COVID’s Impact on your Business’ Health Insurance / HealthChoice

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okay good morning everyone it's a couple minutes after 8 30 so we want to get going we do have a bunch of information to cover today so we want to thank everyone for joining us this morning um as always want to make sure that the information that we talk about in the webinar today is not taken as any sort of legal advice you want to make sure you're consulting with your teams internally and your business partners and from the audio standpoint if anyone does have any issues just know you can't do both the computer and the phone audio so just make sure you have both of those options if you are having any issues so i want to introduce

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um our guests for today so obviously myself jeff bashing from rogers gray a lot of you have been on a bunch of our webinars so i want to thank you for your continued support um today we have scott meehan who's the vice president of sales at blue cross blue shield of massachusetts joining us as well as our president and ceo at rogers grade dave robinson so we're going to try to give a couple different perspectives on what's been going on with covid and the whole 2020 and everything that's been happening you can kind of see in this slide here so i think if i could put up a poll you know has this been the hardest year ever

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to run a business and to manage a business i think everyone would probably agree if it's not the top it's definitely somewhere near the top so this year you know we kind of came into the year the only thing we talked about was the paid family medical leave and all of a sudden march came and it was covered 24 7. so what's been going on with the economy business is closing um some real some industries taking some major hits the restaurant hospitality industry still really struggling uh administrative new laws coming in the

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ffcra with the new required leave trying to figure out how to manage that kind of an interesting precursor to paid family medical leave coming this january as well as then cares act tpp loans finances and you know we look at it from a standpoint as well you know it's it's our job to look at things from the employee benefits side so making sure for our clients there's some financial longevity there of your insurance programs keeping costs in control uh taking care of your people something that we kind of hold very near and dear to our hearts um and then

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some underlying challenges that we found from this year for you know being an essential business having a strong benefits program who a lot of the people on the call probably share share that with us um some underlying challenges that come with that and and how to how to help overcome those we want to spend some time today sort of talking about that and and what it means to be you know an employer of choice so um you know we have this new normal everyone's been talking about a new normal and you know what has 2020 brought on so i think i'd probably like to

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start with dave if you want to talk about you know what does it mean what's our new normal at rogers gray what did things look like what you know what were sort of the things as the leader of our organization that kept you up at night beforehand and then i'm sure you probably have a slew of new problems now um that that really you and the executive team are really worried about so do you want to kind of start us off where what it means you know what 2020 has meant for us looking back yeah sure it's good to be with you all and uh jeff i want to thank you for you know i woke up in a good mood today and then you reminded me of all the

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things we've been through in 2020 about covet and quarantine so thanks for changing the tone of my day but hopefully we can turn everybody's day around and talk a little bit about all the things were impacted as a business so whether we're in a pandemic or not pre and post pandemic and even though we're in the middle of it we have had one continual focus and that has been to be an employer of choice and there's many things that we do again pre and currently uh do uh to make sure that

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we can do that and and the things that we primarily focus on are what are our core values we spend a lot of time developing them we spend a lot of time living by them in fact we do that every day we have our full commitment to them whether you're uh just starting at the organization or on the top within senior management we make employment decisions based on our core values and so even if somebody is an a plus contributor if they do not match our core values we may change their employment decision or or status

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we also spend a tremendous amount of time investing in our core values uh we we give rewards on around the whole company based on hour six and i hope that each and every company on this call has uh taken the time to develop whatever number is appropriate for you and then the last comment i make jeff is that when when i look back throughout this crazy time we've been living in i look at our senior management meetings before this pandemic and and we would spend probably four to five hours together

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and about half of that was spent on how do we make our company better so that our employees which is our number one asset enjoy coming to work even more and what changed was as soon as quarantine and march hit we did that 24 hours a day and we were so focused on the safety and security of our folks uh which i know we're going to touch on later today um but one thing remained constant and and that is what i started with is we want to be the employer of choice in this region and beyond so uh we'll

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hopefully challenge you all to do the same and and uh look forward to continuing this presentation yeah and absolutely and i think obviously scott from from your side with blue cross blue shield i think you know more than ever it's always kind of been that that golden standard in the healthcare marketplace here in new england but specifically massachusetts but i think more than ever uh people have probably been looking at you guys this year for help and assistance uh really probably more more than they ever have in the past is

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that fair to say yeah absolutely and before i eat this i comment i thought i just want to say thank you jeff for having me today and dave and the rogers a great team and uh and thank you for everyone on the on the line today uh it's great being here uh first of all dave very impressive what uh what you said about rising gray and i i love um what you had to say about your your corporate culture um obviously for for me personally at blue cross i've been with blue cross for over 21 years and i've never been more proud of how we reacted to the crisis the

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covet crisis i never thought in all my years that we would have to pull out our game plan on how to handle a crisis but the first thing we did in a six step process was to make sure that we had ensured the safety and well-being of our employees and everybody started working remotely which was not new for us because in years past we have worked very hard to make sure that people are in position to continue to work during snow days so we were able to take advantage of the work we did on

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preparing on snow days to keep business moving to move forward right into the working remotely at home but from there our second step was we needed to make sure that we our members had access to care and right away we uh we dropped all the prior authorizations the referrals we waived co-pays we allow folks to um get their referral of their pharmacies their prescriptions filled uh early which were which was a must at that time uh we also um you know made sure that operationally

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that we were moving forward and we were running on all cylinders we had to work with our broker partners to make sure that in our accounts to make sure that the communication was going uh getting sent out during because every day as you recall everything was changing so rapidly um that we need to get those communications out but for the last thing i would say is that i was very impressed with how we reacted or responded to the community uh because that is a big part of our dna is how to give back to the community uh and if you recall we've actually we've donated um

