TAHU Update Volume No. 3 Issue No. 3 November 2001
NOVEMBER MEETING
Monday, November 19, 2001
Marriott at RTP
Exit 281, Miami Blvd.
11:45 am, Luncheon Meeting
NOVEMBER GUEST SPEAKER
Andrew Barrett
Executive Vice President, PNNC
For 15 years has served PNNC, a pharmacy benefit manager located in Raleigh, as Executive Vice-President. The business covers a total of 375,000 lives with over 3,000,000 scripts processed annually valued in excess of $150,000,000. There are over 850 employer groups who contract with PNNC, primarily through third party administrators. The Pharmacy networks are primarily in North and South Carolina.
Clients include, Progress Energy, General Parts, Hickory Springs Manufacturing Company, South Carolina local government Assurance Group, and General Shale. In addition we manage many hospice programs, the state senior assistance program, a program for atypical anti-psychotic drugs and the states HIV program.
Greatest strengths of PNNC are flexibility in plan design, multiple on demand on line reports and superior customer service.
Andrew has a BA from Barton College, MS Appalachian State University and Ed.D from NCSU. He has been a college chemistry teacher, a community college dean, and the Executive Director of Roanoke Valley chamber of commerce in Roanoke Rapids, NC. He is active in the Stephen Ministry program and ministry leadership team at Hope Lutheran church in Wake Forest.
Andrew will present to us information about prescription drug costs, trends and strategies to control drug costs.
SPONSORED BY
Carolina Benefit Administrators, Inc.
President's Message:
Gene Lee, Jr., CHC
The October TAHU meeting featured a report of the Durham/RTP area economic growth underway thanks to some major overseas corporations who have pegged our region as prime for quality of living and affordability. Major dollar investments are being spent now that will only strengthen our region's economy. The Greater Durham Chamber of Commerce President and CEO, Tom White provided the facts and the latest communication video tool showcasing the cooperative plan to train and provide a source of trained labor for employers. The region already has a coveted skilled and research based population who continues to sustain our reputation for productivity scientific excellence. We are encouraged that much effort continues to be invested in assuring that we capture a share of quality business to our area. Thanks Tom White and the cast of supporting staff at the Durham Chamber.
The annual TAHU golf tournament at Eagle Ridge was great fun for all our members and guest. Board member, Mike Alexander along with volunteers produced an excellent event again at a new golf course enjoyed by high and low handicappers alike. The final dollars for this year's charity are still being counted and will be reported as soon as complete. Well done Mike and thanks to the cast of volunteers.
Please take the time to read this newsletter to learn about the activities underway thanks to your TAHU board. We will be finalizing a decision to make a monetary contribution to the help those affected by the tragic events in September. United Health Care is helping us to conduct another recruitment of members for our chapter. Special thanks need to go out to the Raleigh-Durham area sales and marketing leadership at Partners Health Plan for helping TAHU to produce and mail last month's newsletter. Continuing Education arrangements are being planned for you. Your board of very busy but dedicated professionals is contributing a great deal on a local, regional and national scale to the strengthening your association. More exciting things will be reported in upcoming newsletter issues. Thank you for being a NAHU member and for supporting us with your presence at the monthly meeting. Saludos Amigos!
Law & Legislation:
Nancy Winter & Bill Hendrickson
The National Health Service: Once the darling of Great Britain, the National Health Service (NHS) has fallen on hard times and ill patients are suffering greatly. Two recent articles clarify some of the problems. In the London Sunday Times of May 27, 2001, an article titled "The Island where nothing Works" was printed from the German magazine "Stern". The article graphically describes the daily routine of Dr. Sam Everington who says he practices Third World Medicine. After ten hours of surgery, he makes house calls in an area of London inhabited by the poor who find themselves unable to be treated in a timely fashion through the NHS. He explains the condition of an elderly woman, suffering from a bad fall and needing hospitalization, but being told to wait four or five months for a "possible" admission. Dr. Everington is quoted "I often feel more wretched than the patients, because I see their suffering and cannot alleviate it. We are short of almost everything".
