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EBRI: employer, worker contributions to health-savings accounts are falling
The percentage of employers and workers making contributions to health savings accounts (HSAs) fell in 2014. That’s according to new research from the Washington, D.C.–based Employee Benefit Research Institute (EBRI). The organization posted a news release about the research to its website on March 26. EBRI is a private, nonprofit research institute that […]
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The percentage of employers and workers making contributions to health savings accounts (HSAs) fell in 2014.
That’s according to new research from the Washington, D.C.–based Employee Benefit Research Institute (EBRI). The organization posted a news release about the research to its website on March 26.
EBRI is a private, nonprofit research institute that focuses on health, savings, retirement, and economic-security issues.
HSAs are an element of so-called “consumer-driven” health plans (CDHPs). CDHPs involve high deductibles and tax-deferred savings or spending accounts that workers and their families can use to pay their out-of-pocket health-care expenses.
EBRI notes that about 15 percent of the population was enrolled in a CDHP in 2014, representing about 26 million individuals with private insurance.
Among the 15 percent of people enrolled in a CDHP, 57 percent (or 9.3 million) had a health-reimbursement account (HRA) or had opened an HSA, while 43 percent were enrolled in an HSA-eligible health plan but had not opened an HSA.
Employer contributions
The new EBRI analysis indicates that two in three workers (67 percent) with an HRA or HSA reported that their employers contributed to the account in 2014, down from 71 percent in 2013.
The percentage of workers with an HRA or HSA-eligible health plan whose employers contributed to the account had steadily increased between 2009 and 2013, according to the EBRI.
Worker contributions
Individuals’ contributions to HSAs had been growing until 2011, but have declined since then, EBRI found.
Between 2006 and 2011, the percentage of individuals with employee-only coverage contributing nothing to an HSA decreased from 28 percent to 11 percent.
At the same time, the percentage contributing $1,500 or more increased from 21 percent in 2006 to 44 percent in 2011.
More recently, between 2011 and 2014, the percentage of individuals reporting that they contributed nothing to their HSA increased from 11 percent to 23 percent, and the percentage reporting that they contributed $1,500 or more fell from 44 percent to 30 percent.
Among those with individual coverage and employer contributions, the percentage with contributions between $200 and $999 decreased, while contributions of $1,000 or more increased in 2014.
Both lower- and higher-income individuals slightly lowered their contributions in 2014, and lower-income individuals were less likely to contribute anything than higher-income individuals, the EBRI analysis found.
EBRI bases the findings on the results of the 2008–2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey and the 2006 and 2007 EBRI/Commonwealth Fund Consumerism in Health Care Survey, the nonprofit said.
Contact Reinhardt at ereinhardt@cnybj.com
New York DFS to insurers: boost your cyber defenses
The New York State Department of Financial Services (DFS) is calling on insurance companies to “strengthen” their cyber-hacking defenses. Benjamin M. Lawsky, superintendent of financial services, in February announced a series of measures to require insurers to take stronger steps to ward off cyber hackers. In the coming weeks and months, DFS will
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The New York State Department of Financial Services (DFS) is calling on insurance companies to “strengthen” their cyber-hacking defenses.
Benjamin M. Lawsky, superintendent of financial services, in February announced a series of measures to require insurers to take stronger steps to ward off cyber hackers.
In the coming weeks and months, DFS will integrate “regular, targeted” assessments of cyber-security preparedness at insurance companies as part of the department’s examination process.
It’ll also put forward enhanced regulations requiring institutions to meet “heightened” standards for cyber security; and examine “stronger” measures related to the representations and warranties that third-party vendors send insurance companies.
“Recent cyber-security breaches should serve as a stern wake-up call for insurers and other financial institutions to strengthen their cyber defenses. Those companies are entrusted with a virtual treasure trove of sensitive customer information that is an inviting target for hackers. Regulators and private-sector companies must both redouble their efforts and move aggressively to help safeguard this consumer data,” Lawsky said in the news release.
DFS conducted a survey with a focus on cyber security involving a “significant cross-section” of its regulated insurance companies.
A total of 43 firms, with combined assets of about $3.2 trillion, completed a survey seeking information about each participant’s cyber-security program, costs, and future plans.
