Category: Healthcare


Hidden Opportunities, A Strategic Compliance Series

Hidden Opportunities Overview

In this webinar series we explore ways organizations can go beyond basic compliance and improve their “organizational soil” through a strategic response to the No Surprises Act and the Transparency in Coverage regulations. Our goal is to help organizations create a competitive advantage. Does it make sense to expend limited resources to merely comply with the law and regulations, or is there a way to strategically “design the compliance away” while differentiating the employee value proposition?

For example, a knowledgeable horticulturist may use the high temperatures of the summer season, which are a normal part of the environment just as law and regulation are a normal part of the business environment, to solarize the soil. This is a low cost and simple process of spreading a plastic sheet over an area of soil to trap and intensify the sun’s energy. It is a process that works well to destroy weed seeds and pathogens. Similarly, a knowledgeable Humaculturist® can employ techniques to leverage laws and regulations to strategically improve the organization. This webinar series seeks to identify some of these techniques.

The topics from the series include:

Hidden Opportunities: No Surprises Act
Surpassing Mere Compliance – Including Reference Based Pricing
Preserving the Harvest…Leveraging HSAs
Hidden Opportunities: Transparency
A “Dope” Response to Pharmacy Transparency
Mental Health Parity…A Lucid Approach
Pest Management, Minimizing Plan Losses through Fee Disclosure

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes experts in organization design, actuarial science, clinical, and legal can guide the process to achieve optimal behavior. Please contact us.

Read About CEO’s Interview on Trends in Diabetes and Excess Mortality

Read about Humaculture’s CEO’s, Steve Cyboran, ASA, MAAA, FCA, CEBS, interview with Life Annuity Specialist featured in Diabetes is Killing More Americans Than Ever Before. Steve explains the trends in diabetes over the last 40 years. The rate of diabetes almost quadrupled from around 3% in the 1980s to 11.3% in 2023. Deteriorating health is a contributing factor to elevated health costs, disability rates, and mortality.

The good news is that there is quite a bit insurance carriers and employers can do to stem the tide and help People become healthier to the benefit of the insured and the Organization’s bottom line. Contact us to discuss how.

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].

Watch CEO Present on “Excess Mortality: A Peek Under the Iceberg”

ICSL A Peak Under the Iceberg

Watch a replay of the Insurance Collaboration to Save Lives (ICSL) presentation on “Excess Mortality: A Peek Under the Iceberg” in which our CEO, Steve Cyboran, ASA, MAAA, FCA, CEBS participated. Steve discusses possible causes leading to an increase in mortality and morbidity post COVID-19, how we can use proactive health risk mitigation to respond, and what the returns may look like.

Presenters

  • Steve Cyboran, ASA, MAAA, FCA, CEBS, CEO, Consulting Actuary, Humaculture, Inc.
  • Josh Stirling, Founder of Insurance Collaboration to Save Lives, Insurtech Advisor, Board Director and Former #1 Ranked Insurance Analyst
  • Valerie Chezem, ASA, MAAA, Assistant Actuary, Everence®
  • Mary Pat Campbell, FSA, MAAA, Vice President, Insurance Research, Conning
  • Teresa Winer, FSA, MAAA, Actuary, Office of Insurance and Fire Safety Commissioner, Georgia

Objective

At the ICSL, dozens of industry executives have been developing a plan to help insurers proactively address the tragedy of on-going 20% increased mortality since 2020. Excess mortality and morbidity is a problem for our industry, and society. The ICSL brings together insurers to work together to solve it. Learn more about the impact we can make in the video. Steve Cyboran presents at 27:31.

Key Takeaways

  • Through May of 2023 US mortality continues to be 20% high for ages 15 through 45
  • There are underlying health conditions leading to excess mortality
  • Insurers and employers can have impact that makes financial sense
  • There are innovative ways to improve financial results

Presentation

Watch the presentation:

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].

Insurance Collaboration to Save Lives (ICSL): Upcoming Actuarial Presentations

2023-05-24 Event Image

Watch our CEO, Steve Cyboran, present at the following events.

Description: Excess Mortality – A Peek Under the Iceberg

Everyone is attentively watching the current excess mortality and morbidity crisis unfolding. We think it’s just the tip of the iceberg. Join our cross-industry team as we share a proprietary analysis of U.S. and global public health data digging into the underlying problems. Discover the iceberg of health problems underlying the elevated death and disability we see playing out in the bottom line. Can anything be done to slow this train? Risk mitigation strategies for insurers will be explored, with an invitation for participants to exchange ideas within the group. This will be a combination of presentation, panel, and Q&A discussion with multiple presenters including actuaries and other industry experts.

