the HCAA membership that can provide more extensive expertiseThis program is designed to give guidance and suggestions but not to replace expertcounsel If you would like to become a Subject Matter Connector please fill out this Formand return it to hcaainfohcaaorg

If you would like information on any of the subjects listed below please visit the SubjectMatter Connector webpage for a listing of the Subject Matter Connectors to contact

Account ManagementLegal and Compliance Financeand AccountingMarketing BusinessDevelopment SalesInformation Systems andTechnologyStop Loss Risk Transfer CaptivesOperations Claims Stop LossReimbursement Eligibility CallCenter PPO NetworkManagement Provider RelationsPlan Documents SBCs

Human Resources Labor TrainingPharmacy Benefit ManagementCare Management PopulationHealth Management Precertification UM Large CaseManagement DiseaseManagement Health RiskManagement Behavioral Health EAP Member Communications Education Engagement Decision Support TransparencyTools Social Media

Save The Date for TPA Summit 2017

New Certified SelfshyFunding Specialist Designees

Congratulations to the latest roundshyup of dedicated individuals who have shown a commitment to serving selfshyfunded health care plans

Scott Armstrong Jessica Lee Jared Lenzinger John Montgomery Elisabeth WassonZachary Weimer

2017 Sponsorship Opportunities AwaitA huge thank you to all our 2016 Sponsoring

Organizations ndash your contributions and commitment to

our association and advancing the business of selfshy

funding are greatly appreciated We have many

organizations already signed up for 2017 sponsorship

opportunities as well so thank you

HCAA sponsorships are a great way to gain maximum exposure for your organization to a

key market of influencers and purchasers You can choose to sponsor a particular event

such as Executive Forum or TPA Summit in several unique ways or provide general

sponsorship for all of our programs HCAArsquos partners and sponsors also receive many

benefits such as marketing free registrations and program discounts that you donrsquot want to

miss out on Review all the currently available opportunities online and secure your

sponsorship spot in our new Online Store before they sell out

Thanks to Our Sponsors

Get Social with HCAA

Copyright copy 2016 All rights reserved

Our mailing address is5353 Wayzata Blvd Suite 350 | Minneapolis MN 55416 | Web wwwhcaaorg

Phone 8886371605 | Fax 9522528096 | Email hcaainfohcaaorg

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Health Care Administrators Association middot 5353 Wayzata Blvd middot Suite 350 middot Minneapolis MN 55416 middot USA