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hundreds of millions of dollars to uh covert charities we've actually um loaned the state uh people employees from blue cross to help with the tracking or the tracing uh and then if you recall we also had commercials out there or advertisement but was really to keep people positive during this time the last thing i'll say though is that's when things kicked off but i think moving forward uh internally for our employees it's all about work-life balance um you know because there is it's a there is a new norm right now

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and there are kids that are hybrid in school or caring for elderly parents and how do you balance the work-life balance uh and also support people during the covert and also during the social unrest yeah and i think scott that's a great lead-in to kind of talking about some of the more you know direct operational challenges that everyone has gone through this year so you know i i share in that that remote working you know i even before covet i probably was working remotely i would say nine out of nine out of

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every 10 business days but i think you know dave we've seen it on our side of things where we have offices you know 10 plus offices now people everywhere business is closing um you know having to change some of our interactions with with our our customers that we're used to just stopping by in an office somewhere down the cape um but you want to kind of talk about some of the things that we've done on we'll get to the the people part of it i think the people part of it's super important when we're talking about mental health and caring for you know trying to help with child care issues etc but

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the directed the operational side of things um you want to talk about just some of the things that we've kind of done this year that and maybe we hadn't we've probably done some planning on it behind the scenes but not with the assumption that we have a worldwide pandemic and having to sort of execute some of it so you want to kind of go into some of the operational stuff yeah i'd be happy to you know you mentioned we probably planned for you right we've always had a disaster manual but that was to prepare for nor'easter's blizzards and hurricanes not a pandemic

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and so this drew curveball to all of us here and on the line so we had to contemplate things like when and if we close offices we decided on march 16th we had our annual meeting which is our biggest business meeting internally where we bring all 220 people together and we had a keynote speaker and so the day before we we decided we had to cancel because of the safety of our team so we had to make decisions like that that we had already paid for budgeted but it did not matter what

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mattered was the safety of our people and our clients we had to think about how do we get remote because we are here to serve our clients and we needed to do that as fast as humanly possible because our clients are having questions what does this mean for me do i have business interruption coverage do i not how does insurance respond to this pandemic which has been a huge topic throughout this process we were able to go remote in about 24 hours and i recall the the phone call was made to a supplier cdc we were able to buy the last 23

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chromebooks out of boston so um everybody was scrambling it wasn't just us and we had to really help coach our management we had had some remote work done but uh not a tremendous amount so we had to really take advantage of zoom take advantage of microsoft meetings and and really help coach them with this new norm that they're going to be entering into all while in in the midst of a tremendous amount of fear so we had to really think back and i mentioned we have six core values one of them is trust

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we talked a lot about how do we make sure our team is doing exactly what our clients need we can't be with them we can't sit in the same room and um we we believe strongly that we need to trust our people and they're going to do the right thing and so we've been proud of how they've performed uh but nonetheless we have changed our practice and and are even further as a result of this challenge looking to turn it into a positive we've decided to to um roll out a remote work policy in which about

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40 of our people are going to take advantage of so if there's any good in this there's the ability to have flexibility and to change our business practice yeah and i think that's that's another excellent lead in into the next so i know we're spending a little bit of time kind of going backwards and seeing where 2020 is going but i think you know you'll see as we move forward through this really probably starting here and forward it's really you know what are we gonna do 2020 the rest of 2020 and into 2021 to assure

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you know business continuation to assure operational continuation and then we're going to talk a little bit on the you know the financial side of it as well but you know dave i know you mentioned it and if you want to kind of just i guess dovetail on what you mentioned before but the challenges specifically with you know the the employees the the the mental health of employees dealing with child care the you know having to be home with zooms and kids running around um you know we've done some pretty specific things around that that i think have been really cool i think it would

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be it would be a good uh if you could share a little bit of that happy too you know before i do it i look at that picture and i feel like that's what i see every day i come home from work and i hope i hope that not everybody has to uh bear through this difficult time with young children but those of you that do i can certainly emphasize and sympathize with you it's it's not easy the distractions uh remote work and and all those things so i'd say where did you get the picture of my wife that is not my wife but it is how she looks

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a lot of time um so uh to your question um you know what we we our number one core value is our people here we talk about trust and our people is number one next to our clients and what we did is we tried to create an environment where they could thrive in such a difficult situation um the mental illness that was was so prevalent and remains prevalent among all of our employees is something that we think about and we're concerned about and we realize what they what we want to do and what we

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believe our team and our colleagues want is they want to know what's going on they want to know what we're doing to plan so early march we decided we were going to hold all user zooms uh every single wednesday and there's a funny insurance commercial that geico did called hump day so we call them hump day and we have some fun with it my brother and i mike robinson um we we banter a little bit as brothers do but we really help them understand what we're doing as a business and why and what it means to them and

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the things that we would do is is uh share how we're handling remote work what we understand about ffcra we made the decision we were going to pay in full um and we were going to make sure that no matter what there were going to be no people expenses cut the only expenses we were going to cut were the ancillary projects that we had we made that commitment publicly um when things started we've done things even recently as last night we send meals to to colleagues that we know are having a difficult time for whatever reason just to help brighten their day um we

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we've done things that we know homeschooling is not something we've all been trained in i've tried it i've failed miserably i've been fired but as by the principal my wife and we tried to supply some financial resources to allow for classes to help them really further the education of themselves or their families and so we've allowed for financial stipends there um we we do zooms actually we hired a therapist to have a confidential zoom

