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Walt Bernard Podgurski,  Editor,  440-773-1108, 

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Editorial Mission Statement: The goal of this publication is to provide readers a broad selection of what is being written about the insurance industry and related issues. Some articles may have a “tilt” towards a particular perspective one way or another. Inclusion in this newsletter is not an endorsement of any views or content; but report the various and differing views appearing in media.
  Monday, 08/26/19 - https://DailyInsuranceReport.com 

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Surprise out-of-network bills are hurting workers’ wallets and employers’ bottom lines
By Evelina Nedlund / ebn

Out-of-network healthcare can be costly and is often something patients try to avoid. But when an emergency occurs, a visit to an in-network hospital can still result in an unpleasant surprise — a highly expensive medical bill because the patient was treated by an out-of-network physician.

Surprise billing and related costs are increasing among inpatient admissions and emergency department visits to in-network hospitals. From 2010 through 2016, 39% of more than 13 million trips to the emergency department at an in-network hospital by privately insured patients resulted in an out-of-network bill, a new study published by medical journal JAMA Internal Medicine finds.

“This is becoming a bigger and bigger issue,” says Kim Buckey, president of client services at DirectPath. “We'll probably see more employers working at state and federal level to put some pressure on their representatives to do something about this. They're paying their share of these higher out-of-network costs and it's hitting their bottom lines as well as their employees.”

NXT  NXT Employee Benefits Investor Forum
Founders & Chief Executive Officers
  • Deliver your strategic investment and / or strategic partnership message to an audience of venture capitalists, private equity companies, angel investors, and the venture funds of banks and insurance companies.

  • Presenters bring a diverse spectrum of (employee benefits) technology expertise!

  • In addition to fintech and insurtech, presenting organizations include innovative and rapid growth product and service opportunities in the employee benefits marketplace.


Lawmakers’ rejection of Proposition 3 is costing Utahns $2.5M each month, state Medicaid director says
By Benjamin Wood / The Salt Lake Tribune

By rejecting full Medicaid expansion under a voter-approved ballot initiative, and opting instead for a more restrictive program, Utah lawmakers have rung up millions of dollars in monthly health care costs, the state’s Medicaid director said Thursday.

“Our estimate is it’s about $2.5 million per month that the state is spending in additional general fund [payouts] right now — spending more now than it would if we were under full expansion,” Nate Checketts told members of the Legislature’s Health Reform Task Force.

Checketts’ comments came during a presentation on Utah’s Medicaid expansion, which hit a snag last month when the Trump administration indicated it plans to reject the state’s request for a waiver from the requirements of the Affordable Care Act, or Obamacare.

Under the federal health care law, states are eligible to receive enhanced funding for Medicaid beneficiaries by expanding enrollment to include anyone earning less than 138 percent of the poverty level, or $16,753 for an individual. But Utah lawmakers, citing the potential for excessive costs, rejected full expansion and instead enacted SB96, which limits enrollment to 100% of poverty while leaving the remaining expansion population to purchase subsidized health insurance on the Obamacare marketplace.

The Business of Making Value-Based Healthcare Possible

The traditional fee-for-service model prioritizes volume over value and, therefore, seeks to treat as many patients as possible. By contrast, the value-based care model measures success over the longer term — and bases it on patient health outcomes. Some common characteristics of the value-based model include measuring outcomes and costs for each patient, integrating patient care across providers and grouping practitioners according to the conditions they’re treating, and expanding access to high-quality healthcare in the places where it’s most needed.

As beneficial as this change is for patients, the main drivers of the transformation are structural. Providers have always earned more profit from patients with commercial insurance than from those with government-provided insurance, such as Medicare and Medicaid. But today, the number of patients with government-issued healthcare is increasing by around 1.5 percent per year, according to the Harvard Business Review, which is forcing providers to find new ways to keep their businesses healthy. Most notably, they need to find ways to grow their market share across all payer and patient populations. Value-based care is helping them do that.

AI And Healthcare: Is The Bloom Finally Off The Rose?
David Shaywitz Contributor / Forbes

What a rough few weeks it’s been for AI and healthcare. In just the last ten days, we’ve seen the publication of a number of commentaries that collectively express a significant degree of caution, if not outright concern, about the extravagant expectations around the application of AI to healthcare and drug discovery.

Let’s start with the two peer-reviewed publications, both in the journal Digital Medicine.

Tech Solutions Can’t Fix Social/Political Problems
AI innovations don’t fix warped incentives – i.e. you can’t expect to fix a social/political problem with a technical solution

You Can’t Fix Foundationally Flawed Data With High Volume
Another relevant DM paper, published online three days after the Panch paper, focuses on the concerns that, essentially, biased datasets will train biased algorithms to generate clinical recommendations that “potentially exacerbate health disparities.”