He goes on to say "Everything in British hospitals has got much worse. Lots of waffle, big announcements, and then absolutely nothing." Most clinics are overfilled, dirty, and have too few doctors. Men and women, often not even separated by curtains, lie in rooms with up to 30 beds. Eight out of ten people working for the NHS would rather give up their jobs.
A more recent article of September 1, 2001 from the New York Times outlines how many Brits leave for the continent for surgery that otherwise might be done after considerable delay at home. One patient, suffering chest pains from a blocked artery waited three years in vain for surgery and finally hopped the channel to Brussels for a triple bypass which he paid for himself at one-sixth the cost of private surgery in Britain. Many frustrated patients travel to Belgium, Germany, Norway, France and other European countries for treatment unavailable at home--and the NHS often will pay for this off-site treatment.
Even as health care conditions deteriorate in Britain, the government is not keeping up with the needed budget money to support the increasing need. But the British are a plucky lot and still support the system and want it to remain even as they complain and often leave home for necessary treatment.
The examples so clearly outlined above are proof positive that abandoning private health care as we know it in the United States can quickly lead to no health care.
In order for private health care to survive, and even thrive, we need to assure that private health insurance will survive. Did you know that NAHU started just two weeks before the economic crash of 1929? If you haven't done so, read the History on www.nahu.org. This is a cool organization. We have a heritage of insurance agents, just like us, getting together in a voluntary fashion to piece together the policies and best practices that have shaped the legal and regulatory climate for the insurance industry. NAHU (not always quite by that name) members have seen the industry through the depression & several wars - and here we are facing a huge crisis and the private insurance industry is yet strong and able to take on the challenge. Even during bad times, our health care has never looked like NHS and I trust it never will. Not sure if this is just another "war rumor", I heard that Osama himself used an American Hospital in Dubai, United Arab Emirates earlier this year for kidney trouble? Even he cannot escape the truth. We're the best & our team is going to win.
Making Laws: In the NAHU Region III conference calls of the past few months, at our NCAHU Board meetings, over NAHUnet and a few other health insurance/health care forums, I'm in awe of the level of understanding and the manner in which insurance professionals pool their experience to consider what should be the best laws for the industry. They recognize the finer distinctions between concepts, ie. high utilization and low utilization products, catastrophic and routine medical expenses. There's been a lively discussion on NAHUnet recently how far we could go making insurance policy decisions based on distinctions between those who make stupid life style choices and those who suffer maladies at no apparent fault of their own. A vocabulary long known to the insurance professionals, but not so well known to policy makers. We understand these finer distinctions and we should never allow insurance policy to be made in circles we consider to be beyond or above us. ( That political realm where they can't even make the distinction between "people without health care", when they mean "people without health insurance"). They need our help and want our help - and that's why legislative involvement is important for us, and can even be fun.
Mental Health Parity popped up in both the Federal and State legislative reports this month. At the Federal level the Senate 543 and the House 3090 have passed and will need to be reconciled. Either way, it looks like the current MHP Act will be extended and perhaps expanded.
At the State level, the MHP Bill (H808) has been in a subcommittee all this time. It did not pass the House before the Cross-over deadline April 26th, so it can only be eligible for consideration during the 2001-02 legislative session if it has an appropriation attached to it. The bill sponsor tried to add the $25,000 appropriation to the bill [aren't these legislative rules fascinating?], but so far the request has not cleared the committee.
The NC Patient Bill of Rights (SB199) was ratified October 11th. The PBOR at the Federal level has stalled due to more critical issues at hand.
HIPAA Privacy Rules: If laws do sometimes seem to go awry, we do have checks & balances. The Association of American Physicians and Surgeons (AAPS) has filed a new lawsuit. From Greg Scandlen's 10/29/01 Health Policy Comment: ".... AAPS argues that HIPAA's misnamed privacy rules violate the First, Fourth and Tenth Amendments to the Constitution, and impose unjustified regulatory burdens on small physician practices. You may remember it was AAPS that successfully sued the health care task force headed by Mrs. Clinton for being in violation of the federal Administrative Procedures Act, so this new suit is doubly significant."