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meeting with those that are interested that needed the help and that was received very well we've done a lot of different things we've not done them all and i'm sure a lot of you on this call have done done some things that are great um but what we've focused on too is is trying to help people have access to care and so we took a look at telemedicine which is something we're going to get into later on here but we use this as an opportunity to help people feel comfortable that telemedicine may be your safest bet

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and a lot of people have changed how they view the consumption of medical care and uh we're really trying to make sure that we can help them and guide them through that process and telemedicine has been a huge part of that yeah and it's the the telemedicine has been pretty cool even you know for me personally i had my my annual physical over zoom this year so it was something you know it's different and you know you kind of you push in your stomach and you say this hurts the batter and check your thyroids etc but it's it's something where we want to make sure that everyone's getting the

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care they need and scott that's a it's a great transition to where you know this human capital management the employees blue cross probably sees that twofold because you have your own employees as well but then you have millions of members across the state where you're looking out for their benefit as well so do you want to share some of the stuff that blue cross has been doing and i think it'll be a good kind of dovetail into the telemedicine slide we have coming up as well right i i think dave said it the best you know i think that we're all trying to do things um to enhance the

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positivity within our teams because there's a lot going on uh when it comes to covert and social unrest and also just the work-life balance um and like roger the gray and many of you on the phone we've done things uh you know like trivia day or we've done cook in the evenings right before uh you know dinner we've done cooking classes you know so people folks can get together cook a meal and have some fun together with their wine and um and then have dinner ready to go uh so we've done some things to keep people positive but we've also

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done a lot more we've gone out of our way to make sure that we've been listening as a company and communicating uh i know we do a lot of skip level um meetings with our reps to make sure that they feel like they're being heard uh i even i've noticed that we've done a lot more because of zoom we've done a lot more zoom meeting from whether it's our president ceo or our senior management on the sales team whatever it may be it's a lot more communications going on just to make sure people feel like they're in touch and being heard uh and just being listened to

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so that's been very important but you also talked about you know telemedicine i think some things that i would say internally obviously we have access to our own behavioral health physicians that are on our teams so we've actually hosted internally behavioral health uh webinars internally we've actually it was so successful internally that we've actually said why aren't we doing this for all our members and about three months ago uh early in the summer we actually started doing mem member webinars for

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behavioral health uh which on which you know unfortunately has been very well attended and i say unfortunately because it shows the demand that's out there um and then so in the now but that also goes to you know you know obviously covert has been a very tough time for a lot of us but i also i like to think of the positives that come out of it and the positive that i see is how uh how um telemedicine is being utilized and how it's taken off because it does help access to care and it does

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help people get um at least uh a physician on the phone um you know when needed so it's actually you can see the spike in in demand and utilization uh in telemedicine it's absolutely happened yeah and scott i remember we had a conversation not that long ago so at least to this slide but some of the stats you shared with telemedicine almost knocked me off my chair so i mean this obviously goes now telemedicine's always been around it's not something that's you know that was new this march but it's something that was a little bit underutilized and

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i think as we move forward again we're talking about you know what has happened this year and what are some of the things that we can potentially use as a silver lining moving forward and i think that that telemedicine increase obviously i mean you see the spike where january february you're at 350 400 000 and all of a sudden in april we're at almost 12 and a half million so andy scott with blue cross you guys you guys mentioned when we talked i mean your telemedicine numbers are through the roof as well correct now absolutely gone through the roof um

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and like i mean you know i would say like for example i know um you know i think we're closing in on over two million uh telehealth you know visits uh so i mean just it's amazing and we went we were going from uh maybe uh 200 visits a month and now we're closing on 2 million in just a short period so like absolutely like you said has uh taken off um you know since marched our telehealth spend uh is 150 times uh already the spend of all of last year so think about that our telehealth spend

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for claims uh year to date in 2020 is already 150 times all of compared to all of 2019. yeah that's that's uh it's a crazy number but in the grand scheme of things it's it's a positive number because you know we always we're we're talking about making sure members you know are making smart decisions when they can and you know telemedicine has always sort of been a part of that um but now more than ever i think it's you know again a silver lining from the pandemic is potentially furthering the development of really

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utilizing telemedicine to its full capacity i think it's the covid pandemic has has really advanced that and i know dave on our side of things i know we do some different things on on our medical plan compared to others but um do you want to just share briefly on on kind of how we what we've done with our telemedicine how i guess how it's different from normal and then what we've kind of done as a to to beef it up from where it was originally sure so under the premise of long-term sustainability with our health plan uh

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to offer to our families uh that we work with we we constantly watch what we can do to help um better manage our claims and there's a lot of different things that we do there one that jeff's getting at is we decided pre-pandemic that we were going to carve out because we're on a self-funded platform in our captive we're going to carve out our telemedicine services and what we did there is we did it on a standalone basis so that the claims did not hit our

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medical plan and why that's important is because that's where your increases come from on your overall medical plan is is how you're performing your loss ratio your medical loss ratio so we decided to carve it out and um it was fortuitous because of the pandemic and now all of a sudden consumerism which we've been talking about for years is now happening people are using telemedicine and so so it was financially beneficial to to all the participants on the plan to do that and the other piece we did during

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in it allowed us to do is during the pandemic and quarantine we were able to add on mental health support and um that has been a tremendous asset because people need help there's a lot of people out there that feel that just failing in everything as a parent as a as an employee and as a spouse so they need that help and we've had tremendous feedback from our team that that was such a great addition um we did it at no cost because we knew that they needed it

