Martha R. Temple

Today's webinar by Study Groups and Below the Line Club featured Ty Franklin, Senior Consultant and Actuary at Alera Group, Inc., who talked about the current state of American health insurance and how to take control of your healthcare spend. #healthinsurance #employeebenefits https://lnkd.in/gMycBkrV

1

Thanks to Greg Stancil from Scott Insurance for sharing how HealthJoy's Member Health Goal questionnaire has transformed his clients' approach to MSK and chronic pain issues! Watch the video below to hear more about how HealthJoy delivers personalized care that provides game-changing results. #HealthierwithHealthJoy #BringingBenefitstoLife

56

1 Comment

Andrew Toy, President of Clover Health, talks about how the US healthcare system being almost exclusively provided through a health insurance model can change the dynamics of the market versus other countries. That can create complications, but can also create opportunities for an insurer to make change, like Clover is working to do. Watch the clip at https://lnkd.in/eVJFHTiq and catch the full episode at https://lnkd.in/eQbhWN6E #insurtech #insurance #futureofinsurance #innovation

1

🚨Musculoskeletal (MSK) conditions: A significant driver of healthcare expenses For many companies, MSK costs are among the biggest challenges in managing healthcare spend and Edward Jones was no exception. When Ryan McCracken, Director of Benefits at Edward Jones, analyzed their healthcare trends, he saw MSK conditions consistently impacting their bottom line. His goal was clear: find a comprehensive solution that could reduce costs, provide exceptional care, and ensure simplicity for employees navigating their benefits. That’s where Lantern and our Network of Excellence came in. In the video below, Ryan shares why Edward Jones chose Lantern as their partner to address MSK challenges and improve outcomes for their team. 🔗⬇️Want to hear the full story? Follow the link in the comments to watch our complete conversation with Ryan.

17

1 Comment

𝐒𝐞𝐧𝐢𝐨𝐫 𝐇𝐞𝐚𝐥𝐭𝐡 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐌𝐚𝐫𝐤𝐞𝐭 𝐭𝐨 𝐒𝐞𝐞 𝐌𝐚𝐬𝐬𝐢𝐯𝐞 𝐆𝐫𝐨𝐰𝐭𝐡 𝐛𝐲 𝟐𝟎𝟑𝟎 𝗥𝗲𝗾𝘂𝗲𝘀𝘁 𝗙𝗼𝗿 𝗦𝗮𝗺𝗽𝗹𝗲 𝗟𝗶𝗻𝗸 𝗥𝗲𝗽𝗼𝗿𝘁:https://lnkd.in/g6Phtu_U Market Intellix (MI) published a new report, titled, "Senior Health Insurance Market." The report offers an extensive analysis of key growth strategies, drivers, opportunities, key segments, Porter's Five Forces analysis, and competitive landscape. This study is a helpful source of information for market players, investors, VPs, stakeholders, and new entrants to gain a thorough understanding of the industry and determine steps to be taken to gain a competitive advantage. #𝗢𝗽𝗽𝗼𝗿𝘁𝘂𝗻𝗶𝘁𝗶𝗲𝘀 • 𝗚𝗿𝗼𝘄𝗶𝗻𝗴 𝗦𝗲𝗻𝗶𝗼𝗿 𝗣𝗼𝗽𝘂𝗹𝗮𝘁𝗶𝗼𝗻: The global population of seniors is rapidly increasing, particularly in developed countries, presenting a significant opportunity for growth in the senior health insurance market. • 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗶𝘃𝗲 𝗣𝗹𝗮𝗻 𝗢𝗳𝗳𝗲𝗿𝗶𝗻𝗴𝘀: There is an opportunity to develop innovative insurance plans that cater to the specific needs of seniors, such as long-term care insurance, critical illness coverage, and plans with wellness programs. • 𝗘𝘅𝗽𝗮𝗻𝘀𝗶𝗼𝗻 𝗶𝗻 𝗘𝗺𝗲𝗿𝗴𝗶𝗻𝗴 𝗠𝗮𝗿𝗸𝗲𝘁𝘀: Emerging markets, particularly in Asia and Latin America, are experiencing a rise in the senior population, creating opportunities for insurers to expand their offerings in these regions. • 𝗘𝗻𝗵𝗮𝗻𝗰𝗲𝗱 𝗖𝘂𝘀𝘁𝗼𝗺𝗲𝗿 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻: There is an opportunity to improve customer education and awareness about the benefits of different senior health insurance plans, helping seniors make informed choices. 𝗧𝗵𝗶𝘀 𝗿𝗲𝗽𝗼𝗿𝘁 𝗶𝗻𝗰𝗹𝘂𝗱𝗲𝘀 𝘁𝗵𝗲 𝗳𝗼𝗹𝗹𝗼𝘄𝗶𝗻𝗴 𝗺𝗮𝗻𝘂𝗳𝗮𝗰𝘁𝘂𝗿𝗲𝗿𝘀 • Berkshire Hathaway • Prudential plc • Zurich Insurance • China Life Insurance Co.Ltd • Allstate • AIG • Manulife Financial Advisers Pte Ltd • AXA • Allianz • Aviva • Japan Post Holdings Co., Ltd. • Generali • Chubb • Reliance Nippon Life Insurance • CPIC • Munich Re • MetLife 𝗞𝗲𝘆 𝗕𝗲𝗻𝗲𝗳𝗶𝘁𝘀: • The report provides a qualitative and quantitative analysis of the current Senior Health Insurance market trends, forecasts, and market size from 2019 to 2026 to determine new opportunities. • Porter's Five Forces analysis highlights the potency of buyers and suppliers to enable stakeholders to make strategic business decisions and determine the level of competition in the industry. • Top impacting factors & major investment pockets are highlighted in the research. • The major countries in each region are analyzed and their revenue contribution is mentioned. #SeniorHealth #HealthInsurance #Medicare #SeniorCare #ElderCare #MedicareAdvantage #MedicareSupplement #LongTermCare #SeniorLiving #RetirementPlanning #SeniorBenefits #AgingPopulation #HealthcareForSeniors #SeniorWellness #AffordableCare Market intelliX Global Trends & Analysis