The Moratorium on Mandates (HB1048) was also ratified in October. Our lobbyist Robert Paschal noted: "The National Federation of Independent Business was the primary sponsor of this bill, which provides that health benefit plans shall not mandate coverage beyond what is required as of June 30, 2003. Of equal importance is the bill's provision authorizing the Legislative Research Commission to study the issue of mandates and their impact, and this could tie in nicely with the LRC's study of high-risk pools. Note that under HB 1048 employers are not prohibited from electing to expand their plans' coverage."
Viatical Settlements Rewrite (HB 359) was also ratified early in October.
The Economic Stimulus package at the Federal level will be very important to this industry. The House & Senate versions differ in details, but it looks like there will be some kind of subsidies for COBRA and other assistance to displaced workers for their health insurance coverage (tax credits?), and the Archer MSA will be extended through 2003.
The NC High Risk Pool project: We received a list of all the carriers from the Department of Insurance and have drafted the letter to go out to seek their opinion on a high-risk pool for NC. Some new studies have been found and are available through our http://www.ncchirp.org website. The Charlotte chapter has invited TAHU's Ken Johnson, along with Robert Paschal, to speak on the HRP project at their November meeting. Also NAHU is forming a High Risk Pool Working Group, and Ken will be asked to serve on that. On http://www.ncchirp.org, we have posted a letter from a family who rather eloquently described their plight which includes, a layoff, possible bankruptcy of the previous employer (no COBRA), and the high cost of a very effective, life-saving multiple sclerosis medication - good folks who would probably get good assistance if they were indigent -- but having worked all their lives so they could now own their home, put kids through college? There's got to be a better way within our insurance industry to take care of these risks - protect assets against these compound catastrophic situations, and have a vehicle for the 1% who are chronically medically uninsurable. According to experts who have seen it both ways, the vehicle, that would allow the rest of the small group and individual insurance markets to thrive, is a high-risk pool.
Nancy Winter
nancy@medsaver.org
919-493-9405
Membership:
Lynn Collins
Please welcome the following new members to our Chapter:
SizSiz Wong of SizSiz Wong Insurance Agency
Kathryn W. Ketter of Colonial Life & Accident Ins. Co
Communications:
Gianina Campbell
Monthly meetings are the 3rd Monday of each month starting at 11:45 am.
The next meeting will be held on November 19, 2001 at the Marriott (Research Triangle Park, NC - Exit 281, Miami Blvd.).
All members and their guests are invited to attend.
Come join us for Food, Fun, Fellowship and Learning
Guaranteed seating for the luncheon meeting is by reservation only.
Please fax this notice back to 919-477-8867 (local to the Raleigh/Durham area) to reserve your place. The week prior to the meeting you will receive a notice via fax.
Guaranteed seating for the luncheon meeting is by reservation only.
Attendee: ________________________________
I (will) be attending the November meeting.
I (will) (will not) bring a guest/prospective member.
Guest name: __________________________________
There is no need to fax the response back if you are not planning on attending the meeting/luncheon
Please RSVP no later than November 14th.
As the success of the Triangle Association of Health Underwriters largely depends upon the benevolence of corporate contributors, we are proud to honor the following organizations for their continued support of our many programs and activities:
Diamond Sponsors
2001-2002
Blue Cross & Blue Shield of NC
United Healthcare
Please extend your appreciation to the Triangle members representing these organizations and remember their generosity when placing coverages.
Please remember that the cost of lunch for TAHU members is $12. Guest and non-member lunches are $16.
There will be a $3 charge for lost or misplaced name badges. Please remember to turn in your badge at the conclusion of each meeting.
Triangle Association of Health Underwriters
P.O. Box 19177
Raleigh, NC 27619-9177
