Designed for groups with 5 to 99 enrolling employees, AmeriShare and ATA America offer an alternative approach to funding employee healthcare benefits. Ask us how to show your clients how they may reap the benefits enjoyed by larger employers in a way that makes sense for smaller businesses.
ATA Carrier Update
Jason Powers (00:02:41):
Hey everyone. We’re going to give some other folks just a few more minutes to join us before we get started. Thanks for being here this morning.
Jason Powers (00:06:41):
Welcome back to our carrier product update series. I’m your host Jason Powers here with Legacy Brokers and I’ve got Tom Stein from American Trust Administrators with me today. Excited to share content about their product and mirror share with you. Before we get started, if you’re not familiar with Legacy Brokers, you’re going to get familiar with American Trust here shortly, but if you’re not familiar with us here at Legacy Brokers, we’re a general agency located in the Kansas City market, but our reach is really on a national basis. I think we’ve got producers in 17 states across the country and our whole mission really is to support everything that health insurance agents are doing out on market. Our specialty is group health insurance, and really our focus in that group health arena is on self-funded group health plan. Our staff here is a great team of resources available for all agents to help you build, protect and preserve your book of business out market.
Jason Powers (00:07:40):
I got start in this industry in 2000, actually working at American Trust Administrators. We’ve talked about that before. I was the national sales director at ATA, I’ve also served in various roles and health underwriters. If you’re not a member of health underwriters, I certainly encourage you to consider joining. It’s always been a great asset to me with plenty of great contacts and good network available throughout. I also serve as an investment committee chair on the board of directors for Barton Mutual insurance company. That’s about as close as the PNC as I come I don’t generally do anything else in the PNC world. And when I’m not doing what I here at Legacy, or I’m not in the insurance world, I spent a lot of time on the soccer fields with four boys that are all in some way connected to the game of soccer. And then the rest of whatever energy I have left, I give to my wife, the last 22 years. Today, I’ve got with me a good friend of mine who I come to know and respect over the last 10 years, Tom Stein from American Trust.
Thomas Stein (00:08:52):
Hey, how are you? My name’s Tom. Thanks, Jason. Yeah, a little bit about me. I basically took Jason’s chair in American Trust Administrators as the National Director of business development. I am lifetime a TPA guy, my first sales call was in eighth grade with my dad. So at this point I’ve got a bit of experience, still learning the ropes, but every day we get a little bit better. You want to know a little demographic? I am happily married, beautiful wife, little dog that’s 85 pounds, little with me, I guess. But yeah, life is good here in Kansas City. And my picture up there with me on a camel, which… I don’t know, I see an adventure, so you got to go with it.
Jason Powers (00:09:40):
Yeah, I’m excited to have you here and this isn’t your first time on this. You’re a return honored guest. It’s kind of like the Saturday night live, right? This your third time on show.
Thomas Stein (00:09:58):
And I was actually wondering as we walked in here, are we going to put people who have been on the show… right.
Jason Powers (00:10:03):
That’s a great idea. Line the wall with both…
Thomas Stein (00:10:07):
Hall of arms. The building out the studio.
Jason Powers (00:10:11):
Well, now that you know a little bit about Tom and I, it’s a great time to tell us about yourself. So just a moment, our DJ Josh is going to launch a poll to ask you some questions about who you are. How would you define your role or responsibility as a licensed insurance agent in the role of insurance? And this helps us, I think really just determine, as we build out content throughout the year, how do we really best serve the agents that are coming to our events, logging into our carrier product update series so that we can really understand your business model, which helps us, how to better serve those agents. All right, give just a few more seconds here, and go ahead and end that poll for me Josh. Looks like we got about 57% participating in the poll and half of those are group health insurance agents, so that’s great. We got some other other industry professionals on, so we appreciate your joining us this morning. Want to stop there.
Jason Powers (00:11:35):
All right. This is our carrier product update series, throughout the year we have other events, just as you registered for this event, you can register for all our events on our website at LegacyBrokersKC.com, under the events tab. You’ll see there on the screen, we’ve got another upcoming carrier product update, an episode with our carrier product update series with being dental. And then we launched straight into our CE classes, starting with self-fund at university. It’s a three part series starting on April 13th through April 27th, every Wednesday, from there on, three weeks in a row, we’ll start with self-funded university part one, which is the basics of self-funding. The part two is how to read and analyze self-funded quotes. And then we’ll wrap it up on the third week with part three, where we dive into how to read and analyze self-funded claims reports because there’s not all the same.
