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RBS (REGULATORY BUDGET
ACOs THREATEN TO CHANGE THE WORLD OF HEATH INSURANCE
By: Nicola Crean, CHS Marketing Coordinator
One major goal of the Patient Protection and Affordable Care Act (PPACA) is to develop a healthcare system that ultimately values the type of quality being delivered to patients. The PPACA has multiple components and provisions that aim to contain costs and shift the focus to patient care within the healthcare industry.
Part of this legislation allowed for the creation of Accountable Care Organizations (ACOs), which is an organization of medical professionals that work as a team in order to coordinate care for a patient while keeping costs at a minimum. The primarily goal of ACOs is to reduce medical expenses, in addition to improving the care provided to patients.
“ACOs are about moving from a world where we are paid for the quantity of services to a world where we are paid for the quality of services,” Sree Chaguturu, medical director of population health management at Partners Health Care in Boston said in an article published in BenefitsPro.com (The mainstream media predicts ACOs will kill health insurance).
The original intention for creating ACOs was so that they could function within the Medicare sector in order to primarily reduce healthcare expenses. According to an article published on NPR’s website (Accountable Care Organizations, Explained), this most current model looks to provide financial incentives to doctors and hospitals that are able to provide quality care, while still containing the cost.
How these organizations will operate still remains to be seen. Guidelines for ACOs operation were originally published in January 2011. Although they have been modified since, the general purpose of these organizations seem to remain consist among all entities. It was not until earlier this year that Medicare felt this new model was ready to be tested.
Once the details were finalized, 32 ACOs that had previously agreed to participate in testing out this model began actively working. Throughout the course of the year, Medicare will monitor how cost is being affected by the organizations in addition to the quality of patient care being provided.
The financial agreement that is currently in place is that Medicare would still run their traditional fee-for-service payment plan. The new system, however, would look to provide an incentive for ACOs to lower costs. Essentially, by keeping expenses at a minimum, the organization would share in the savings, according to the NPR article.
Although there may be skepticism regarding how successful the ACOs will be, Medicare anticipates a significant decline in cost in addition to improved quality of care.
“I think we’ll see people making house calls, going into nursing homes, calling patients in more regularly, at times, to make sure that their health is improving,” said Dr. Richard Gilfillan, director of the Innovation Center that oversees these ACOs, as reported by the Boston Globe (Understanding Accountable Health Care Organizations). “People will feel a very different touch from the health care system as a result of this program.”
In addition to increasing the level of care that is provided, ACOs also will look at ways to get a patient healthy and maintain that. It comes as no surprise that healthy patients cost less, so from a cost perspective it pays to spend on promoting healthy behaviors.
There is speculation that as the popularity of ACOs grow, they will eventually be the demise of the American health insurance system. Although this cannot be proven, it does raise the thought that the future of these organizations and how the rest of the industry will be affected is uncertain.
As Medicare tracks the progress of the first 32 ACOs, the industry will be watching. As the results come in on whether or not this model reduces health costs, decision will have to be made by insurance companies and TPAs in order to determine how they will counteract this program should it ever enter the private sector.
Read more on potential affects on TPAs and insurance companies.
COMPANIES TO FOCUS ON EMPLOYEES' TOTAL WELL-BEING
By: Nicola Crean, CHS Marketing Coordinator
Although there are many contributing factors to a business being successful, the loyalty of employees is an important element to the growth of a company. However, employers are becoming increasingly aware that faithfulness is not something that can be relied on.
In fact, a new survey released in March of 2012 by MetLife suggests that one in three employees plan to resign from their current position by the end of the year. The study’s results indicate that loyalty is at a seven-year low with the average company losing between 20 to 50 percent of employees annually.
While there is not one situation that can be blamed for this shift in the working relationship between companies and their employees, there are several components that have helped to create this new dynamic.
According to an article in The Fiscal Times (Declining Employee Loyalty: Red Flag for Business), James Harter, chief scientist for Gallop, said the factors that influence loyalty include whether or not employers “look out for employees’ best interests, pays attention to their career path, gives them opportunities to improve their well-being and so forth.”
In addition, with the economic strain being an issue for majority of companies, it has become common to increase the amount of work expected from one employee in order to contain costs. With all of these factors considered, companies are opting for a more holistic, all-encompassing approach to overcoming wellness issues in the workplace.