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yeah in scott we actually we did have a question that just came in it's probably worth just kind of talking about here quickly to ducktale what dave mentioned on you know as we're kind of as we move through the presentation we're going to start talking a little bit more about cost control but a question came in around just the difference between you know a telemedicine visit for blue cross blue shield versus a normal doctor's visit from from a claims experience standpoint so you know we don't necessarily have to get into exact type of numbers you know what's the difference between an office visit

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a telemedicine visit yeah it's a great question and i think when telemedicine was originally rolled out um the goals of it we had i i had three goals one was it was supposed to help with access to care affordability and make sure it was the first step to make sure that you also get quality of care um when the pandemic broke out um one of the things we did as we as you recall is that it was which was important for blue cross was to make sure our members had access to care and what we did is we actually started

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um covering uh the telemedicine at no co-pays and we also uh told the providers that we would actually for the time being we would reimburse the providers of the same amount for a telemedicine call as we would actually do for an impressive visit so since then there are some legislative um bills uh here locally at the state level one from the senate

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and one from the house where the senate would like to continue uh to pay uh have carriers pay the providers the same amount um for telemedicine call as they do for in-person office visit um for two years and that would also include phone calls emails and and text messages the house uh is a one year to help with the transition for the providers to pay the same amount for telemedicine as in

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as an in-person visit but it would only be for phone call um in in in video where i'm going with this as you can see it's your question is that right now is the same cost today uh as um for telemedicine as in person eventually that should go back down where it is a cost reduction in a telemedicine call or visit uh versus inpatient but we're very we want to see telemedicine be utilized but it has to be affordable it has to make sure it continues to

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provide access to care and most importantly we also need to make sure it doesn't impact quality of care right and that that's probably a pretty good transition there so you know part of what we wanted to talk about here and i know we've been getting questions we've talked about it a little bit but just the impact you know so that the title of the webinar sort of kova's impact on our businesses health and you know a little bit of a play on words with it being what about health insurance as well because it's a big expense you know people spending millions of dollars on it so you know i i think at least the

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conversations that i've had is okay here we are in in 2020 covet pandemic starts in march so members are not going to the doctor's office so it's you know they don't want to go they don't want to be around people that are sick so overall claims utilization is down and so scott so from that at least from that standpoint would you say that's fair 2020 all else equal claims utilization has been down oh scott can you hear me

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sorry about that i was on commute um so no question yes during the peak during the peak months it was absolutely a reduction in claims utilization yep and i think that's you you qualified it as a key because i think i think the overall assumption is that 2020 claims are down but i think you qualified correctly that the peak of it claims definitely went down and we'll get to that in the you know the next slide but telemedicine utilization is up per our last slide that's absolutely you know that's right on point um and

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then as we get into 2021 so what do we do you know the rest of this year into 2021 these businesses renewing now you know what what do we do what what can we plan on for next year you know if utilization was down are we looking at decreases next year which i you know we're going to get to in a minute but you know elective services on the overall have been down um this year so does that mean they're going to go up next year is there going to be a sort of a market correction our claims going to be on the rise and i think you know scott you provided this data here but do you want to run

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through you know this next slide here to talk about what's really actually going on right now yeah absolutely i think number one no one has a crystal ball um and but i do know our folks uh our actuarial folks are definitely looking at the data um very very uh thoroughly and since day one looking at all the analysis that we've said that we're going to look at this whole situation not short term but over a two to three year period and we believe that two to three year period

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that when this is all said and done that this pandemic will be a cost additive to the health industry so when you look at this slide here in front of you you can i like to call it the v so if you can see where the zero percent change on the left hand side there's like a great line that goes um horizontal from left to right that is the average pre-covered levels okay so you can see that the various services um

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dropped especially in april dropped dramatically and you can see with the v you could see as we got into june in july the increase so i'm just going to read a couple stats um that i have in front of me but you could so that will help with this slide but um so what we've seen is non-urgent emergency room uh has rebounded but more more slowly but it is now prac back to pre-covert levels i think you'll notice looking at the slide that outpatient elective services

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and inpatient electrosurgery have have seen large increases over the summer months it is now well above pre-covert levels uh total office visits that's now in person in telemedicine combined are are above pre-covered levels uh diagnostic covatesting accelerated in july and the number of tests is on track to be nearly double that of june uh if you just looking at the slide and you can see telemedicine uh continues to be very high behavioral health has been strong um you

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know in incline utilization even um during the you can see it was above well above the um the the uh the average during the peak but you could see it taken off during the summer months um so so that's what we're seeing now so so jeff as you mentioned during the peak we actually saw that cost reduction but now you can see that it's coming back above uh pre-covered levels but it is starting to balance off so the net for 2020 at the end of the

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day it would still probably be uh a reduction in claims for this year but we we are thinking as i mentioned looking at this over two to three years so we have to be careful that we don't under we have to right price the the rates to make sure that we provide the most aggressive rates we possibly can without underfunding the rates for future years uh the things to keep an eye out for that when you look at 2021 um is what's it gonna what's the impact of vaccines

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what's the impact of just a second peak of having uh covert claims come in you know although in this peak in april peak you saw the reduction in claims if there is a second peak uh in december into early 2021 we don't expect the dramatic reduction in claims like we would we've first seen uh providers and facilities are more prepared uh for a second wave to not only help the people that are test positive but also to make sure that they give

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care uh to those uh not covet positive because there won't be that complete shutdown as before other things to consider as you look in 2021 into 2022 is what's the impact going to be for those folks who didn't get their preventative services early on or their vaccines during the the first wave did if we did not catch something with that during a mammogram or colonoscopy what is the long-term ramifications of that into 2020 into 2022

