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Leader in Health Plan Cost Containment Cites Three Economy-Driven Reasons Why Self-Insured Health Plans Should Brace for Claim Increases and Fund Reserves Accordingly
Date:3/18/2009

KING OF PRUSSIA, Pa., March 18 /PRNewswire/ -- Healthcare Data Management, Inc. (HDM), a leading, independent provider of health plan analytics for public corporations, Taft-Hartley plans and government agencies, sees storm clouds ahead for self-insured plans. "If CFOs are not taking today's economy into account in anticipating medical expenses and reserves, employers can be placed in the desperate position of unexpectedly having to come up with millions of dollars in cash," explained David McSweeney, COO of the King of Prussia, Pennsylvania-based HDM.

The reserve is the amount accrued by a self-insured employer in anticipation of paying claims.

McSweeney, a veteran of many years of C-level leadership in the health insurance industry, working with HDM's nationally-known consulting actuary, Barbara Niehus, F.S.A., M.A.A.A., have identified three factors brought on by the nation's economic crisis that are likely to put upward pressure on claim costs.

"The first factor is the increasing financial pressure being placed on healthcare providers," Niehus explained. "Payors will see more uncollectable debts. Hospitals and other institutions have seen their endowments shrink. All of this creates pressure to bill more to insurance plans, ultimately resulting in higher claim payments than anticipated," Niehus continued.

Niehus, an actuary with over 30 years of experience in group benefits and insurance, emphasized that now, more than ever, plan sponsors need to be diligent about getting the full value of administrator discounts and protecting against unnecessary charges and medical coding errors such as up coding and unbundling.

"The second factor is that employees who are stressed financially and in fear of losing their jobs can have more medical issues," McSweeney explained. "Moreover, employees who think they're going to lose their jobs tend to focus on medical needs for thems
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SOURCE Healthcare Data Management, Inc.
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