While this may only be one contributing cause of declining employee loyalty, focusing on developing a workplace that values both physical and emotional well-being is essential to creating more satisfied employees.
WorldatWork released the Total Rewards and Employee Wellbeing study in February of this year. For the purpose of the study, employers that attempted to take an integrated “well-being” approach ultimately focused on four major components. Physical, emotional, financial and spiritual health were determined to contribute to an employees’ productivity and overall attitude in the workplace.
A Wellness Trend Study in ComPsych2011 reports that 36 percent of workers describe feeling tense throughout most of their day. Although stress may be an inevitable aspect of working, well-being programs aim at teaching employees how to overcome and handle feeling overwhelmed and anxious.
Companies are beginning to see that there is more to decreasing health costs and increasing productivity then simply focusing on the physical aspect of wellness. The Total Rewards and Employee Wellbeing study demonstrates that even though majority of employers that responded had some type of wellness program in place, 77 percent expected to expand well-being programs in order to incorporate topics like stress reduction, work-life balance and financial education.
Developing programs that are of specific interest to the company’s culture is also important. The needs of engineers may be very different of a sales staff, which should be considered when determining what programs to offer workers.
It may only take one unique activity that sparks the interest of people, leading them to be more open to the program in general. Something unusual, such as a laughter club, which was part of Cognizant Technologies’ well-being program, can have the ability to intrigue employees.
“Only health and happy associates (employees) can deliver the best with improved productivity,” says Shankar Srinivasan, chief people officer of Cognizant Technologies, first reported in an article published in Business Line (Making Wellness Work).
Additionally, it goes without saying that an employee’s level of satisfaction and overall happiness with the workplace environment place a big role in their opinion of a company. Working hard to create healthy employees that strive to have a positive attitude is also a way to cultivate a more loyal employee base.
THERE ARE SOME BEHAVIORS
YOU JUST CAN'T REGULATE.
By: Chacko Kurian
Regulations depend on carrots and sticks. If you don’t
pay your taxes, there will be serious consequences – the
stick. If you buy a home with a home loan, we’ll let you
take the interest payment deduction on your taxes – the
carrot. The HITECH Act has a number of sticks associated
with the security of Protected Health Information (PHI). We
at CHS will be addressing the issue of security of PHI in
forthcoming articles. There is, under some circumstances,
one link in the security chain that no regulation can affect
-the uninformed behavior of the user. This article addresses
one method where cyber criminals make unwitting users
partners in a security breach.
Prior to founding
Apple Computers, the Steves (Wozniak and Jobs) could be
found ripping off Ma Bell using a blue box to make long
distance phone calls (domestic and international) for free.
The subculture that reveled in this activity called
“phreaking” was probably the progenitor of the subculture of
hackers who, today, like to hack computer systems just
because they’re there. There is the story of Steve Woz(niak)
actually making a “phreak” phone call to the Vatican and
asking to speak to the Pope while pretending to be Henry
Kissinger with a think German accent. These are the guys who
later found legal ways to take your money.
Before the age of digital telephone switching systems,
telephone switches reset trunk (long distance) lines with a
tone at a specific frequency – 2600Hz. This meant that the
trunk line was disconnected at one end and available for
dialing at the other end. The dialing was also accomplished
by tones at preset multiple frequencies. How did one get
those frequencies? Legend has it that the 2600Hz frequency
was discovered by accident by Joe Engressia, known among
phreakers as ‘Joybubbles’, at the age of 7! He was
apparently able to whistle at that frequency and so attach
himself to the dialing end of an available long distance
But how does one progress from knowing that you could get
a trunk line to using it to make free long distance calls.
In 1954, the then undivided Bell System published an article
in the Bell System Technical Journal about the basics of
signaling using multi-frequency tones. This piece of
information by itself was of little use. The second and
final piece of the puzzle was published, again courtesy of
Ma Bell, in the November 1960. Bell System Technical Journal
in an article called “Signaling systems for control of
telephone switching”. This article published the actual
multi-frequency tones used to control the switches. From
that information to the creation of the reputed “Blue Box”
that became a clandestine product was a short step. With one
of these boxes, anybody was able pick up a phone and make
free long distance calls.