FINANCE IN A NUTSHELL: The student loan and retirement savings quandary

Everyone knows or has heard about the student loan crisis in America and its effects on the U.S. economy. The latest debt amount reported is over $1.5 trillion. This staggering figure makes it the second largest component of household debt — with an average default rate in the 10% range. For individuals not wanting to be part of another negative statistic, they are determined to pay off their loans. In the process, they may be tempted to postpone saving for less immediate needs, such as retirement. After all, it is so far in the future. A study found that approximately 29 percent of Americans between the ages of 18 and 29 postpone retirement savings because of student loans.

The problem with that strategy is the individuals delaying retirement savings are missing out on the benefits of compounding during their early professional careers. Even small amounts can add up to significant earnings by the time they begin thinking about retiring. Young men and women should not have to choose one option over the other. Actually, they don’t. Carefully putting together a plan can help develop a strategy to overcome their student loan dilemma and, in concert, save for retirement. Here are a few steps to consider:

Never miss a student loan payment
Utilize the company’s 401(k) match
Pay down highest-interest-loans first
Available tax advantages

Ladenburg Makes Investment In Newday Financial Technologies
Ladenburg Thalmann Financial Services Inc. (NYSE American: LTS, LTS PrA, LTSL, LTSF, LTSK, LTSH) ("Ladenburg"), a publicly-traded diversified financial services company, today announced an investment in Newday Financial Technologies Inc. ("Newday"), a San Francisco-based startup focused on delivering easily accessible, low-cost impact investing strategies that align with the values of investors, with a target audience of new investors, especially Millennials.

Newday is the second strategic investment by the Ladenburg Innovation Lab since its launch two years ago, and follows its investment in Track Technologies in July 2018. The transaction reflects the Ladenburg Innovation Lab's strategy of investing in early-stage companies that seek to capture opportunities shaped by transformative social, economic and cultural trends and adapting the unique tools and solutions developed by these startups for use by Ladenburg's five independent advisory and brokerage firm subsidiaries: Securities America, Triad Advisors, Investacorp, KMS Financial Services and Securities Service Network (SSN). Financial details of the transaction were not disclosed.

Adam Malamed, Executive Vice President and Chief Operating Officer of Ladenburg, said, "Our strategic investment in Newday further advances the Ladenburg Innovation Lab's mission of identifying the most important macro-trends that are fundamentally shifting how people think about and consume financial advice, and investing in startups that seek to address these trends. By seeking to help Ladenburg's financial advisors capitalize on these macro-trends, our Innovation Lab is amplifying our broader mission of aligning Ladenburg's financial capital, intellectual capital, technology and other growth resources with our financial advisors to drive their success."

Newday encourages values-based investors to engage more meaningfully in the causes they care most about, including investing in those causes. Newday's platform allows users to make impact-oriented investments as low as $5 in portfolios designed to align with values such as environmental sustainability, animal welfare and gender equality.

Founded in 2017, Newday is an institutional asset management organization that its founders Alexander Meek and Anthony Randazzo established as a democratized channel through which investors could align their values with their investment strategy. The firm has seven investment funds oriented around United Nations sustainable development goals:

The Shuffle Continues in Top 10 Topics for the NAPA 401(k) Summit
More than 4,200 votes have been received on the potential topics for the NAPA 401(k) Summit – and there are six new Top 10 Topics!

At the end of Week #2, the top trending topics now are:

Measuring retirement plan success – how are advisors quantifying impact of their work beyond investments and fees (#4 last week).
What plan sponsors really think (holding steady at #2).
Coupling education with plan design to drive improved participant outcomes (up from #6).
Excessive fee suit successfully defended in court trial (new to the list and the Top 10!).
How you can differentiate your practice by bringing together wealth management and a unique 401k offering using managed accounts (another new entrant).
Disruptive forces in the retirement space (up from #10 last week and #7 the week before).
Why “pensionizing” a 401(k) plan is the future of retirement plans (new to the top 10).
Plan health metrics, retirement readiness analytics, and benchmarking that help advisors shape plan design and improve their value prop (another new to the top 10).
Financial wellness – how it can differentiate your practice (yep, yet another “newbie”).
HSAs, that other retirement bucket (and yet another new addition).


Monday, 08/19/19 - Family healthcare spending now equals the cost of a new Harley-Davidson, report says

Tuesday, 08/20/19 - Buyout firm Centerbridge nears $1.5 bln deal for GoHealth -sources

Wednesday, 08/21/19 - PTO Exchange Secures $3 Million in Funding to Transform Employee Benefits for the Future of Work

Thursday, 08/22/19 - Cigna seeks sale of group benefits insurance business, valued as high as $6 billion

Friday, 08-23-19 - Could next year be the beginning of the end of traditional employer-sponsored health insurance?

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Walt Bernard Podgurski - - Editor