The department’s analysis of the insurers surveyed found that a “wide array” of factors, not just reported assets, affect the “sophistication and comprehensiveness” of the insurers’ cyber-security programs.
The DFS “did not necessarily find” that the largest insurers had the “most robust and sophisticated” cyber defenses, even though that “may be expected,” according to its news release.
Letter to insurers
The DFS has also expanded its information-technology (IT) examination procedures to focus “more attention” on cyber security.
That’s according to a March 26 letter that Lawsky wrote to insurance executives and that the department posted on its website.
DFS will add new questions and topics to its existing IT exam, including the reporting structure for cyber security-related issues; management of cyber-security issues, such as the interaction between information security and core-business functions; and resources devoted to information security and overall risk management, according to the letter.
The letter also listed additional topics.
DFS said it would schedule IT/cyber-security exams after conducting risk assessments of each institutions. To help in the assessment, DFS asked insurers for a report with several pieces of information.
They include the job description of the current chief information security officer, that person’s training, and organization chart for information-security functions.
DFS wants the report to describe how the organization maintains information-security policies that address “confidentiality, integrity, and availability,” the letter said.
The department asks insurers to identify and describe their use of “multi-factor authentication for any networks, systems, programs, or applications,” according to the letter.
Insurers should describe their incident-response program, including how incidents are “reported, escalated, and remediated.”
DFS also wants insurance companies to describe any protection they use to “safeguard” sensitive data that is “sent to, received from, or accessible to” third-party service providers, such as encryption or multi-factor authentication, according to the letter.
In total, Lawsky’s letter listed 16 pieces of information the DFS seeks in the requested report.
CNY Strategic Positioning for Community-Based Health Care and Human-Service Providers
“One of the best aspects of health care reform is it starts to emphasize prevention.” — Anne Wojcicki My recent column described the monumental Medicaid Managed Care Reform Initiative (MMCRI) being implemented by New York state as rapidly as possible. The reform initiative is being implemented under the umbrella of the Delivery System Reform
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“One of the best aspects of health care reform is it starts to emphasize prevention.”
— Anne Wojcicki
My recent column described the monumental Medicaid Managed Care Reform Initiative (MMCRI) being implemented by New York state as rapidly as possible. The reform initiative is being implemented under the umbrella of the Delivery System Reform Incentive Program (DSRIP) with the formation, implementation, and operation of 25 Performing Provider Systems (PPS) throughout the state.
Acronyms, acronyms — when it comes to health care, their use is without limits.
The Central New York Care Collaborative (CNYCC) is the state-authorized PPS for six counties in Central New York. Cayuga, Oneida, Cortland, Onondaga, Madison, and Oswego counties represent the primary counties forming the PPS Region Provider Network. CNYCC health-care providers accounted for less than $1 billion of Medicaid spending in 2013, which represents less than 2 percent of total New York annual Medicaid spending ($55 billion). As one might expect, the vast majority of state Medicaid spending occurs in the greater New York City metro area, where there are 15 separate PPS regional entities.
The focus of this column is on strategic positioning for community-based health care and human-service providers in the CNYCC region. Each of the 25 Performing Provider Systems is led by hospital systems. In the case of CNYCC, sponsors include Auburn Community, Faxton St. Luke’s, St. Joseph’s, and Upstate University hospitals.
The hospitals in the CNYCC region are supported by more than 100 health-care and community-based providers who have committed to be a part of the CNYCC Network that will provide cost-effective, coordinated managed care to Medicaid-eligible individuals in the region (https://cnycares.org).
Each PPS was required to submit project implementation plans to the New York State Department of Health by April 1, 2015. These implementation plans relate directly to the 11 DSRIP reform projects selected by CNYCC, following a comprehensive needs assessment. The CNYCC projects are extensive and affect virtually every one of the more than 100 Medicaid service providers in the region. The projects selected by CNYCC requiring an implementation plan are as follows:
a) reate integrated delivery systems that are focused on evidence-based medicine/population health management
b) mergency-department care triage for at-risk populations
c) mplementing the INTERACT project (inpatient transfer-avoidance program for SNF)
d) ospital home-care collaboration solutions
e) ntegration and co-location of primary-care services and behavioral health services
f) nstitute for Healthcare Improvement — implementation of its “Conversation Ready Model” for palliative-care options
g) trengthen mental health and substance-abuse infrastructure across systems
If the initiatives above sound like monumental efforts at moving mountains, they are. Others may say, “I thought we were doing an effective job in each of these areas already.” Those individuals would be dead wrong. The current Medicaid service delivery system is fragmented as evidenced by the more than 100 providers in the six-county region.