To be able to win this questionable prize, the phreaker
required two pieces of information and they were found in
two locations, but once they were combined, the information
became quite powerful. Today – cybercriminals put two pieces
of information discovered from different locations together
to achieve their nefarious goals..
Spear Phishing is the technique by which pieces of
information stolen from different locations are put
together, by cybercriminals, to steal your identity, your
money and anything of value. How does this work? Unlike the
shot gun approach taken by those Nigerian scam artists who
send out millions of emails, the Spear Phisher is looking
for prey with a small email blast to very targeted
prospects. All they need to start the process is one piece
of information – your email address and sometimes your name.
They don’t need anything like a credit card number, the
password to your on-line bank account or your social
security number– well, not yet. The attack is quick and over
in less than a day, before security and software companies
have an opportunity to react.
A typical Spear Phishing attack starts with an email that
comes to you and looks something like this, courtesy of the
Microsoft Safety and Security center
Remember they already have your email address and
sometimes your name so the “Hello” salutation is not so
innocuous. It looks very familiar but the highlighted items
should make you suspicious. If you examine the links you
will find that they link to unsecured and unfamiliar sites
as shown below:
Once you click on the link and enter the information
they’re asking for, they’ve got you.
Another variation of this technique is to send you an
email making you an offer that sounds reasonable on the
surface, but requires you to open an attachment with the
details of the offer. Again, once you open that attachment,
they’ve got you. What happens behind the scenes is that the
attachment has a robot program that can do almost anything
that they want it to do. It can install a keystroke logger
and send your internet banking or credit card passwords to
the cybercriminal. It can give control of your computer over
to the cybercriminal and so enable more of these schemes to
be run from your computer. The possibilities are endless.
Sometimes the Spear Phisher makes the email look like its
coming from your boss – again remember he has email
addresses and names. The email may require you to give up
password and other authentication information in order to
perform a “security audit” or an “account verification”.
Key to making this criminal endeavor work is that it
requires your participation to either provide the missing
information or open the attachment. So the best defense it
to verify the email by contacting the sender by phone or
alternate method if the email looks suspicious. A good
antivirus program installed on your computer can help
too.Remember for the scheme to work it requires your
We might as well brace for a number of these email
attacks. Recently Epsilon, a division of Alliance Data
suffered an illegal entry on its client’s email databases.
This is the company that processes marketing communications
for loyalty programs like Marriott Rewards, Citibank
Advantage and many other large organizations. Imagine the
rich information for cybercriminals that email addresses,
names and loyalty program associations can provide. If you
belong to the Marriott Rewards program like I do, expect an
incredibly valuable offer to come to you via email. Do not
open the attachment even though the logo looks almost right
and the text has only one or two spelling mistakes.
There’s lots of regulations coming from Washington DC
these days, but I don’t think they can think one up for
CHS SOFTWARE UPDATE
CHS Software you may want to use
Often, we at CHS, are
guilty of not informing you of products or features that we
have implemented over the past year that you may want to
use. This year we have rounded out our individual
enrollment, billing and administration offering with a full
cycle product. If you sell individual policies or sell
voluntary products in addition to your regular employer
sponsored group health offerings, this may interest you.
"Full Cycle" in this context means the following:
i) taking the application for enrollment of the
individual/family on the web, after getting their responses
to qualifying/underwriting questions,
ii) enrolling them in the plan of choice,,
iii) billing their credit card or bank account at the
appropriate frequency, i.e. monthly, quarterly,
semi-annually or annually,
iv) applying the payments received against the appropriate
v) disbursing premium/commission and other payments to
carriers, brokers/agents and other suppliers
vi) updates to Accounts Receivable, Accounts Payable and
General Ledger without manual intervention after set-up.
We would like to say that all of the above happens
"automatically" (a grossly over-used word) but it doesn't.
It happens with minimal, but appropriate, human
intervention. For example, there are checks and balances in
place to make sure that premium billing adjustments owing to
changes in family composition or product choices are made
accurately. The web enrollment product, CHS iCoverNow, has
to be customized with your logo, color palette, questions
and response logic. Users of our product like it. It has
allowed them to grow into areas where they couldn't before.
We believe that this will interest administrators of
individual health plans who sell to the public at large and
may become a valuable tool in the context of health care