Monica Schmude

As Bob Dylan famously sang, "The Times They Are A-Changin'." Indeed, we're facing some possible changes to Medicare Advantage that could impact us all. It’s important to stay informed and prepared as we navigate these shifts. By understanding what's on the horizon, we can continue to provide the best service and advice to our clients. But amidst all these changes, there’s one thing that remains steadfast and reliable: Hospital Indemnity! It’s the perfect complement to any Medicare plan, offering additional peace of mind and financial protection. Hospital Indemnity is a true constant in an ever-evolving landscape, and it continues to be a "win-win" for both agents and clients. Now is the time to leverage the stability of Hospital Indemnity to make a real difference. By educating our clients on its benefits, we not only enhance their coverage but also reinforce our role as trusted advisors. This product bridges the gap between Medicare Advantage and Supplement plans, ensuring comprehensive protection for our clients. Let’s embrace the opportunity to make a positive impact. Get out there, share your knowledge, and start selling! Every conversation you have is a chance to make someone’s life a little easier and a lot more secure. Together, we can navigate these changes and come out stronger on the other side. Remember, success is not just about numbers; it’s about the lives we touch and the peace of mind we provide. So, let's all be winners! Stay positive, stay motivated, and let’s make a difference in the lives of our clients. #Medicare #Motivation #StayPositive #ClientCare

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Health equity in healthcare is a critical focus area that has seen greater emphasis in recent years. It's exciting to witness examples of programs and advances emerging to achieve the bold goal of health for all. #HealthEquity #Healthcare #HealthForAll

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Medicare savings = Increased employer cost Medicare has a much larger impact on employer health plans than many realize. Fierce Healthcare highlighted one area in this recent article - here’s what it means for employers and what you can do about it. https://lnkd.in/gxpwTjKn #makehealthcarebetter

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Understanding the unique needs of different generations is crucial in providing them with the right coverage. Seniors often seek the most comprehensive insurance they can afford, but many misunderstand Medicare Advantage's limitations. Join Brandon Clay and myself for an exclusive Drip the HIP Wired event Live on LinkedIn this Tuesday, June 4th, as we dive deeper into bridging these gaps and ensuring better security for our seniors. #InsuranceInsight #LinkedInLive #MedicareAdvantage

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The 12th edition of the America’s Health Rankings 2024 Senior Report provides a comprehensive overview of the state of health care for our senior population in the United States. As a geriatrician committed to the quality of care and well-being of our seniors, I find the data compelling to celebrate areas where progress has been made, and identify areas where challenges exist. Together, we can be united in helping our seniors live happier and healthier lives! Read the full report: https://lnkd.in/gEVCxSac

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The opening line to this article nearly knocked me over: "Today, healthcare generates approximately 30% of the world’s data – a figure that is expected to hit 36% by 2025." A THIRD OF THE WORLD'S DATA! That's a lot of data. But so what? Why am I posting this article at all? Money. See below on ways AI can drive down healthcare costs. From the article: "AI is exceptionally well positioned to emerge as a change agent to facilitate, streamline, and improve payment accuracy operations. By utilizing the abundance of healthcare data—held by stakeholders—AI and predictive analytics enable the development of innovative solutions that address a wide range of challenges across the payment integrity value chain." "AI-powered platforms and solutions can tackle both traditional pain points, such as fraud, waste, and abuse, as well as emerging challenges, like the rapid growth in claims related to genetic testing and the complexities of specialty pharmaceuticals." If you know a young person looking for a career path, healthcare data analytics seems to be growing! Let's hope AI can help drive healthcare costs down. We need some downward pressure in this area. #healthcarespending #employeebenefits #hr Rubicon Benefits, a division of World

