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“Excellent Conference”
“Great networking environment”
“The best program yet”
“Another great conference”
“Thoroughly enjoyable & informative conference”
“The conference was very well done”
These are just a few of the comments voiced by the attendees of the 2003 annual MCRA conference which was held in Miami’s South Beach. While the weather was a bit on the cool side, our speakers made up for it—they were “hot”.
The conference officially opened with a Welcome Reception on Sunday night. This was a great way for participants and vendors alike to network and get acquainted with one another.
Monday morning began the start of the presentations with our MCRA President, Steve Murphy, welcoming all and introducing the first speaker, Elaine Cribbs Rizza, Esq.
HIPAA – The Basics and the Bullets
Elaine Cribbs Rizza, Esq., President of the Rizza Group, gave one of the more interesting presentations on that new “age-old” favorite “HIPAA”. Elaine’s presentation on PHI and Privacy Standards and to whom they apply; helped all of us to understand more clearly the Business Associate role and how it affects the broker and the reinsurance carrier. Needless to say, the role of the Business Associate and who is a business associate, while clearly identified by Elaine, is still somewhat confusing to the client.
Elaine identified seven key points to consider when dealing with information that falls under the privacy standards.
Underwriting Round Table
Dan Melanson, Assistant Vice President of Risk Based Solutions, led the panel of four underwriters. Others on the panel were Nathan L. Hays, Director of Managed Care Reinsurance Programs at Cairnstone Re; Patti Sciubba, Vice President, Managed Care Underwriting IOARe; and Lou Garafalo, Manager PEL at Lexington Insurance Company.
Several topics were discussed such as:
- high cost drugs and other carve-out products
- disclosure statement
- capitation
- reinsurance participation
- high excess coverage
As you might expect, this roundtable discussion and audience participation produced different views and philosophies for the future. Needless to say, there were a lot of take-aways for everyone in the room.
HMO Reinsurance and Insolvency Management
The afternoon session on Monday opened with the history, past and present, of insolvency coverage presented by Harry Sutton, Jr., FSA, who is currently with Redin and Anders.
Harry’s presentation brought out the fact that underwriting for insolvency requires a detailed review of financial data both current and historical. As a thorough review will eliminate those HMOs that do meet the criteria set out by the various reinsurers. The alternatives to insolvency also need to be reviewed such as a letter of credit. Overall, while the probability of insolvency’s are low, potential losses can be staggering.
Management of Catastrophic Injury and Disease
Senior Vice President of Product and Business Development, Michael R. Burcham of Paradigm Health presented the need for catastrophic Injury and Disease Management. Michael presented the various factors that would lead to creating carve-out products to effectively manage healthcare outcomes and expenditures.
Six characteristics of a successful carve-out product are:
- multi-disciplinary approach
- definable disease
- coordinated care
- provides contracts for care
- risk based pricing
- report outcome measurements
Several participants at the conference have seen the development of disease management and neonatal carve-outs.
Current Claim Issues:
Reporting Requirements and Other Challenges / Obstacles
The first day of the conference came to a close with the effervescent, Adria Garneau, CEBS, Senior Consultant at Niis/APEX Group Holdings. Adria presented us with more valuable information from the claims arena and as always provided something new and stimulating for us to take away.
This year, Adria challenged us to review our contract wording in regard to claims provisions; subsequent claims, penned claims and arbitration. It is critical that the definition sections of policies are very clear to avoid litigation down the road.
Distribution Strategies for Carrier in the Managed Care Marketplace
The Tuesday morning session opened up with Peter Robinson, CEO, Reinsurance Advisory Services. Peter presented the history of HMO reinsurance in the 80’s with Bob Morey and the history of the 90’s, which saw the growth of provider risk nationally.
Roles of the underwriter, broker, reinsurer were presented and the effect of each on the client.
Complex Medicine, Simple Wisdom
Jack G. London, MBA, MHA, a Senior Consultant, with NIIS/APEX Group Holdings, Inc., presented The Challenge of Health Care from several perspectives:
- Our families
- Our economy
- Our resources
- Our future
- Our problems
- Our services
Key to the future will depend on managing utilization, consumer education, success of carve-out programs, wellness programs and the ability to think outside of the box.
Cost Containment
Kathy Barr, RN, BSN, Marketing Director of Envision Care Alliance reviewed the case management process and stressed the importance of a specialty focus.
Kathy discussed several disease states in detail. One of these was end stage renal disease. As we know hemodialysis is growing at exponential rates. A routine case can cost as much as $200,000. She also, discussed drugs and she often offers doctors the option of offering the drugs at a reduced cost or she will supply the drug from her own sources.
Open Forum
This session was lead by Cathy Sussman, Sr. Account Executive, from Allianz. Many of the topics, Cathy identified, had come up during the course of the conference.
The group generally believed that carriers will continue to exit the market and capitation will continue to diminish. There is a big concern within the group about self-insurance, especially in the provider market where premiums previously were lower than claim recoveries. It seems that many clients don’t understand why the need to purchase the coverage. There is a belief however, that this is cyclical and may turn around in a year or two when the client realizes the value of reinsurance.
The MCRA Board would like to express their appreciation to all the speakers for their contribution in making this conference a great success.
A heartfelt Thank You to our sponsors Evergreen Re and NiiS/APEX Group Holdings for their continued generous support.
And of course the MCRA Board wants to thank all of the attendees for their valuable interaction.
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