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uh and then lastly um is you know behavioral health uh claims unfortunately continue to um tick upwards right and so scott you know i know we've we've talked about it a little bit but there's i i think a lot of people are going to start seeing we've been talking about a quote-unquote covid trends popped on to to rates looking at a renewal so you know i've seen it anywhere and this isn't obviously unique to blue cross blue shield this is kind of across the marketplace but you know seen it anywhere from two three four

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five percent and so i think that just goes back to talking about that you think you know you being blue cross blue shield underwriters etc um see this as a as a net cost increase at the end of the day so that is that something that you know everyone who's budgeting for the future should be on the lookout for or i so if you ask our cfo uh the answer is yes um and so again we do think this is cost going to be cost additive

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over the two to three year period uh and roughly by you know four to five percent um as you mentioned when we look at our calculations for the 100 plus there is a a covert factor and that's i like to call that a mature factor because obviously what happened in april and may is not a true uh indication of what um claims are gonna look like in 2021 you know underwriting you know is their job is to try to look at today's

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data uh put it into the calculation and try to make sure that the right price the rates for future years and i think that's the balance right now for all carriers is how do you provide the most aggressive rate you possibly can for our customers and for our members without making sure that um that we don't under price for future years and there's that balance of try um you know in that you know which and we're trying to be financially responsible

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uh both short term and long term yeah and that that that makes sense and i think that's going to be the underlying theme of the sort of the rest of the presentation here is how do we have that both short-term and long-term viability so you know the one thing that that we saw pretty early into the pandemic i remember having a conversation with dave is that you know all of a sudden we're seeing some you know we've talked about direct challenges with covid so operational quick work and remote mental health challenges with employees

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but some underlying challenges where you know if you're offering a strong benefits package which a lot of companies do that's you know kind of a feather in your cap if you want to have a strong benefits package um there can be some underlying challenges that come with that and you know i think even dave is it fair to say that we experienced that at rogers gray it is um you know we we do look at this as a very important part of our employee benefits package as you mentioned jeff what we experienced through covet is is um we were a company that did not perform any layoffs but there were a lot

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of companies in our area that did it's in and even some of the spouses of our employees were laid off so what we saw was a rather significant influx of enrollment into our plan and that's okay that's why we offer health insurance but what we need to make sure that we do is understand the impacts right so so there were some high cost claimants that came along with those layoffs and again we are offering health insurance because that's what we're proud to do uh

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what we need to do is manage consumerism and drive behaviors and not just let those things happen and we're gonna touch on a couple strategies today um but the the key is that you need to take control of your communication and and plan for those things um we started talking about in in before they happened in march because it was just an immediate reaction we realized that people still need health care and so what are the next things that are kind of down the line um dominoes that are going to come from

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from this pandemic and and that's what we're planning for now yeah and one of the things that that has hit and i know our service team internally has received questions on this but it's something that you might not have thought of but it was a you know it was a a result of having employees come and go is is in that second bullet there the different rating methods so we've had you know going from there's really three segments in massachusetts of of health insurance ratings where you're under 50 employees 50 to 99 and then if you have 100 or 100 or more

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enrolled and with layoffs or having people come on you could actually bump go up or down a different market segment and what does that mean and so we've had some that have gone from you know over 50 to under 50 some from under 50 to over 50. some that were 100 plus that then drop below and what does that mean all of a sudden you know are you not seeing your claims reporting anymore so you know scott i know this is something we had come in from from our client so do you want to just touch on some of the the potential impacts of jumping

37:21

different market segments whether it be you know that under 50 merge market to the 50 to 99 to the 100 plus right thanks jeff um so i think for folks who may or may not know um that we judge uh or categorize um what segment you should be underwritten in um based off full-time equivalence so if you're a company that has less than 50 full-time equivalents you're going to be cons underwritten in what we call the merge

37:51

market or the small group and that is just a pure rating calculation methodology based off your company's demographics if you have over 50 full-time equivalents uh you're outside the small group but what happens is when you when you get above 50 full-time equivalents if you have 51 to 99 enrolled um then what happens you're in an area where they it's a balance of your demographics and and they will potentially look uh under the

38:22

hood on your claims and then when you're old but you don't see those claims and when you're over a hundred there is a rate and calculation where you can see your true claims so as jeff mentioned that depending on your demographics or your claims that what we have found is that there are some winners and loses when you do change from one rating methodology to another or underwriting philosophy to another um right now in the current dynamics i i have seen most times that when groups fall

38:53

below 51 from the 50 plus below to the less than 50 most times we have seen the rates go up um because that small group is that merged market where this a lot some of the small businesses are helping to subsidize some of the costs for the individuals you know jeff if i may that is a key thought process that employers need to do even if you're considering doing layoffs going forward what scott just mentions is real we we had one client that um remained nameless but they were

39:24

over 50 went down um to probably about 10 and the remaining 10 were in their late 50s early 60s they saw a 62 increase on their health insurance rate that is not sustainable so you have to think of all of the facets before you make decisions about the the employee of your people so just keeping that in mind is part of the picture yeah absolutely and i think that's you know we did a webinar earlier this year with citron cooperman and one of their partners mark and he said

39:59

you know this is the year where you really need to take a look at everything within your financials so you know we know from our client that obviously health insurance is probably the second largest expense behind payroll so really understanding you know not only you know why you're paying half a million million two million dollars in premium but understanding why you're paying that type of those premium numbers understanding you know why it is what it is and what

