Tag Archives: employer

Limelight Health’s Jason Andrews

Jason Andrew, CEO and Co-Founder of Limelight Health, talks about the platform for the employee benefits industry, and how it innovates manual legacy processes to make a better experience for brokers, carriers and employers.


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Beam’s Alex Frommeyer

Alex Frommeyer, Founder and CEO of Beam, software designed to deliver better a dental and ancillary benefits experience and solutions for small and medium-sized employers.


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healthcare quality

Healthcare Quality: How to Define It

In a previous article, we mentioned the Centers for Medicare and Medicaid Services’ (CMS’s) new provider reimbursement model, Medicare Access and CHIP Reauthorization (MACRA), which replaces the current reimbursement formula. MACRA will include an incentive component that will replace those in plans today; performance criteria will roll out in 2019. From the providers’ lens, they are faced with the need to hire more administrative resources to keep up with the tracking of their performance, and the big question is: Are consumers making different choices based on the performance results of a physician or hospital? When there are more than 150 different measures in place today, how is an occasional consumer of healthcare services able to assess the most important criteria in finding the right physician?

During a recent employers’ conference on the East Coast, the forum featured two panels consisting of the health plans and the providers. The panels were set in a Q&A format to enlist the leaderships’ views on various topics facing the employers, and it was a fascinating dialogue we have attempted to capture below.

In the first panel with the execs of five major carriers, the opening question asked for a one-minute overview of their health plan’s area of focus in addressing the employers’ challenges. The responses were consistent among the leaders — the focus is on the individual consumer and value-based contracting. When the discussion evolved into quality criteria and outcomes to identify high-performing physicians, the leaders acknowledged that defining quality and outcomes is a challenging endeavor, and each health plan has its own formula to assess the providers’ performance. One commented that a physician practicing in the morning could be viewed as a top performer by a carrier, while that afternoon, she could be ranked as a poor performer by another, even though the physician was delivering the same process of care for all her patients. The leaders agreed that employers really needed to weigh in on what was important to them so that there was greater consistency in the scoring logic with the physician community.

See Also: Are Your Health Cost Savings an Illusion?

The next panel was with the chief medical officers (CMOs) from the major systems and a primary care practice, and a number of relevant things were learned. There was unanimity in the frustration with the variation in the quality metrics being used by commercial carriers and CMS. One physician said he had never been asked for input on the quality metrics, and he was ready to engage in that discussion. The physician leaders asked for the employers to outline what was important to them so there could be a common set of standards for the commercial market — a consistent request from the leaders of both healthcare stakeholders.

Two of the CMOs were primary care physicians, and they both acknowledged that we have not given enough attention to the resource that has the greatest opportunity to lower employers’ costs — the family doctor. The primary care physicians can build trusting relationships with employees; they can help avoid the unnecessary services being provided; and they can help educate and channel the patients into the appropriate specialist, when they are equipped with quality and cost information.

The CMO from the largest health system acknowledged that there was 30% variation (aka waste) in the way care was being delivered within the community and that there was opportunity to improve the results. If we know there is variation in care even with performance-based contracts in place, what is the catalyst to get serious on consistency? Are there any other services that you purchase with a 30% variance? Would you continue spending money for that service knowing there is wasted spending?

After the event, there was a conversation with an employer, and we discussed the employers’ opportunity to help shape and define the quality metrics. This employer stated that he did not have experience or knowledge on how to establish criteria, and he was surprised to hear health plans were looking for his guidance, because he thought it was their role. When the discussion moved to the employer’s overall business, he acknowledged its internal business units established the quality criteria in assessing the vendors’ performance.

So, how do we move beyond the billboards and the marketing campaigns to understand the healthcare suppliers’ performance? Who has the greatest opportunity to drive change in a free-market system? We believe the one paying the bill has the ability to drive a more consistent outcome for high-quality, cost-effective healthcare. Let’s recognize and reward the physicians who are delivering a Six Sigma approach to healthcare so the other suppliers will be motivated to change. It’s time for employer-driven healthcare.

Politics of Guns and Workplace Safety

The politics of guns in America are volatile, divisive and passionate, yet the risks that firearms present to organizations every day do not depend on the politics of the moment. Employers must deal with the reality of gun violence in America. A RIMS 2016 session discussed the legal aspects of what organizations can do and the practical implications of creating a firearms risk management program.

Speakers were:

  • Michael Lowry, attorney, Thorndal Armstrong Delk Balkenbush & Eisinger
  • Danielle Goodgion, director of human resources, Texas de Brazil

What Risks Do Firearms Pose?

OSHA states that an employer must provide “employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

See Also: Active Shooter Scenarios

There are several risks to your organization, including:

  • Operations can halt in the case of a shooting. You have issues like police investigations and possibly injured employees.
  • Workers’ compensation will kick in if employees become injured.
  • General liability will be activated to cover injuries of non-employees.
  • Reputational risks are possibly the largest risks. You do not want your business associated with a violent act.

