mills - reduce your health ins cost
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Reduce Your Health Insurance Cost By Knowing the NumbersLeigh A. Mills, AAI, CIC, GBAVice President -Senior ConsultantTRANSCRIPT
Leigh A. Mills, AAI, CIC, GBA
Vice President - Senior Consultant
Reduce Your Health Insurance Cost
By Knowing the Numbers
Objectives
Coaching How To…..
Understand
Be Strategic
Challenge
Negotiate
Impress
Claims Data – PMPM
Pooling Level
Benefit Changes
Trend
Medical Trend
Inflation (30%)
• Increased cost of services & goods
Utilization (60%)
• Technology
• Aging Population
• Government Mandates
• Cost Shifting
Leverage (10%)
MidPoint
March 2008 – January 2009 = 11 months
February 2009 – July 2009 = 7 months
Total Months of Trend is 18 months
Oct
07
Nov
07
Dec
07
Jan
08
Feb
08
Mar
08
Apr
08
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Feb
09
Mar
09
Apr
09
May
09
Jun
09
Jul
09
Aug
09
Sep
09
Oct
09
Nov
09
Dec
09
Jan
10
Claims Data Period
Plan Year Renewal
Projected Claims in Excess of $100,000
aka Pooling Charge
Large Claims Added
Claimant deceased
Claimant no longer covered
Treatment completed
Unusual claim
Claim being covered by Medicare
Medical Loss Ratio
PPACA set MLR at 85%
Direct Claims Paid to Providers
Activities to Improve Healthcare Quality
• Case Management
• Care Coordination
• Chronic Disease Management
• Wellness Programs
• Supporting Health Information Technology
• Hospital Discharge Programs
• Measures to improve patient safety and reduce medical
errors
Credibility
Credibility(close enough for horseshoes)
To Estimate:
Number of covered employees x 20
Then take the square root of that
number
For example:
254 employees x 20 = 5080 and the square root is 71
Your claims data is approximately 71% credible
Other Adjustments
Underwriters have the
Power to Give
And the
Power to Take Away
Leigh A. Mills, AAI, CIC, GBA
Vice President,
Senior Consultant
Compass Consulting Group
(904) 434-0822
Thank You!