40:30

other options are out there and and that's where you know we just want to make sure that everyone understands that there are other options out there so our little the little people graphic down at the bottom it's it's basically a way to say that you know it's it's kind of the 80 20 rule in the grand scheme of things 80 of your cost is driven by 20 of your population so that's that's kind of a long-winded colorful way of saying that so you know what options are out there for you as an employer and i think you know for anyone that's

41:00

talked with us before you know we dave mentioned it earlier we mentioned it but you know we are members and a captive and it's a captive that we manage and it's something that you know most people probably have not kind of kicked the tires on before but it's an option that's out there um you know we do our best to make sure people understand it the pfa is an option that is out there that we have been um we've been using probably for the better part of 2020 and it's been a really good option for those that are still fully insured so whether blue cross blue shield or another

41:30

carrier it's a really good way to sort of um get the feel of self-funding without actually taking on the risk and taking advantage of that you know the opposite of you know 80 of your employees are only 20 of your costs so how do you how do you make that work in your favor so i know a question that came in and you know dave for us you know where we just ticked over 215 employees we probably have 125 or so on our medical plan which might be similar to those out there on the call

42:00

um but you know the question that came through is i think looking back on it it's easy to say hindsight you know it's a great decision you know everything we've gone into our captive things have gone well it's it's been good but when you were making that decision you know the when we were pulling the plug and saying okay we want to try this you know what what were kind of the factors that went into that so for the decision makers on the call that might be having to look at something different might not be a captive could just be a pfa it could just be something different um what were the decision making factors that that you used

42:32

you know for for us at rogers gray both from the financial executive side but then from the people side as well sorry i think um we tie it back to as i mentioned the beginning our core values but what we focused on specifically to your point jeff is a how is it going to affect our people what's the long-term sustainability of it we didn't want to just jump in for a year and jump out that's not good for anybody and it makes our our team lose faith because we're jumping around and it really is not good uh practice and then really can we

43:08

start taking better control of our financial future through our medical insurance and our strategy so that was the biggest one and i don't think enough employers take that conversation seriously i think it's it's um just a label of strategy right what is strategy really and so when you look at when it all flushes out and we're in the middle of of uh covet 19 our teams no matter what employer you're you are are listening more acutely than they ever have

43:39

and so if we're not as employers driving consumerism if we're not as employers letting people know how the plans function or talking about different ways to manage our claims we're really missing the boat and we're not we are going to continue to see major increases so those are the things that we've thought about and that's the the number one thing i would challenge all of you to do is really start having those conversations with your team one simple strategy uh alice mcgicker and our chief people officers is putting together

44:10

micro videos so that when we talked a minute ago about spouses joining our plan they understand what their options are so all those are pushed out to our entire team and their families and they can truly understand what they are paying for so those are the things that we'd encourage you to think about because there are so many options out there um that didn't exist several years ago or or weren't as um great of options before yeah and quick shout out dave you mentioned allison our chief people

44:42

officer so a lot of people on the phone um especially you know clients of ours have probably had the the privilege of chatting with allison but a lot of the things that she has done we've we've helped pass along to clients so if anyone ever does i was actually on the phone allison and and uh an hr officer at a big private school yesterday but allison is has been great chatting hr with people and yesterday was a lead management talk trying to figure out how to handle paid family medical leave coming but

45:12

um a lot of the great things that allison has come up allison and her team have come up with we've really tried our best to share some of those success stories with clients so you know a couple of things that are up here so pfa we actually have a webinar we're not going to spend any time on it today but we have a webinar coming i think it's next week on it in the captive self-funding john turco and one of the other one of my colleagues we did one a few weeks ago on that so those are both up on our youtube channel so if anyone's looking for those we can we can pass those along but um really

45:44

really cool options the capital one was pretty cool it was i know for the people that went on it was a little bit eye-opening but the pfa when we have company is going to be great too and dave i know it kind of goes into our next conversation where you know contribution strategy i think again you mentioned that word strategy strategy's thrown around a lot um but again the the employer of choice i would say conundrum but it's you know it's obviously it's a great thing to be but at the same time it comes with its challenges so the idea is doing something

46:15

in a vacuum that really sets you up you know it works today it works tomorrow and it's on the path to work long term so i know we just had a conversation around our contribution strategy but dave you just want to just spend a minute on this and then we can dig into one of our one of the other programs that we just talked about yeah we we did what you just said jeff we look at this short term long term if we're going to look to do what's best in 2021 we're going to lose in 2022 we have to have a multi-year approach we're looking at things like claim distribution across all tiers

46:46

and how that really can help us measure are we too good of a health plan that we're bringing in bad risks so so we really measure that with the premise of recruiting and retaining the best talent um we drive our thinking towards a long-term sustainable approach and and there's a lot of strategies and and specific initiatives within that that we're happy to share with any of you uh but jeff just gave me a hint that i should stick to a minute maybe he's saying i've been long-winded i don't know

47:17

no i do doing good and i will say another quick shout out to so kl on our account exactly on our service team has a fantastic uh contribution spread strategy spreadsheet thing that we've used with a bunch of clients to sort of show you know a bunch of different ways to look at it from employer employee um you know long-term annually monthly the whole the whole nine yards so if anyone is looking for help just sort of trying to figure out what does a potential shift in contribution strategy

47:48

look like holistically we do have a great resource that kl put together for us um so i think the the before we kind of close so this is one program something new for this year um i know i've had in the course of my benefits career over the last almost 15 years i've had occasional conversations around you know for those trying to come up with a total compensation package for employees that's equal you know what happens if an employee is not on my plan versus it on my plan can i give them

