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It is time for the 36th Annual SIIA National Educational Conference and Expo. Similar to previous years, Complete Health Systems will be exhibiting at the show, which will be held on September 25 -27, 2016 in Austin, TX.

Be sure to stop by booth #700, so we can show you how CHS can help improve how you manage self-insured programs.



By: Nicola Heredia, CHS Marketing Coordinator

As Americans continue to feel the pinch when it comes to health care spending, it appears that self-insured employers are filing more catastrophic claims than ever before.

The choice to be self-funded allows employers more control over their health plans, while still enrolling in stop-loss coverage to protect them from hefty bills. According to a report released by stop-loss insurer Sun Life Financial U.S., their self-funded customers made 25% more claims of $1 million in 2015 compared to last year.

The company’s Top Ten Catastrophic Claims Conditions report looks at how money is being spent, costly medical conditions and emerging trends throughout the insurance industry as a whole.

“By highlighting the conditions that create catastrophic claims and providing insights into trends influencing high costs, we can help employers anticipate what they’ll see when self-funding and raise awareness about the importance of cost-containment resources and stop-loss insurance,” Brad Nieland, vice president for stop-loss insurance at Sun Life Financial U.S., said in a statement.

During the four years that Sun Life has performed this annual study, there has been a total of $9 billion in medical expenses charged by providers. Employers have ended up paying approximately $5.3 billion and received $2.3 billion in reimbursements from their stop-loss coverage. The numbers demonstrate the importance of having stop-loss insurance in order to protect self-funded entities from large, unpredictable claims.

“Self-insured employers, brokers and third-party administrators have the chance to implement cost containment strategies that protect both their employee’s quality of care as well as the company’s bottom line,” said Laura Rollinson, stop-loss claims director for Sun Life.

The increase in claims totaling $1 million and up is a sign that employers need to become more aware of their company demographic and overall health status. Developing programs and incentives to motivate employees to get healthier and manage their wellbeing is vital to controlling medical costs.

"Additional efforts are needed to increase the proportion of the population that engages in all five health-related behaviors and to eliminate geographic variation," the CDC research team wrote. "Collaborative efforts in health care systems, communities, worksites and schools can promote all five behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged."

So what are the five behaviors that the CDC’s research has developed? Not smoking, regularly exercising, moderate to no drinking, maintaining a healthy weight and getting adequate nightly sleep.

Identifying low risk behaviors is one step in the right direction. However, it is imperative that employers figure out a way to motivate their staff and incentivize them to become healthier individuals that do not become a costly burden on the company.

"Both the federal government and the private sector need to take a careful look at high-cost claimants," said Tevi Troy, CEO of AHPI. "Employers, for their part, are developing innovative approaches to high-cost claimants and are in a unique position to establish programs that address this group."

The Society of Human Resource Management has developed a list of possible approaches employers can take in an effort to reduce the cost of high risk employees:

  • Gather Information: Collect data to understand how chronic illnesses develop to help with earlier detection.
  • Require Training: For individuals who have previously had large claims, require education sessions to give them knowledge to take control of their health.
  • Implementing Company-Wide Wellness Program: Support each other as a company and dive into the world of wellness and healthy living together.
  • Improve Screening Techniques: Performing health screenings will create a profile, assisting in early chronic illness prevention.


By: Nicola Heredia, CHS Marketing Coordinator

As the insurance marketplace continues to get more competitive, plans are looking for ways to attract and retain consumers based on more than just price. With providers focusing on value of care, insurance companies are exploring new ways to engage consumers and make them feel part of the health care process in its entirety.

Patients are continuing to be more active in their health care, where their money is going and how it is being spent. The more informed consumers are; the more insurance plans need to be able to provide them with tools necessary to feel like they are knowledgeable when it comes to their health.

“Health plans, providers and life science companies may be able to accelerate consumer engagement by focusing on developing online information resources, mobile applications and personal health devices that can help individuals in their patient populations and customer bases become more engaged,” reported the Institute of Healthcare Consumerism (IHC).

According to the Deloitte Center for Health Solutions 2015 Survey of US Health Care Consumers, the results of the study demonstrated that engagement of health care consumers is trending up in three specific categories. The importance of a provider/patient relationship, more resources available online and the use of technology are the primary areas that the study found are increasingly important to consumers.

Over the past few years, more of the financial burden has been placed on patients to cover higher deductibles and out-of-pocket costs. As a response to that, consumers are questioning treatment options, in addition to how their health care money is being spent.

“It’s clear that consumers will need significant education, tools and support as they assume more financial responsibility for healthcare costs,” said Steve Auerbach, CEO of Alegeus, in a press release. “Although our index demonstrates that healthcare consumers are making some progress, they still have a long way to go.”

Alegeus, a consumer directed health care solutions company, released their 2016 Healthcare Consumerism Index earlier this month. After surveying over 1,000 American health care consumers, the company reports that although the public may be responsible for paying for more medical costs, there is a lack of tools available to explain and help consumers manage.

Although 76 percent report that they are diligent in getting the best value for their medical dollars, more than half are not clear on what their financial obligation is until the bill comes after the service. This prevents consumers for being able to save or shop around for services.

The report also demonstrated that consumers are more focused on retirement savings over health care, with only 34 percent indicating that they know they should save to pay for health care costs down the road. The lack of knowledge that still exists among the public demonstrate an opportunity for insurance plans to engage with consumers to create financially smarter individuals.

Studies like the Deloitte Survey and Alegeus’ report help identify what insurance companies could be doing better. Memorial Hermann Health Solutions is one company that has looked at different avenues to become more appealing to their consumer base.

“We made a lot of changes to really make sure that we were communicating and approaching individuals on a direct level,” said Neil Kennish, associate vice president of market and sales at Memorial Hermann Health Solutions, in an interview with “What does it cost them? And to try to get away from the vagaries around copays and deductibles. Simplify it for them as much as possible.”

As the insurance marketplace grows with diverse competition, companies must look for ways to separate themselves from other plans offered. Focusing on the customer experience and providing tools to help them manage their financial responsibilities with their own health plan is invaluable.

Click here to get a unique perspective on today’s health care consumer based findings from Deloitte’s 2015 Survey of US Health Care Consumers.



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