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CC #1 Owned Auto vs HNOA (Hired and Non-Owned Auto)   Why is the first of my Healthcare Coverage Conundrums about auto? Auto exposure (whether owned or HNOA) has been a consistent coverage request on healthcare accounts for years but it is an emerging claims front and can be a frequency as well as severity issue, despite this, it oftentimes gets overlooked or thrown in with little or no charge. The auto exposure can vary widely in healthcare from 1 or 2 non-owned autos on a surgery center account, to hundreds of autos in a fleet for a hospital or hundreds of non-owned autos on a home healthcare or medical staffing account. The auto exposure can be addressed by a commercial auto policy or as a coverage grant under a healthcare PL/GL policy.   Coverage Conundrum: Duplication of coverage  Several years ago I was in a renewal meeting for a large insured that purchased a miscellaneous medical policy that included professional and general liability, HNOA, employee benefits liability and sexual misconduct coverage. They also purchased Managed Care coverage, excess coverage, property, worker's compensation, and owned auto. After finishing my part of the renewal presentation I was looking through the other lines presentations and noticed the owned auto policy included a symbol 1 for "Any Auto" which includes symbols 8 and 9 for HNOA. The healthcare policy I was writing also included HNOA coverage. Clearly this was a duplication of the HNOA coverage under my miscellaneous medical policy and their existing owned auto policy. After the meeting before heading to the airport I pulled our wholesale broker aside and explained the auto situation to him. In the end, I removed the HNOA from my terms, which lowered my premium by roughly $9,000, and he became a hero to his agent and the insured for finding them some significant savings.   The Takeaway? Often wholesalers may not be involved in the placement of the owned auto policy so duplication can occur. It's always a good practice to confirm the ISO Business Auto Symbols covered under an owned auto policy and remember that Symbol 1, "Any Auto" is going to be broader coverage under the owned auto policy for HNOA, vs this exposure being added to an E&S healthcare policy.    Next week's CC will focus on additional considerations specific to auto exposures for healthcare risks. 

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Very interesting lawsuit filed against Aetna could have ripple effects on MA plans ability to have such rich supplemental benefits embedded in their MA policies. A number of providers have risk-share contracts with MA plans that allow them to share in cost savings below a certain medical spending threshold in the MA plans. The suit was filed by Bridges Health Partners which owns a number of hospitals, specialty providers and more than 400 primary care physicians Bridges Health Partners alleges that Aetna is calling supplemental benefits “medical spend” despite them being more of a marketing ploy and therefore reducing the shared savings that the providers should have received under the terms of their contract with Aetna. Their press release calls out benefits like gift cards, OTC medications, meals and gym membership and then they add a little “etc.” and then they call out the fact that the gift cards and OTC have to be bought at CVS locations. The press release does not mention dental or vision although some of the articles about the lawsuit did call those coverages out as well. They filed in PA state court where the local network of providers will presumably get a more sympathetic ear. The suit says “This Court has jurisdiction over the subject matter of this action pursuant to 42 Pa. Cons. Stat. §931 over Aetna pursuant to 42 Pa. Cons. Stat. §5301 as Aetna carries on a continuous and systematic part of its general business within Pennsylvania and has directed its wrongful conduct at this jurisdiction.” They notably did not say anything in the lawsuit about dental or vision benefits, the biggest cost by far was for OTC and meals. Considering the major repercussions this could have across the industry, this is one to watch. Of course they could keep their supplemental benefits and just exclude them from the “medical cost” calculation I won't post it publicly but can share the lawsuit pdf if you dm me

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In case you missed it, the 2023 Humana Impact Report was published last month! Bruce Broussard's letter for the 2023 Humana Impact Report dives into his perspective on our progress and the ways in which we are caring for the needs of our customers, our employees, our communities and our environment.    If you’re interested in learning more, you can explore the full report by clicking on the following link: https://huma.na/3U52dg0     #HUMemployee #TeamHumana #HumanaImpactReport 

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Although "interoperability" may seem esoteric, and certainly not top of mind for the typical employee, employer HR/Benefit, and consultant teams - it's critical for improving the patient (and thus, employee) experience, as well as for providing the closer-to-real-time access necessary to support sophisticated clinical management initiatives. Thanks for posting, Frank! #healthmanagement #dataanalytics #employeeexperience #patientexperience #hrstrategy

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Episode 2 of #CoffeeTalk is LIVE! Just wrapped up a discussion in Nashville about the importance of short-term care insurance. Did you know about the nuances of Medicare outpatient observation status? Let's talk solutions! Share your thoughts in the comments below. #seniorcare #shortterm

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"Additionally, since 2019, the share of total spending by Medicare, Medicaid and commercial insurers in primary care has steadily declined;" - --- Great point to consider...new efficiencies (Phone based telehealth, community based Urgent Cares, Concierge MD services, etc.) might also account for the fewer visits to traditional points of entry (translation: MOST expensive) such as ER's. That alone has likely translated to untold millions in decreased spending on claims. Great read, Thomas, thanks for sharing your "shore life peace of mind" today!