So, from a strategic-positioning perspective, what should a community-based Medicaid service provider do in response to the MMCRI and PPS structure?
The answer to this strategic question is both complicated and complex. This is particularly true since community-based service providers are purported to be an integral component to the primary objectives of MMCRI. Those objectives are a 25 percent reduction in avoidable Medicaid emergency-room visits, hospital admissions, and readmissions within 30 days of discharge, over a five-year DSRIP timeframe.
One of the key strategies for community-based providers to consider has been and continues to be the formation of and membership in one or more Independent Provider Associations (IPA).
1. Independent Provider Association (IPA) defined
An individual group of physicians and/or other health-care providers that are under contract to provide services to members/enrollees of different MCOs, ACOs, and PPSs, as well as other insurance plans, incorporating a fixed-fee per enrollee (capitation) or based on a pay-for-performance model (partial capitation), service care-outs, and/or targeted performance incentives.
ν For example, the primary focus of managed-care organizations (MCOs) since the early 1970s has been on reducing the utilization of emergency room and hospital inpatient admissions.
ν The increased recent emphasis on reducing hospital re-admissions is an area where community-based providers can have direct and significant influence.
ν An IPA serves as the fiscal intermediary between groups of providers, which are members of the IPA and the MCO.
2. Types of IPAs
a. Independent
b. Captive — typically owned/controlled by the MCO or a health system
c. Partnership between MCO and IPA entities
Depending upon facts and circumstances, any one of the three alternatives may be appropriate. Provider control is greatest in the independent model IPA. Depending upon the attitude and relationship between the PPS/MCO and the individual providers, the captive and partnership models may be desirable or, alternately, not feasible.
3. Characteristics of the Independent IPA model
ν Formation of the independent IPA is a grass-roots effort of the providers who are also members of the IPA.
ν Board representation consists only of representatives from participating provider members of the IPA.
ν Decision-making authority rests with the IPA board that is initially appointed by the IPA provider members.
ν Can be formed as either taxable or tax-exempt, depending on membership, structure, and objectives.
ν Contract negotiations with PPSs/MCOs are managed directly by the IPA board, its independent legal counsel, and individuals designated with contract-negotiation authority.
ν Primary advantage for the PPS/MCO is that through a single signature, a regional network of providers can be PPS/MCO network participants without having individual negotiations with each provider.
ν Single-signature contract authority by the IPA Board is powerful from a negotiation and leverage perspective.
ν In order to pass legal requirements and anti-trust regulations, an IPA cannot be formed for the sole purpose of negotiating rates.
ν Rather, in addition to rate negotiation, the IPA must assume some degree of financial risk and/or targeted performance-based incentives as a condition of the contract with the PPS/MCO.
ν In order to effectively function as a joint network entity of multiple providers, there must be some evidence of “clinical and financial integration” (e.g., electronic medical records, billing systems, clinical protocols, etc.) among IPA provider members.
ν Financial risk, coupled with clinical and financial integration, represent “safe harbors” that allow regional provider IPA networks to operate without substantial risk of anti-trust challenges.
Membership in a provider-sponsored IPA is one of many strategic considerations for community-based service providers to evaluate in developing an appropriate strategic position that is responsive to integrated and regional reform initiatives.
Gerald J. Archibald, CPA, is a partner in charge of the management advisory services at The Bonadio Group. Contact him at (585) 381-1000, or via email at garchibald@bonadio.com
Crystal Ball winner Daino discusses his path to CEO of WCNY
SYRACUSE — Besides his role as president and CEO of WCNY, Robert Daino also holds the same title for Promergent and ServeCentral LLC, both of Syracuse. Promergent is a “process, change and document management software and services provider,” according to its website. ServeCentral is a software company that targets the legal-services industry, according to its
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SYRACUSE — Besides his role as president and CEO of WCNY, Robert Daino also holds the same title for Promergent and ServeCentral LLC, both of Syracuse.