By the end of these sessions, attendees will understand:

  • An up-to-date perspective on the current excess mortality and morbidity crisis
  • Insight into the myriad of underlying health conditions
  • Innovative ideas to improve financial results

Country Relevance: Non-Nation Specific

Experience Level: All levels

Presenters

  • Steve Cyboran, ASA, MAAA, FCA, CEBS, CEO, Consulting Actuary, Humaculture, Inc.
  • Josh Stirling, Founder of Insurance Collaboration to Save Lives, Insurtech Advisor, Board Director and Former #1 Ranked Insurance Analyst
  • Valerie Chezem, ASA, MAAA, Assistant Actuary, Everence®
  • Mary Pat Campbell, FSA, MAAA, Vice President, Insurance Research, Conning
  • Teresa Winer, FSA, MAAA, Actuary, Office of Insurance and Fire Safety Commissioner, Georgia

August 23 11-12:15 EDT: SOA Life Meeting

September 11 10:30-11:30 EDT: Society of Insurance Research

September 14 2-3 EDT: SOA Life Meeting Virtual Event

October 25 10-11 AM EDT: 2023 SOA ImpACT Conference

November 7 12:30-1:30 PM EST: 2023 SOA ImpACT Conference Virtual

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].

Houston Business Coalition on Health Conference Presents The Value of Alternative Medical Facility Healthcare

August 2023 HBCH Presentation Image

Join the Houston Business Coalition on Health (HBCH) for its annual meeting where HBCH will be outlining the value of alternative medical facility healthcare. Our CEO, Steve Cyboran, ASA, MAAA, FCA, CEBS will be facilitating a session during the meeting.

Panel topics include:

  • Independent Primary Care Clinics
  • Onsite / Near Site Clinics
  • Retail Clinics
  • Ambulatory Surgical Centers
  • Free Standing Imaging Centers
  • Free Standing Specialty Infusion Centers
  • Community Oncology Clinics
  • Home Health Care
  • Digital / Telemedicine

Event Info

Breakfast and Lunch: Included

Time: August 24, 2023 7:00 AM – 7:00 PM (CDT)

Location: 6500 Main St, Houston, TX, 77030, United States (Rice University – Bioscience Research Collaborative Building)

HBCH Employer Member: $50

Employer Non-Member: $75

HBCH Associate Member: $100

Associate Non-Member: $350

Event Link: https://coalition.houstonbch.org/ap/Events/Register/MrD6wGoP

LinkedIn: https://www.linkedin.com/company/houston-business-coalition-on-health/

Houston Business Coalition on Health Presents Houston Smart Network

2023-05-24 Event Image

Join the Houston Business Coalition on Health for this employer-only event (consultants may come with their client) where HBCH will be outlining the concept, timeline, and benefits for participating in the Houston Smart Network. Our CEO, Steve Cyboran, ASA, MAAA, FCA, CEBS will presenting during the meeting.

Lunch will be served!

HBCH is on the cusp of developing a Houston-based alternative to your regular health plan that provides more for less. HBCH will highlight Smart Network benefits, including better health outcomes, less cost for you and your employees, and an integrated, simple employee experience.

This interactive discussion will include:

  • The urgent need for a Smart Network in Houston
  • Overview of the Smart Network – a different but proven type of benefits option
  • Smart Network Design Elements
  • Actuarial Analysis of the Smart Network
  • Local and National Provider Assessments
  • How to Get Started

Presenters

Objective

Explain the benefits of the Houston Smart Network, understand employer interests, including willingness to support financially, and learn about new Texas legislation that will be gamechanger for employers. Interested employers can contribute to the development of the Houston Smart Network, and each dollar may be matched by two major philanthropic organizations.

Event Info

Fee: Free!

Lunch: Included

Time: Tuesday, June 6, 2023 12:00 PM – 4:00 PM (CDT)

Location: 50 Waugh Drive, Houston, 77007 (United Way of Greater Houston)

Event Link: https://houstonbch.org/smart-network-overview/

Watch CEO Present on Insurance Collaboration to Save Lives

ICSL Image

Watch a replay of the Insurance Collaboration to Save Lives (ICSL) Executive Briefing, in which our CEO, Steve Cyboran, ASA, MAAA, FCA, CEBS participated. Steve discusses how small investments can yield significant returns. Not only does preventive medical screening in this collaborative need to achieve outcomes, but it also needs to make economic sense. Return on investment can be increased by decreasing screening costs, increasing the effectiveness of screening, and targeting larger policies first.

Presenters

  • Josh Stirling, Founder of Insurance Collaboration to Save Lives, Insurtech Advisor, Board Director and Former #1 Ranked Insurance Analyst
  • Steve Cyboran, ASA, MAAA, FCA, CEBS, CEO, Consulting Actuary, Chief Behavioral Officer, Humaculture, Inc.
  • Sven Lohse, Principal, Research at Canton & Company

Objective

At the ICSL, dozens of industry executives have been developing a plan to help insurers proactively address the tragedy of rising mortality and morbidity. Excess mortality and morbidity is a problem for our industry, and society. The ICSL is bringing together insurers to work together to solve it. Find out the impact we can make from Steve Cyboran in this presentation on slides 33-36 and at 32:46 in the video.

