Legislative/Regulatory UPDATE: SIIA: Self-Insurance Institute of America, INC.
Federal Judge Strikes Down Centerpiece of Association Health Plan Rule
Late yesterday, the DC District Court issued a decision striking down two important aspects of the U.S. Department of Labor’s (DOL) Association Health Plan (AHP) rule. In particular, the court ruling invalidates the new “pathway” that would allow:
1) “unrelated” employers located in the same State to form a “bona fide group;” and
2) self-employed individuals to participate in an AHP.
If this ruling goes into effect, it would mean that organizations like Chambers of Commerce and other business groups with employer members in different industries may not form a “bona fide group” and sponsor an AHP. It would also mean that organizations could not cover self-employed individual members under an AHP.
The Federal Court’s decision can be found here: https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv1747-79
Related employers, those in the same industry, were not impacted by the court ruling. This means that these industry-specific group may still be considered a “bona fide group” for AHP purposes. Importantly, industry-specific groups are not limited by geography, meaning these groups can offer AHP coverage in multiple States.
The Self-Insurance Institute of America, Inc. (SIIA) is disappointed by the ruling and continues to advocate for an appropriate path for the establishment of AHPS for self-employed individuals, and unrelated employers. In addition, SIIA feels strongly in the allowance of self-insured AHP formation under the same rules permitted for fully-insured AHPs
The lawsuit against the DOL rule was brought by 11 states and the District of Columbia, arguing that the process through which the AHP regulations were developed violated the Administrative Procedure Act (APA), which governs agency rulemaking processes. Additionally, the states’ attorneys general argued that the final AHP regulations would increase healthcare cost, and that it would violate current law surrounding the Affordable Care Act (ACA) and Employee Retirement Income Security Act (ERISA).
U.S. District Judge John Bates, who formed the decision, sided with the state arguments, where he believed that the AHP regulations did in fact seek to circumvent ACA requirements, and the judge ruled that the DOL exceeded its statutory authority under ERISA.
In his decision, Judge Bates remanded the AHP rule back to the DOL for further consideration to determine whether the “unrelated” employer and “working owner” portions of the rule can be “severed” from the rest of the regulations. This separation may be no easy task considering how integral these two portions of the rule are to the overall policy of trying to expand AHP formation.
While DOL will likely appeal this ruling, it remains unclear when the District Court ruling will take effect. Based on recent precedent, it has been standard that a District Court ruling does not take effect until the appeals process is exhausted. Thus, the immediate effect of the ruling remains an open question.
It is important to note that the original DOL rule did not include provisions allowing self-insured AHPs beyond geographical boundaries, an issue which the court ruling will not help in terms of additional action by the DOL.
SIIA will update members as the Federal Court, Department of Labor and Congress continue activities related to Association Health Plans. Should you have any questions or would like to understand this issue further, please contact Ryan Work, SIIA vice president of federal government relations, at [email protected].
PRESS RELEASE: David Boucher, Former Executive BlueCross BlueShield of SC, Named Chief Business Transformation Officer, Bumrungrad International Hospital
HASBROUCK HEIGHTS, N.J. & BANGKOK–(BUSINESS WIRE)–Bumrungrad International Hospital (BIH), the Joint Commission International accredited multi-specialty hospital in Asia offering state-of-the-art diagnostic, therapeutic and intensive care facilities, announces that David T. Boucher, former president, chief operating officer, UCI Medical Affiliates and Companion Global, both wholly-owned subsidiaries of BCBS of South Carolina, will lead BIH transformational initiatives. Boucher will focus upon international insurance billing functions, the end-to-end appointment booking and consumer inquiry process, expatriate marketing and public presentations and digital initiatives, such as the upcoming launch of a telemedicine service.
As one of the largest private hospitals in Southeast Asia, serving 1.1 million patients annually, including over 520,000 international patients from over 190 nationalities, BIH will rely upon Boucher’s extensive healthcare experience in the United States. Boucher is recognized as an accomplished healthcare and hospital executive with a track record for improving healthcare delivery and medical insurance operations through disruptive innovation, applied technology, proactive marketing and patient-centric operations.
“When I first traveled to Bumrungrad in 2006 to assess its capabilities for participating in the international medical tourism marketplace, I was duly impressed by its advanced technology, highly trained medical staff and quality outcomes,” says Boucher. “Since that time, the BIH approach has been further enhanced and today, the hospital is a beacon for international medical travel thanks to a patient-centric, people-first approach to delivering high quality care at lower costs.”