48:20

you know a little extra bump and pay because we're paying so much money for someone who's a family plan so we've come up we've we've been approached by these voluntary waiver programs so they're programs that we've actually been talking about um and you know dave i'll let you kind of dig into the spouse's dependence medicare eligible ones but it really is a way to just make sure that you as again going back to what market citroen said make sure that you understand what's available out there for for holistically your entire employee

48:51

population and and this is potentially a win-win scenario where not only is it a win for employees from a coverage out-of-pocket standpoint it can potentially be a pretty big win for the employer as well looking at you know as dave mentioned you know potentially trying to not take on some of the bad risk that may be out there et cetera so they're going to spend a minute on the voluntary waiver stuff sure so this is a program that's been around since the early 90s but has not been prevalent in mass

49:21

so it's not something new and shiny it's actually a sustainable proven model what this allows us to do we're rolling it out here it allows us to provide financial incentive for our our employees to look at their spouse's plans and help supplement the cost of that plan there's a lot to it and there's there's regulations around it and it's it's considered under the legal realm of an hra but this can help you as employers control those uh enrollments on your plan without

49:54

pushing people away in fact you're helping them and so that is a really important thing to think about in addition um the the option of looking at a medicare supplement you know we live in demographics of a population that may be nearing medicare age so these are the things that employers need to start thinking about and there's downsides to each of them you need to vet it you need to understand it but this allows you to really maintain

50:23

a healthy health plan for example if one of our employees opted into our vwp they could conceivably be a high cost claimant and all of the sudden that claim is no longer on your plan they wouldn't leave your plan if they couldn't get equal or better coverage and you're actually helping them subsidize that cost while maintaining um a less expense than you would have otherwise with them on the plan whether they're a high cost claiming or not so um it is it can be communicated very

50:56

effectively we've built out faqs we've built out a very clear strategy for change management to roll it out but this is a strategy along with medicare um supplement plants that we're seeing needs to become a trend and it's not yet this is what employers need to do right and i think this probably goes into that bucket of of things to look at as you're thinking about long-term sustainability of your benefits package so it's not necessarily a one size fits all this is the right

51:26

solution everywhere but it's in that same conversation as pfa as potentially a captive voluntary wafer program prescription discount programs etc and it's all it's all really the linchpin of it is communication and engagement it's all how it's communicated so i think that's the big thing it's just letting everyone out there know that there are other means for potentially controlling your healthcare plan other than let's get to our renewal let's see if it's good or bad let's negotiate it down

51:56

as much as we can and let's rerun it for next year so i think that's i think that's the big thing um i think that's a big thing the big message to take away from here um and then so i do we do have a couple questions coming in that i will get to at the end but just uh i want to make sure we get through just kind of some of the closing thoughts from from both dave and scott so scott do you want to start with just kind of words of wisdom as as we head forward you know closing out 2020 heading into 2021 just from the blue cross blue shield side of things

52:26

yes and i'll keep it sure because i know you got a couple questions you want to answer and we got to wrap things up but i think um you know as we move forward regardless of covert and narcoven we're all in this together and i think the ways in regards to trying to keep healthcare affordable and enhance the quality that our members receive and enhance the experience they receive there's a lot of tools out there um that that can help our our employees or our members uh to be better consumers and i think if you if you hear you've

52:58

heard this before i'm not telling anyone anything they haven't heard before but it is true that the biggest way we can uh help offset the cost of insurance is to have our members be healthy better consumers but we need to do a better job of providing um those tools for them and also making sure that they understand that the what tools are available i know at blue cross uh we've spent a lot of time and money just um into enhancing our what we call my uh my blue choice

53:29

my blue web application and on there we have the tools for employees to search the doctor search pharmacy search for cost quality etc so my two words of wisdom that we are all in this together there are tools out there resources out there but we just got to make sure that our folks get to those um those tools to be better consumers yeah and scott i i will echo that that's been a big push at our open enrollment so you know obviously open enrollments now have been you know mostly virtual um you know

54:00

we're looking forward to the days where we can get back in front of of our clients and their people um but i know the big push this year has been you know try not to make sweeping changes you know understand what's out there but you know it's the reality of it is let's try to keep things as close to where they were as before but a big push on exactly what you're talking about some of these member benefits that you know might come in a member packet where back in the days whenever we got a member packet that you know might be a couple of sheets in there that you know people maybe wouldn't look at as closely

54:32

those are the things that we're focusing on heavily this year when we're doing open enrollments and really making sure they understand all those tools that are available to them um you know any any member health benefits any physical benefits like you said to look for care you know telemedicine make sure everyone has that at their fingertips um i think that's been a big push this year and then dave do you want to just chat on our side before we get to a couple questions before you just oh yeah one last thing just so i would say two things two last things if anyone who has blue cross uh if you you or your employees haven't

55:03

downloaded the myblue app please do so and then jeff i would also mention that i know you showed some alternative solutions like with the pfa and the captive i know they also provide great resources as well so at the end of the day hopefully folks are using those resources absolutely yeah mobile app has been a big one we've actually built out a couple of mobile apps for uh for clients this year to help make sure that um the message not only makes it past the zoom meeting but it's something that they can carry around 24 7 on a mobile phone

55:34

so we definitely echo that as well dave you want to jump in sure so just uh you know point scott made is that we're all in this together he's right uh and as a result we believe that people are thinking differently more than they ever have our employees are thinking differently whether it's how they consume health care whether it's how they operate their day whether it's how they look at an employer or their family it's just different through different lens so what i would challenge each and every one of you to do is to start thinking longer term because we're