Promergent is a “process, change and document management software and services provider,” according to its website. ServeCentral is a software company that targets the legal-services industry, according to its LinkedIn page.
Daino holds a bachelor’s degree in computer science from SUNY Oswego. He started his career at General Electric, where he worked for 10 years before starting his own firms.
In his career, Daino has also developed software and hardware for electronic systems for the U.S. Navy, the Federal Aviation Administration (or FAA), and other commercial businesses, according to a WCNY news release distributed Feb. 10.
How does a software developer eventually become the top official at a public-media company?
“I was doing my civic duty,” quips Daino, noting it all started at a pledge event 13 years ago.
The Central New York Sales & Marketing Executives (CNYSME) has chosen Daino as the 2015 recipient of the Crystal Ball Award.
The organization annually bestows the award on a local businessperson who has contributed to the sales and marketing profession and has worked in community development and support.
“I was quite honestly very honored,” Daino says. “It was quite a surprise, a pleasant surprise.”
CNYSME will present the award at the 39th annual Crystal Ball Award and Sales & Marketing Excellence Awards (SMEA) at the Holiday Inn Syracuse / Liverpool on April 16.
Daino spoke with CNYBJ at WCNY’s headquarters on March 12.
As the latest Crystal Ball recipient, Daino believes CNYSME is recognizing WCNY’s changes in messaging, programming, and location.
“The new building [serves as] a very large statement of that and a culmination of a lot of hard work [in] repositioning and rebranding the fact that this is the community’s asset,” says Daino.
Daino joins a list of past Crystal Ball winners that includes the 2014 recipient, Howard Dolgon, owner, president, CEO, and team governor of the Syracuse Crunch minor league hockey team; and the 2013 recipient, Peter Belyea, president of CXtec and TERACAI.
Change the message
As Daino recalled it, the marketing vice president at Promergent in 2002 told Daino that the firm “needed to do more in the community” and suggested the company answer the phone during a WCNY pledge drive.
Daino “didn’t want to” get involved because he didn’t believe in it, he says.
“I was so anti-pledge,” he says.
The company eventually decided to participate, but the phones weren’t ringing that night, which left Daino frustrated.
“I got up and walked over to a line producer and said, “Hey, we need to change the message … We can’t do the same old tired message. People want to see their money work for them,” Daino recalled saying.
He offered a dollar-for-dollar match for every dollar raised, if WCNY would change the message.
The pledges increased that night and Daino wrote a “very large check” that he didn’t expect he would have to write, he says.
WCNY’s then-CEO Michael Fields called Daino the next morning and asked to meet with him about joining the station’s board of directors.
Daino accepted the offer, knowing that WCNY was involved in a digital transition at the time, he says.
He had been performing work for both the FAA and the military. Daino knew the Public Broadcasting Service (PBS) system, with all its towers, had a government-owned, built-in network and “perhaps we would create an emergency-management system,” he says.
“Well, I can get on the board and maybe help, in a very entrepreneurial way, a new revenue approach to help a public-broadcasting station. And I was a tech guy,” he says.
Daino eventually became the board’s vice chair, and when Fields left WCNY in early 2005, the board asked Daino to serve as the interim CEO during the search process.
Four months later, the search committee called him in to review a candidate and handed him a folder.
“I opened it up, and it was my picture,” he says.
At the time, Daino looked at WCNY as a “41-year-old startup.”
Daino’s other companies, Promergent and ServeCentral, continue operations in the ProLiteracy building next to WCNY at 104 Marcellus St in Syracuse.
“I moved [them] down here, so I could walk back and forth. It was easier,” he quips.
New location
Daino helped lead WCNY in its recent move to a new location on Syracuse’s Near Westside.
WCNY, Central New York’s public-media company, on Oct. 30, 2013, formally opened its new, 56,000-square-foot broadcast and education center at 415 W. Fayette St. in Syracuse.
WCNY moved into the new facility earlier that year after having previously operated at 506 Old Liverpool Road in Salina.
Daino believes the organization’s West Fayette Street location is “more visible” and provides “that touch dimension,” that makes it easier for the public to get to know the organization.
By the Numbers: March jobs report
The U.S. Bureau of Labor Statistics (BLS) on Friday, issued its jobs report for March. Here are the highlights: · Jobs added: 126,000 (Analysts/economists
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