2

It’s crucial for supplemental benefits today to demonstrate clear value for both members and their health plan partners. This is a concept we understand well at Papa, having created and scaled a category-defining model—and we continually invest in research to further validate and inform our approach. Like our latest claims analysis that showed Medicare Advantage members who engaged in at least one #Papa visit were associated with a 9% reduction in medical costs. And the impact doesn’t stop there. 🚀 Members who engaged in more Papa visits saw even greater cost reductions, showing the potentially exponential impact long-term connection can have on an individual’s health, including: • 19% reduction in medical costs for members who average more than two Papa visits per month • 30% reduction in medical costs for members who average more than three Papa visits per month 📈 As plans look to enhance their offerings following the recent #CMS Star Rating recalculations, further investing in companion care is proven to maximize impact for your members. Learn how Papa can reduce healthcare costs and improve outcomes for your plan: https://lnkd.in/ejMf_But

49

3 Comments

Are we stuck in the past with workers' compensation assessments? 🤔 In our latest podcast, Dr. John Alchemy, MD, AAFP, QME of Rate-Fast challenges the status quo, introducing the game-changing Functional Loss Rating (FLR) method. 🎯 Key takeaways: • Why traditional methods like Four Corners Rating fall short • How FLR's precision captures true injury impact • The potential for faster benefit distribution and claim settlements Is it time for a revolution in workers' comp? Listen now to find out how FLR could transform your approach to impairment ratings. Discover more information on this topic in our blog: Understanding Confidence in the FLR (Functional Loss Rating) Method – RateFast Blog (https://lnkd.in/gbcP4mT2) #WorkersCompensation #Innovation #MedicalAssessment #RateFast

4

How can health plans address rising costs? Eric Miller, FSA, CERA, MAAA, VP & Consulting Actuary, says that pairing weight loss medications with lifestyle changes like exercise is just one strategy. During the interview he also shares data from the Segal 2025 Health Plan Cost Trend Survey. Morning Brew Courtney Vinopal https://lnkd.in/g9EmEATV #Healthcare #HealthInsurance #EmployeeBenefits

10

Discover the future of health insurance with self-funded solutions. James Hughes of Verikai shares insights on why more companies are choosing self-funded health plans over traditional models. Gain transparency, control, and cost savings with the latest advancements in data analytics and AI. https://hubs.la/Q02CBJN90 #HealthPlans #SelfFunding #Verikai #EmployeeWellbeing #InnovativeBusiness

1

Discover the future of health insurance with self-funded solutions. James Hughes of Verikai shares insights on why more companies are choosing self-funded health plans over traditional models. Gain transparency, control, and cost savings with the latest advancements in data analytics and AI. https://hubs.la/Q02DJbRV0 #HealthPlans #SelfFunding #Verikai #EmployeeWellbeing #InnovativeBusiness

1

Caught between prioritizing better care or cost savings? We’re here to tell you that you don’t have to compromise anymore. THIS JUST IN 👇 We recently released a three-year continuation study conducted by independent actuarial firm, Wakely Consulting Group. The results showed that members enrolled in elected Personify Health programs experienced 23% lower allowed healthcare costs compared to the market average. Equating to $767.96 saved per employee per year. 💰 And that's not all. The study highlighted additional costs savings like: ↳ 27% lower patient costs ↳ 17% lower emergency room costs ↳ 14% savings for high-cost claimants ↳ 80% lower out-of-network spend With PwC's Health Research Institute projecting a 7% year-over-year medical cost increase for employers in 2024, addressing health costs and outcomes have become business imperatives. So, can one health platform improve how businesses approach health? That’s our plan.  Check out yesterday's press release for more information on the study: https://bit.ly/3WoxDPk #PressRelease #BecauseHealthIsPersonal #HealthcareCosts