56:05

all stuck in this short term mindset we're in the middle of a pandemic we're just trying to survive so make decisions based upon yes the short term but start thinking more long term what are the impacts scott shared some of the tail effects of covet 19 and what that is projected to do with medical costs start thinking that way engage in that conversation and the bottom line to all of this is and it always is communicate to your team be transparent and and let them know the struggles you're having let them know that it's it's been the

56:37

most difficult year you've had they're gonna have a whole lot of respect for you being open and honest about that versus just trying to walk around like you're the knight in shining armor so be vulnerable communicate openly and uh take advantage of this new norm of thinking that people are going through in a positive way for them and for you as a business absolutely so i'm going to quickly share we're up against it so i'm just going to quickly share a couple of the webinars that we chatted about so that the pfa one

57:09

is next wednesday so this we'll make sure that this that gets out to everybody but it is at rogersgrey.com and then we do have so the page family medical leave despite all the chaos of the covid pandemic paid family medical leave is still starting in january so um you know jen pinkham who if anyone has been on the webinars before jen was great through the whole covet business opening closing what's going on ffcra she's going to jump on and give everyone a quick reminder of paid family medical leave so i think the most we've been getting our most

57:40

questions over coordinating with other benefits i think that's going to be a hot topic but just kind of a once-over as well now that pretty quickly we're going to start seeing claims come in so just to make sure that everyone knows you know what to do what to expect having some great conversations around helping clients with with that leave management even clients with pretty robust hr departments so if you're looking if you're struggling you know looking for a plan around how are you going to handle lead management you know you're definitely not alone number one but number two

58:12

there are solutions out there so please take advantage of these webinars they're going to be really good ones coming up and all the other ones i think are up on our university as well so we are at 9 30 we do have a couple questions that i'm going to go over but for anyone who does have to jump thank you very much for for jumping on scott and dave you guys can stay on great if you have to jump as well thank you um but hopefully this was a good you know a brief look back we don't want to spend too much time commiserating on 2020 but at least give you a good idea of what to do what to plan for 2021 hopefully everyone took

58:44

you know one or two good ideas out of it um so hopefully it was helpful and i will get into so there was one question on the so the voluntary waiver program how is that how is that done without discriminating and i think this is where this program you know a lot of the these programs that have happened over the past of hey we'll give you x amount of dollars to you know if you decide not to take our plan and jump on a spouse's plan i think that's where an employer can probably get into some trouble

59:14

around having having a program like that that isn't a written erisa document and i think that's where the voluntary waiver program is an erisa benefit you get an erisa plan document with it um it's something that's that's written up that you as an employer have to obviously follow so that's you know that's the double-edged sword of it it can't be one person gets it one person doesn't but the waiver program is an erisa uh compliant benefit that comes with erisa docs behind it so that's where um and again it's all around communicating it's not if you are

59:44

if you are in x situation you have to take it it's just an option it's all about you know the positivity behind it the potential benefits making sure they understand good bad and different dave is that is that fair did i miss anything there no i agree with you it's non-discriminatory if you're not targeting an age a sex or a high-cost claimant and that's what it comes down to everybody has to be eligible and is so uh based upon the way the erisa law works it it does provide as long as you

01:00:14

apply those uh that set a lens you will not be non-compliant yeah and then so one more just dave so you had mentioned telemedicine carve out earlier and i think that that might catch some people off guard just because telemedicine is we're used to that as attached to our health plan so just want us to spend a minute on what it means you know why we can carve out telemedicine and just kind of the whole process behind that sure so carving out that you can do telemedicine but also pharmacy so really quickly

01:00:45

we we carved out when we went self-funded about three and a half years ago coming up on four years we just went self-funded and and we kept our pharmacy uh within the plan year two we carved out our pharmacy in our high cost drugs through a strategy we can explain to you that saved about 10 percent of our total medical spend now we've moved to look at other things we can carve out through different outlets because there's different providers that have different cost structures so we found a cost structure with telemedicine of a very reputable firm

01:01:17

you're very familiar with the name that we pay per employee per month charge and that is that encompasses all claims that hit that telemedicine plan there are some co-pays that are no different than what we would receive in our plan prior uh but that's how it functions and operates and therefore those claims do not hit our plan it's just the way that we're managing our costs and making sure that like when we go to the grocery store we may not buy the number one brand we made by the the stop and shop brand but it's

01:01:47

still the same manufacturer the same uh ingredients and and so forth right and that's where just you mentioned quickly on the pharmacy so i know on the pfa slide in the pfa webinar coming up we'll talk about it but so the car votes in in a fully insured setting with one of the major carriers you can't do any carve outs so you know it is what it is with the telemedicine pharma pharmacy so the pfa program does have a a unique prescription add-on to it where you know it does do some things with prescriptions that they kind of give it

01:02:19

a self-funded feel like a car about but without actually being a car vote so we've had some we've had some great success stories great conversations with with clients about it trying to help offset some of their prescription costs so those are just two two different things to think about again different different settings one fully insured one self-insured but just a couple different things to think about so i didn't see any other questions come in i know the voluntary waiver was was one that came through and the telemedicine one so i want to thank everyone for jumping on we went a couple minutes over but thanks everyone

01:02:51

for staying we'll make sure to get this recording out and as always if anyone does have any questions please feel free to reach out we'll be more than happy to have a conversation so thanks everyone for jumping on stay safe and here's to a positive and healthy 20 21. thanks jeff

COVID’s Impact on your Business’ Health Insurance

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