At Companion Global Healthcare, Boucher was recognized as a pioneer in employer-focused medical travel benefits. In this role, he secured alliances with 22 overseas hospitals and promoted consideration of overseas procedures for 1.5 million subscribers, enabling knee/hip replacements, heart valves and spleen removals to become a lower cost option for a significant number of patients while sustaining quality and safety of medical care and improving the quality of services.
Boucher also brings 14 years of experience serving Quorum Health Group, a spin-off of HCA, which owned 325 for-profit and managed non-profit hospitals nationwide, where he was CEO of the Carolina Hospital System, as well as Good Hope Hospital. Prior to this, he was a senior administrator of the Northeastern Vermont Regional Hospital, a full service, acute care regional hospital.
Boucher earned a Master of Public Health, Healthcare Administration, at the University of South Carolina, and a Bachelor of Science magna cum laude at Slippery Rock University. He is a community leader, holding board positions for multiple Rotary Clubs, and serving organizations, such as the Paul Harris Fellow & Society, World Affairs Council, South Carolina Philharmonic, SC Arts Foundation and the Columbia Free Medical Clinic. He is on the MHA Advisory Board, University of South Carolina, and was a youth soccer coach for 21 years.
Boucher is a fellow, American College of Healthcare Executives (ACHE), member of the Healthcare Financial Management Association and advisory board member of the Health Core International Consultancy, Inc. Manila, Philippines.
About Bumrungrad International
Bumrungrad International is a Joint Commission International accredited, multi-specialty hospital located in the heart of Bangkok, Thailand. Founded in 1980, it is one of the largest private hospitals in Southeast Asia, with 580 beds and over 30 specialty centers. Bumrungrad International offers state-of-the-art diagnostic, therapeutic and intensive care facilities in a one-stop medical center. Bumrungrad International serves 1.1 million patients annually, including over 520,000 international patients. Visit www.bumrungrad.com
CPR for Bumrungrad
To view the original press release, please click here.
Medical Korea 2019 Reveals South Korea at the Forefront of “Fourth Generation Healthcare”
by Josef Woodman, CEO, Patients Beyond Borders
+19194183812 (mobile, WhatsApp)
This Spring marked the occasion of the 10thanniversary of the annual Medical Korea conference. Hosted by the Ministry of Health and Welfare of the Republic of Korea and organized by the Korea Industry Health Development Institute (KHIDI), Medical Korea has grown into one of Asia’s most important venues for the promotion of Korea’s role in as a global healthcare leader and medical tourism destination. This year more than 2,300 medical practitioners, providers, researchers, media and other professionals from 47 countries converged on Seoul for three days of sessions and exhibits.
In keeping with this year’s theme of relentless global medical innovation, there was predictably much discussion of Smart Health vis a vis healthcare’s role in the “Fourth Industrial Revolution.”
“The theme of this year’s conference is ‘Discover the Next’,” Minister of Health and Welfare Park Neung-hoo stated in his opening remarks. “Korea stands in the middle of the rapidly progressing Fourth Industrial Revolution. In this revolutionary era, the medical device and bio-health sector will lead the national economy.”
To temperthe hyperbole, keynote speaker László Puczkó underscored the need to strike a balance between the rise of Smart Health and “digital detox” (spending time unconnected to wearables and mobiles and other devices). All the data in the world is useless, he cautioned, if the patient experiences diminishing mental and physical health returns along the way.
Korea’s focus on innovative strategies for diagnosing and treating complex conditions, combined with advanced medical devices have resulted in impressive clinical outcomes, to wit:
5-year cancer survival rate*s:
- Thyroid: 100%
- Colorectal: 76.3%
- Breast: 92.3%
- Stomach: 75.4%
- Cervical 79.9%
- Rectal: 71%
5-year post-transplant survival rates**:
- Liver transplant 100%
- Heart: 92.3%
- Kidney: 75.4%
These numbers are no accident. For the past two decades, South Korea has grown from a backwater medical stepchild into one of the world’s economic powerhouses, with healthcare playing a key role.
In fact, the quality of South Korean healthcare is now among the world’s best.Korea is now solidly in ranked amongst the top nations globally in terms of life expectancy, and after nearly 40 years of tweaking, offers the world an exemplary healthcare infrastructure that offers quality care to all its people at less than 10% GDP. Contrast this with the United States, offering far less affordable care to a far unhealthier population at nearly 19% of GDP, with no end in sight.