Presentation

You can access the slides below.

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].

Watch CEO’s Presentation on Strategies to Reduce Total Cost of Care

HBCH Presentation

Watch a replay of our CEO, Steve Cyboran, ASA, MAAA, FCA, CEBS, present at the Houston Business Coalition on Health on How to Reduce Total Cost of Care Through Organizational Culture. Joining him as a presenter is Ray Fabius, MD, Co-Founder and President of HealthNEXT.

Available Support

We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].

Strategies to Reduce Total Cost of Care, in Search of the Holy Grail

HBCH 12-8 Conference-Logo-2022

Come see our presentation at the Houston Business Coalition on Health (HBCH) conference on Thursday, December 8 for Strategies to Reduce Total Cost of Care, in Search of the Holy Grail.

See Our CEO Present at HBCH

Presenter: Steve Cyboran, ASA, MAAA, FCA, CEBS, Humaculture, Inc. CEO presents with Ray Fabius, MD, Co-Founder and President of HealthNEXT

Fee: Free for employers not in health services (use link below)

Time: Thu, Dec 8, 2022, 1:00 PM – 1:50 PM CST

Topic: TCoC Reduction Through Organizational Culture

Location: 6100 Main St, 77005 (Rice University Bioscience Research Collaborative)

Event Link: https://coalition.houstonbch.org/events/details/strategies-to-reduce-total-cost-of-care-in-search-of-the-holy-grail-693081

Employee Benefits – The Humaculture® Perspective

Photos above: Just as different plants thrive in different soils, different people also thrive in different organizations. Aloe vera thrives in thin, rocky, dry soil. Similarly, there are also certain organizations that employ people who may primarily have access to benefits through a spouse or parent and don’t require rich benefits. Other organizations may need moderate benefits (like drip irrigation on grapes) designed and structured to nurture them to thrive properly. Still other organizations may require benefits designed to protect and nourish employees, much like lettuce requires mulch and abundant moisture.

Did any person, or any organization, ever become great by striving to be average? Many business leaders instinctively look at what every other organization in their particular industry is doing, then defensively adopt benefits that make their organization “competitive” with their peers. But, does this approach really make an organization distinctive and magnetic to talented people who will lead to success? Is it really a good idea to attract employees who are concerned primarily about benefits?

Understanding the Nature of the Organization – Vision, Mission, and Strategy

The horticulturist understands that different plants, different production goals, and different climates require soils to be built in specific and intentional ways. Each planting bed is designed with climate, soil texture and drainage, fertility, pH, and other factors in mind based on the types of plants and crops desired. So, the successful horticulturist begins with a vision and mission, then develops a strategy based on the vision and mission while considering climate and available resources. While other inputs may be required (irrigation, support, row covers or other protection), the soil is the key. Without well designed soil one can typically expect mediocre results at best. The most successful gardens “feed the soil, not the plant.” A well-chosen plant in well-designed and prepared soil will naturally thrive and produce the desired fruit.

To be successful and highly effective, organizational leaders must take a similar approach. Each organization has different goals, different purposes, and operates in different business, social and legal environments. All of these factors will have tremendous impact on how the organization is able to attract, engage, grow, retain, sustain, and transition employees or other people who will in some way be a part of, and grow, in the organizational “soil.” Many leaders have at least some idea of their organization’s vision and mission, even if only informally. They also know they need the “right” employees to carry out the strategy to accomplish the vision and mission, so much so that the focus becomes “feeding the plant, not the soil.” But failing to understand the importance of building a good organizational “soil” substantially reduces the effectiveness of recruiting, compensation, benefits, well-being initiatives, engagement, safety, and any other perk or program directed at employees.

Pitfalls of the “We Offer Excellent Benefits” Approach

One large health system sought to have only the “very best” benefits, desiring to be viewed as cutting edge to potential employees and to motivate current employees, which is popular among progressive and innovative organizations. The health system combined the Paid Time Off (PTO) benefits for 7 recently integrated entities by adopting a richest benefit approach. This put the new, larger system above the 75th percentile of its peers. However, the workforce plan and job designs did not allow employees to effectively use those benefits, which led to a lot of frustration and inequitable use. It’s a little like over fertilizing plants, they may be “burned” by the excessive fertilizer. The intent of PTO is to recharge and re-energize people so they can better perform in their job. In this case, the employees felt resentment over a benefit they couldn’t readily access and still meet the patient and business needs of their jobs. There must be an appropriate balance between no time off and full time off. It is important that the PTO be designed for optimal performance. The strategic workforce plan and jobs should then be designed for the level of time off provided (e.g., preparing organizational “soil” to allow the employees to use the PTO benefit to help them thrive).

