Health Plan Economics Newsletter : Issue 2

Issue 2 : Second Quarter 2009


	HDM Initiates Study of Relative Efficacy of Random Sample Versus Claim-By-Claim Health Plan Audits

	HDM Warns Self-insured Plans About Health Plan Cost Escalators

	McSweeney Advises Actuaries to Think More Like Health Plan Auditors

HDM

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HDM Initiates Study of Relative Efficacy of Random Sample Versus Claim-By-Claim Health Plan Audits

Healthcare Data Management, Inc. (HDM) has partnered with two academians from the Haub School of Business at St. Joseph’s University in Philadelphia to compare the efficacy of the company’s claim-by-claim method of auditing medical and prescription drug claims versus the random sample methodology that relies on a 200 to 400-claim sample derived from 100 percent of claims for the audit period.

The study was launched the week of June 22, 2009, using actual HDM client data and audit results... read more>

HDM Warns Self-insured Plans About Health Plan Cost Escalators

HDM, Inc. COO David McSweeney conducted a Q2 2009 campaign to warn self-insured employers about economic and legislative factors that HDM believes will cause health plan costs to rise, beginning now and continuing for the next four to five years.

McSweeney has two collaborators in the campaign: Barbara Niehus, FSA, a consulting actuary with more than 30 years of group life and health insurance experience and David Ermer, Managing Partner of Ermer and Brownell, PLLC, a Washington, D.C.-based law firm with extensive experience in legal matters related to health plans... read more>

McSweeney Advises Actuaries to Think More Like Health Plan Auditors

HDM, Inc. COO David McSweeney advised attendees at the Spring 2009 meeting of the Society of Actuaries in Toronto to think more like auditors and to think less about cash flow and more about client liability.

Actuaries who assist with their client's health plan, generally visit clients once each year. McSweeney’s contention is that actuaries should visit clients quarterly to assist with key health plan decisions such as establishing Cobra rates and helping assure that reserves are properly established to account for claims that have occurred but have not yet been paid by a plan administrator or PBM.

McSweeney emphasized that actuaries can help prevent the health plan waste that occurs with errors, misinterpretations and outright fraud... read more>