Where excellent healthcare infrastructure prevails, medical tourism isn’t far behind. Since the inception of Medical Korea in 2009 more than 2.2 million cross-border patients have visited Korea for care, at a value of $USD 2.6 billion. While cosmetic surgery remains popular, Korean internationally-accredited medical centers are also successfully competing with their Western counterparts in the US and EU for the complex care patient, treating all types of cancers, spinal afflictions, cardiac and bariatrics, to name a few. Prices remain less than half the going rate in return for comparable clinical outcomes and often, a more rewarding patient experience.
Technology Driving Yet Another Revolution
Not surprisingly for one of the most advanced technological nations on earth, bleeding edge advances in Smart Health were topmost in the sessions. Yesterday’s buzzwords are rapidly moving into the deployment stage as the impacts of cloud-based platforms, big data and predictive analytics converge.
One of the biggest takeaways as set forth by Elsevier’s Managing Director Jan Herzhoff,is the rapid transition from traditional evidence-based practice(cumbersome, research-based and unable to keep up with rapidly changing technologies) to practice-based evidence(using existing patient data and AI-driven predictive tools to create opportunities for patient-centric, personalized diagnosis and treatment. Imagine, for example, in working with a breast cancer patient, possessing millions of outcome datapoints (family history, genetic information, demographics, etc) to arrive at a treatment plan tailored to each patient based on thousands or millions of real-world outcomes scrubbed by sophisticated machine learning systems.
This new paradigm helps to transition from treatment as “medical guesswork” to having each patient interact with big data and machine learning to become their own “personal mini clinical trial,” according to Herzhoff.
He also noted that health care data will have grown from 153 exabytes in 2013 to 2,314 exabytes in 2020 globally (an exabyte is an astounding one billion gigs), driven in part by wearables devices, smart implants andother devices, along with global digitization of patient data. The nexus of big data, machine learning andthe Internet-of-things of will soon be capable of assimilating and analyzing existing information to draw new findings that equal or exceed clinicians in arriving at accurate diagnostics and treatment plans. Herzhoff sees large opportunities for Korea to expand upon existing strength to achieve a leadership position on these fronts.
Blockchain Hits the Real World
As most of the healthcare IT world grapples with the rise of blockchain and related technologies, Korea-based MediBloc, founded in 2017 by Eunsol Lee and Allen Kho, now enjoys real-world partnerships with more than 80 medical institutions in 10 countries, including Seoul National University Hospital and Massachusetts General Hospital/Harvard University in the US. As new blockchain efficiencies allow the core benefits of decentralization, transparency andintegrity to shine, Korea is in a position to become a world player, particularly in the areas of chronic disease management and complex cancer care, where Korea already has a leg up.
Similarly, CEO Steven Chang of Korea-based startup HumanScape aims to be at the bleeding edge of integrating blockchain, big data and mobile technologies to improve strategies for chronic disease management and aftercare by integrating PGHD (Patient-Generated Health Data) into one accessible source.
Not surprisingly, many of the speakers espoused cautionary tales of medical algorithms a “black box” where physicians see the results but have no idea how they were derived. As traditional paradigms shift from research-driven, trial and error evidence to real-time data-driven analytics-driven evidence, speakers and delegates alike warned that AI must also provide a glass box, offering a level of transparency that allows practitioners to trust the data they’re being fed, and how it was derived, including built-in biases of tech developers.
Preventive Strategies Applied to Smart Health
Perhaps as important as the exciting, much-discussed technological innovations dominating the healthcare discussion is Korea’s long-time focus on preventive care and wellness–baked into its healthcare system resulting in a demonstrably healthier population and longer life expectancies Oddly, dentistry provides some clues here. The conference held an entire track on dentistry, much of which underscored the new studies that indicate the relation of poor oral health to poor overall health and the role of preventive dentistry amongst adults and children, including useof modern consumer instruments for gum/tooth maintenance; frequent check-ups, et al.
In our rush for more data, more testing, more diagnostics, the latest instrumentation andshiny objects, we should not forget the words of 19th-century Russian surgery pioneer Nikolay Pirogov: “the best operation is the one that wasn’t performed”. It is perhaps here, at the crossroads of hyper-innovation in healthcare and common-sense preventive approaches to physical and mental well-being, where Korea has the greatest opportunity to excel, adapt and compete on the global healthcare stage in improving medical outcomes and patient satisfaction to the good of all.
*International Comparison of Cancer Survival Rates, NCIC, 2017
**Korean Network for Organ Sharing (KONOS) Statistical yearbook, 2015