Similar scenarios are repeated in many organizations, especially as organizations look to benefits and other benchmark surveys to guide their benefit choices. So often, organizations implement or modify benefits programs based on benchmark studies, then struggle with high benefits costs and look for the latest “cost containment” measures, programs, or services. For example, a large utility maintained a traditional sick leave program to remain “competitive” with its industry peers. The 100% pay replacement led to over-utilization, excessive costs, scheduling challenges, and increased time to manage employee relations issues related to absence. It simply became much harder to manage and was not attracting and retaining the employees who would best thrive and contribute to continue to build the organizational “soil.” Yes, “everyone else” was doing it but the choice to be average led to high costs and failed to make this organization distinctive and magnetic to the employees who could best produce the intended “fruit” and nourish the “soil”.

How We Design Benefits from a Humaculture™ Perspective

Humaculture™ recognizes that the organization itself is the key to a thriving, engaged, and contributing workforce that leads to success. Benchmarks are good against which to test designs and cost levels to assure they are distinctive and magnetic, but the designs should first support the vision and mission of the organization. While many advisors may suggest, for example, a healthcare organization should provide rich health care benefits, the Humaculture™ approach would view it a little differently. Humaculture™ would focus on the vision to model healthier behaviors, understand the consumer choices their patients are making, and differentiate the type of talent that may choose their organization (e.g., make the benefits less rich for those who aren’t willing to engage in healthier behaviors).

Such a design would support the organization’s effort to attract, engage, grow, retain, sustain, and transition employees who will buy-in to the vision and mission, be fruitful, and contribute to the tilth of the organizational “soil.” Well-designed soil requires fewer inputs of fertilizer, pesticides, water, etc. to successfully produce a crop. Likewise, well-designed organizations, including benefits and compensation that are aligned to support the vision and mission of the organization, will have much lower costs and achieve greater results than those organizations who “burn” the employees with rich or misaligned benefits. For example, one health plan had a copay for emergency room (ER) visit but applied the deductible and coinsurance for office visits. After switching the design to copays for office visits and increasing the ER copay, ER utilization dropped by 20% and non-emergent ER costs dropped by 99%. Overall, the broader behavioral redesign rolled back the cost levels 3 years of double digit increases without increasing plan participant costs.

So, what steps should be taken to design and implement benefits that support the organizational vision and mission, as well as reduce costs and support employees who thrive? How should you begin to develop an effective Humaculture™?

  1. Either develop or formalize and articulate the Organization’s vision, mission, and strategic priorities.
  2. Consider and design benefits that support the vision, mission, and strategic priorities.
  3. Optimize benefit design by applying principles of behavioral economics and choice architecture.
  4. Develop metrics that will provide actionable insights into the performance of the benefit designs.
  5. Evaluate benefit effectiveness relative to vision, mission, and strategic priorities and performance.
  6. Modify designs accordingly and continue to measure and evaluate.

Applying these Humaculture™ principles will move your organization toward providing fertile “soil” for employees, reduce benefit costs (even before “cost management” techniques or services are used), and contribute to a much more productive and profitable organization. Please see our real world applications of this approach and the outcomes achieved with time off, health care, and financial well-being benefits. Take the Humaculture™ Benefits Assessment to conduct a high level analysis of how you are doing.

About Humaculture, Inc.
Humaculture, Inc. transforms organizations—the way organizational leaders understand the organization and the relationships among the people in it, and the way people think about their position and role in the organization. Humaculture™ is a philosophy and systematic approach for creating profitable, aligned, and healthy organizations conceptualized as “soil” in which people can thrive. Humaculture™ helps organizations create the right culture in order to naturally attract, engage, retain, sustain, grow, and transition people who enable the business—and each other—to thrive. More information can be found at: Humaculture.co. Learn more about our team at https://humaculture.co/who-are-we/.

Authors:
Wes Rogers, Chief Guidance Officer for Humaculture, Inc. Wes has almost 35 years’ experience in consulting and senior management positions with a variety of organizations, facilitating groups of people with diverse perspectives and objectives to coalesce around a singular vision and marshal resources to achieve the vision. This experience provides exceptional insights into how organizations operate and succeed.  Contact Wes at [email protected].

Steve Cyboran, ASA, MAAA, FCA, CEBS, Chief Behavioral Officer, Consulting Actuary for Humaculture, Inc. Over the past 30 years, Steve has worked extensively with leading corporations, higher education institutions, and health systems across the country to articulate a vision for a healthy and effective workplace culture, develop a total rewards strategy to support that vision and brings deep benefits expertise with a behavioral approach and sound analytics to achieve and measure the desired outcomes. Contact Steve at [email protected].


 

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