GUAA Risk Review

Spring 1999

Medical Committee Workshops

By Wayne Fisher,
Trustmark Insurance

The Medical Committee was very pleased to have Marianne Miller, Director of Federal Regulatory Affairs and Policy Development, speak about Patient Bill of Rights. This discussion touched upon the status of congressional debate on patient protection, HIPAA issues including federal enforcement, and other topics currently being debated in the Federal Government.

Steve Noury and Scott Smith, from Coalition of America, presented a high-tech session on Paying Less for Healthcare. All who attended gained by the insights presented regarding the dynamics of our industry. Special focus was given to the current status of managed care and the evaluation made by Coalition of America. Did you know that PPO's are the consumers' choice and that there are 1,035 PPOs in the United States of which 60% are owned by insurance carriers? Our Let's Talk Shop focused on HIPAA implementation. In a session facilitated by Marianne Miller of HIAA and Jeannine Wilson of Starmark, a discussion was held on issues raised by HIPAA implementation. We discussed specific subjects such as determining group size to large general issues such as the Newborns' and Mothers' Health Protection Act. When the session ended, we wished we had more time for discussion. Look for this topic at the next GUAA session!

Do you know what your Brokers think or want? If you attended our Broker Panel Discussion, you might have a good idea. We explored the mind of the Broker community during a session with three Atlanta area brokers. We heard directly from the brokers how they feel about their relationship with underwriters, renewal action, data requirements, and other topics of interest.

Automated underwriting and the advantages it brings are topical in the industry today. John Friesen, FSA, MAAA, VP of Actuarial and Underwriting for Blue Cross Blue Shield of North Carolina presented the process his organization went through to automate their small group underwriting process. The discussion included an explanation of the technical aspects of the system as well as the effect on the human side of the equation.

Arthur Sorg, Sales Director for PCS Health Systems, Inc, gave our attendees a great deal to think about concerning drug trends and the future of the product. Did you know that retail spending increased 70% from 1992 through 1997? That prescription sales grew to $81.2 billion dollars in 1997? This informative session got our underwriters thinking about where this product is heading and how we might address it in our underwriting responsibilities.

Al Bemiss of Zurich Financial Services shared his keen insight in evaluating an MGU. He advised us to evaluate an MGU like we approach underwriting a case by looking at their carrier history, financials, experience, etc. In greater detail, he described how the carrier can determine if the prospective MGU is a good fit.

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