Most think that the Second Amendment bars private businesses from banning guns, but this is incorrect. The amendment applies to governments, not private homes and businesses.

Some employers react by posting signs banning all guns. This simple sign can be a recipe for disaster for several reasons:

  • Have you created a duty? If you post a sign, you have officially created a duty.
  • Why did you create this policy?
  • What are you doing to enforce this policy? Did you have a manual? Did you put up X-ray detectors? Probably not. You have to be able to prove you are enforcing the policy if you post a sign.
  • Did you train your employees to enforce this policy? If this policy is not enforced, a person might be injured by a firearm on your property.

“Bring Your Gun to Work” Laws

This is not a good idea. According to the law, business may not bar a person who is legally entitled to possess a firearm from possessing a firearm, part of a firearm, ammunition or ammunition component in a vehicle on the property.

In Kentucky, an employee may retrieve the firearm in the case of self-defense, defense of another, defense of property or as authorized by the owner, lessee or occupant of the property. In Florida, the employer has been held liable for civil damages if it takes action against an employee exercising this right.

Reputational risks also can apply. You could either get special interest groups protesting against your business or people who refuse to do business with you.

The Middle Ground

It is best to create a policy. Even if you support the right to bear arms, you can do it subtly. There are several provisions on what type of carry you allow and what signs are required. Business owners also do have the ability to allow no guns on the premises.

See Also: Broader Approach to Workplace Violence

Your policy should describe exactly how to approach a customer if an employee sees a weapon, including who should approach the customer, what to say and the steps to take to address the issue. Training is important.

Why Train?

  • Researchers from the Harvard School of Public Health and Northeastern University found the rate of mass shootings has tripled since 2011.
  • In 2014, an FBI study considered 160 events between 2000 and 2013. 70% occurred in business or educational setting.
  • In 2000-2006, the annual average rate was 6.4 shootings. That jumped to 16.4 in 2007-2014.

This is clearly a problem that is getting worse, so why is training rarely provided? Places of business are a target – especially retail, restaurants and businesses in the hospitality industry. The active shooter wants soft, easy targets in large, open, public and crowded areas, and the goal is to kill indiscriminately. If your business is doing well with large crowds, you are a soft target.

Active Shooter Resources

To learn how to manage this risk, you can find resources from:

  • Law enforcement
  • Insurance partners
  • Government
  • Outside experts
  • Legal
  • Human Resources

Online resources include:

3 Things to Know on PPO Networks

Employers across the country are looking to provide employees with the largest and widest PPO networks as a means of giving employees choice.  Somehow the health insurance industry has determined that networks should be “all-inclusive.” The more medical professionals and facilities in your network, the better your network is. It is time to raise a red flag on this kind of thinking. Before your organization looks to increase employee access to doctors and hospitals, there are three things you must understand about PPO networks.

Larger Networks Can Lead to Larger Plan Costs

You hear it all the time. Insurance carriers battle over who has the largest network both locally and nationally. Now, having a network with a national presence can be appealing if you are an employer with facilities and a workforce scattered across the country. However, a larger network opens the door for greater access to poor-performing physicians and medical facilities. The bigger the network, the greater the odds your employees are accessing doctors and hospitals who are not on the right side of cost, quality and outcomes. As a result, your medical plan’s costs continue to rise year after year.

See Also: Untapped Opportunity in Healthcare

A Network “Discount” Can Be Misleading

In a typical medical plan, the majority of the member population will use the plan via day-to-day services such as preventive exams, sick children and the occasional medication. For these folks, a network discount does an adequate job reducing costs for both the member and the health plan. However, imaging, surgeries and hospital stays are driving plan costs today, and it is here where a network “discount” can be misleading. Yes, network discounts are still applied to these services and, yes, the discounts can be 50% or more. However, when facilities are allowed to charge 400%+ of the limit allowed by Medicare, you are not getting much of a deal at all. To put it into simple terms, if I told you my iPhone is worth $2,000 but agreed to sell it to you for a 50% discount, I would still be ripping you off.

Networks Often Block Creativity

Recently, I had an interesting conversation with a national insurance carrier about a mutual client. After a thorough review of the client’s claim activity, we uncovered several facilities that were providing imaging services (MRIs, CT scans, etc.) at a low cost, much lower than the same services provided at other facilities. Knowing this, the client wanted to give members incentives to choose the low-cost facilities when needing imaging services by agreeing to have the health plan pay 100% of the service, saving both the member and the health plan money. However, we were told “no” by the insurance carrier because it had a duty to “keep the rest of the network happy.” If we are going to create change in the health insurance market, employers need to implement creativity into health-plan design. Unfortunately, most PPO networks discourage this kind of thinking.

Remember, there is a place for PPO networks within the healthcare industry. However, if you are an employer looking for creative ways to give your employees access to high-quality, low-cost doctors and hospitals, do not count on PPO networks to pave the way.