69

🚑 **Understanding Health Insurance: Deductibles vs. Out-of-Pocket Maximums** 💼 Navigating health insurance can be confusing, especially when it comes to terms like deductibles and out-of-pocket maximums. Here’s a breakdown: 🔍 **Deductible**: The amount you pay for covered healthcare services before your insurance starts to pay. For example, if your deductible is $1,000, you'll need to pay that amount out-of-pocket before your insurer contributes. 💰 **Out-of-Pocket Maximum**: This is the most you’ll pay for covered services in a policy period (usually a year). Once you reach this limit, your insurance covers 100% of eligible expenses. This provides a safety net, ensuring you’re not overwhelmed by medical costs. 📊 **The Difference**: - **Deductibles** are what you pay first, before insurance kicks in. - **Out-of-Pocket Maximums** cap your total spending on healthcare, offering financial protection. Understanding these terms is crucial for making informed health choices and managing costs effectively. Have questions about your health plan? Let’s discuss! #HealthInsurance #Finance #Healthcare #Deductibles #outofpocketmaximum #insurancetips #education

2

We’re thrilled to share a powerful endorsement from Charles Hamilton, President of the Association of Benefit Administrators (ABA), highlighting the importance of digestive health and the impactful work Oshi Health is doing. 🩺 At the recent ABA meeting, our Chief Commercial Officer, Randy Forman, led a discussion on the hidden financial impact of digestive health for union members and plan sponsors. Charles Hamilton’s insights in this video underscore the critical need for specialized GI care. Key takeaways from Charles' perspective:  💲 Digestive Health is likely a top 4 cost-driver for your fund, and most administrators are unaware of that.  🚨 GI suffering and costs are at near-crisis levels.  🔄 A multidisciplinary approach like Oshi's model works.  ✅ 92% of Oshi patients achieve symptom control in 4 months.  💻 GI patients actually prefer virtual care.  🌟 Oshi patients have reported a 3x improvement in quality of life. Oshi Health is addressing these challenges by providing in-network access to fully integrated, multidisciplinary care from licensed clinicians - as the first GI virtual center of excellence on a national scale, with proven clinical outcomes and cost savings. Join us in driving awareness and improving GI health for union members nationwide. Together, we can make a significant difference. #unionbenefits #digestivehealth #virtualspecialtycare

27

How can health plans help mitigate costs? Eric Miller, FSA, CERA, MAAA, VP & Consulting Actuary, discusses the Segal 2025 Health Plan Cost Trend Survey and how some plans are adjusting their preferred medications list and favoring biosimilars—which are often less expensive. CNN Tami Luhby https://lnkd.in/g4bu6Ejr #Healthcare #HealthInsurance #EmployeeBenefits 

27

1 Comment

Navigating health insurance shouldn't be a maze. Christine Cooper, CEO, aequum was featured in @MedicalEconomics discussing how Transparent Explanations of Benefits (EOBs) are key to reducing patient confusion and improving the provider experience. With the No Surprises Act and Advanced EOBs, we're moving towards clarity, enabling better patient-provider discussions and trust. Let's advocate for clearer health coverage processes and a more equitable system for all. Read the full article here: https://bit.ly/3SrwK6w #HealthInsurance #PatientCare #EOBTransparency #HealthcareTransparency #InsuranceEducation #PatientAdvocacy #MedicalBilling #HealthcareReform #HealthEquity #NoSurprisesAct #HealthcareCommunication #HealthLiteracy #PatientExperience

1

Dependency on decreasing insurance reimbursements was pushing Boston Hernia to the brink, so instead of shifting to a hospital-employed model, Michael Reinhorn MD MBA FACS and Nora Fullington MD FACS decided to go all-in with direct pay. “The transparent pricing of all the services makes the process more streamlined and ensures discussing pricing, and collecting payment is painless for both patients and staff,” shares Dr. Michael Reinhorn. Learn how Boston Hernia grew their direct-pay business by over 1000%, streamlined operations and expanded access to affordable care for self-insured employers, patients, and medical tourists nationwide by reading our case study. https://lnkd.in/ekDHjt8B #directspecialtycare #pricetransparency

20

1 Comment

Understanding member experiences can feel like a whirlwind journey. From constantly shape-shifting through regulatory changes, rising consumer expectations, emerging challenges, to technological leaps—health plans need to stay agile. In fact, health plans that master the art of continuous listening and break down operational silos can ride this wave of change, staying nimble and laser-focused on members' evolving needs.  Our first-ever health plan report, “Health plan member experience in 2024,” report is out now. Download your copy to dig into these insights and more: https://lnkd.in/eSpGKc4B

60