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It was recently announced that United Health’s PBM Optus is going to offer a more “transparent” option. An article titled, “United Health’s PBM, Optum Rx, Launches a More Transparent Drug Pricing Model” written by Alan Goforth. I read the article and based on what I was reading, it seems to me that the average agent and the average employer is not going to understand what is going on after this laugh anymore than they do now. The new version offered by Optus will be known as Clear Trend Guarantee and “will continue to deliver clear information.” My question is what is preventing United Healthcare’s problem with delivering clear information right now? They have clear information now, why do they need a whole new version of Optum to deliver this next year. Further, what new magic has UHC and Optus discovered that will soon allow them to be “more transparent?” Right now, there is virtually no “transparency” offered to small and medium size groups by Optum, or any of the other large PBM’s. In my opinion, there is a better pathway to transparency and that is for independent pharmacies and their local employers to work directly with each other - bypassing the PBM’s. In my opinion, Wall Street is not going to allow any compromise of profitability to occur so how is Optum going to “lower prices” which will “lower margins” which will “lower stock prices” which will raise criticism and anger with investors and stock holders. In my view, gimmicks are gimmicks and it is unfortunate that the employer community is not more vocal in demanding just plain, basic, common sense, understandable information. My view is that there should simply be an itemized report to every group of every claim as to amount, purpose, and provider. Health care and Rx is the only product and service that nobody has any idea as to real cost and nobody really cares. Money in the form of premium is just handed to these carriers - no strings attached, no information demanded, hence no means to control cost because you can’t control costs if you don’t know what they are. Well it will be interesting to see what Optum’s definition of transparency will be when “Clear Trend Guarantee” is launched. Our clients, however, have had clear, itemized transparency about all medical and Rx costs from the first day they became a client. That has led to lower costs across the board. To learn more, contact us. The Ecchic Group 314-997-8865 11704 Lackland Industrial Drive St. Louis, MO 63146 Article: https://lnkd.in/g7XphrTa

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Since when did health insurance companies received thier “MD’s”? This is a long article but a fascinating read. We wonder why healthcare costs continue to escalate and premiums are unaffordable? Well, when you have insurance companies being able to add diagnosis’s and conditions to a members healthcare record which allows them to receive more money for treatment - oh and by the way these members don’t have these illnesses…rocket science not needed here! While this seems like its a “Medicare” problem - it’s happening everywhere. In your commercial and group health plan too. Providers trying to charge patients for negotiated discounts, millions of dollars in fake billings, pharmacy rebates being used to increase insurance company profits versus going back to the companies footing these bills or the patients using the drugs. Insurance companies and the organizations that own physician groups and hospitals have figured out how to game the system to increase profits - not deliver better health outcomes. I do believe that there are a lot of great professionals in the medical field that honestly want to improve the lives of people that they treat - they unfortunately now mostly work for companies that don’t really care much about that.

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Policy changes impacting MA plans are leading to decreased profitability, prompting a focus on margin over membership, according to one CFO. This shift is expected to increase pressure on post-acute providers, potentially resulting in more rigorous rate negotiations and prior authorizations. Understanding the payment landscape and costs for different patient types will be crucial for providers entering negotiations with MA plans. #skillednursing #VBC

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AND...now its official!... Industry experts like Melissa Newton Smith, Rex Wallace,Josh Edwards, Brendan Generelli, Ana Handshuh,) and I believe this is just the beginning of a very tangled web that now must be painstakingly unwoven. One example: According to the freshly released HPMS memo, "only contracts that have an increase in their QBP Ratings from 3 to 3.5 stars, 3.5 to 4.0 stars, or 4.0 to 4.5 stars will have a time-limited opportunity to resubmit their Contract Year 2025 bids, including bid pricing tools (BPTs), plan benefit packages (PBPs), and formularies." But what about all the plans that received below 3 stars at the overall and/or summary levels, leading to strike 1, 2, or 3 in related compliance implications? I, for one, will be closely watching my inbox for additional CMS communications, checking LinkedIn, and reading the headlines throughout the days, weeks, and months to come!

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Supporting the health and well-being of older Americans has been a longtime passion of mine, both as a clinician and a caregiver. It is important for seniors to invest in activities that positively impact their physical, emotional, and mental wellness so they can continue doing the things they love for years to come. In recognition of Older Americans Month, the latest Humana News article linked below shares some helpful tips for building healthy habits and leading a more vibrant life. #HUMemployee #TeamHumana #ActiveAging https://lnkd.in/e9RjQH5S

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