Jason Powers (00:12:35):
Process for today, you are not playing world, you are on mute though, we are in a zoom environment. We do want you to participate though so if you’ve got questions relative to the topic today, be sure to use the Q and A feature in the zoom app controls at the bottom of your screen. You can also use the chat feature to chat with the Josh behind the scenes about any technical issues you might be having with sound or video. And then if you just want to chime in, you have any questions, feel free to use the raise hand feature in zoom, and Josh will bring you on live, unmute you so that you can ask and get your questions answered directly from Tom here from ATA.
Thomas Stein (00:13:16):
I’ll do my best.
Jason Powers (00:13:18):
After today, if you have questions for me, feel free to reach out. I think you’ve been on some of our past episodes or past CE classes, you should have my contact information. You probably get lots of emails from me throughout the year. Be sure to join the conversation on LinkedIn by following Legacy Brokers on LinkedIn, we do share a lot of our content in that capacity. So not only email but also follow us on LinkedIn. Don’t forget to give us a five star Google review, I say this every time, we certainly appreciate the reviews that we’ve had so far, and we like what you see here. It certainly helps us to continue to deliver good content to other agents across the country. And for a myriad of reasons, continue to use our website, LegacyBrokersKC.com for other resources. When we finish this video, we’ll actually post it under the carriers tab, opposed to a ATA’s page, this video, along with supporting marketing documentation and other materials that will certainly aid your ability to sell ATA’s product.
Jason Powers (00:14:30):
So ATA, we talked about it. ATAamerica.com is the site American Trust Administrators is the company, AmeriShare is the product. For those that don’t know who ATA is, Tom who’s ATA.
Thomas Stein (00:14:45):
Well, ATA is small family oriented and owned TPA and NGO in Kansas City. We serve across the country, but we are independent. That’s the biggest thing that we have is we are an independent shop, we do things our way, which allows us to do some really crazy beautiful things with plan design, with how we handle our refunds, with how we handle multiyear retention. There’s some really cool things that we’re able to do because we stay independent, because we stay in like a family oriented company. Like I said, mentioned earlier, my first sales call was with my dad, big Tom. And we’ve been in this space, actually this year, ATA turns 50.
Thomas Stein (00:15:36):
So pretty exciting. We covered helicopters at first, not self-funding, but a little different transition there, but we’ve been doing the self-fund, especially the small group self funding for about 36 years. And we’re, if not the oldist, I don’t know who’s been doing the small group stuff for longer. But on that customizable vein, we’ve got multiple options that we can run, whether it be deductibles, co-insurance, drug cards, spectrums, ag terms. The reason why we do all those things, we try to make it for the trained GA and trained broker, as easy to lift from where they currently are to where they want to be. And so by offering these options they can get a true apples to apples. And then it’s not, this is a different deductible, this is a different drug card, but it’s a different price. It’s everything’s the same and we’re still better off.
Thomas Stein (00:16:34):
And then when you get deeper into the weeds, this is where we shine. You have a much lower fixed cost, and for those of you out there who are newer to self-funded or level funded, there’s always… Probably even do the university obviously, but there’s two categories of cost fixed and claims, and whenever you look at ours, we’ll have a pretty big spread compared to others of our fixed account and our claims account. We have a lot of money going into claims, I know I’m talking a lot here, Jason, but…
Jason Powers (00:17:07):
No, I would say it’s probably your biggest difference, right? If you’re comparing to the book, it’s the big, the carrier model plans. Would you agree that it really comes down to how they structure their fixed costs versus how you…
Thomas Stein (00:17:22):
Sure, and the other thing is, that structure’s huge, absolutely, and what it allows you to do is look multiyear. Because at one point, if you’re just looking, “all right, I’ve got 10 grand in my claims account.” Okay, no big deal. “They’ve got 40.” All of a sudden you’re balanced against all of these increases that are coming year one, year two, year three. And so you are able to keep your cases in the same place. And by doing that as the broker, you have great opportunities to have additional products or you can go out on prospect, you have more time, because you’re not getting hammered. That’s the approach we’ve always taken, it’s a longer term approach, but it’s something we’re proud of.
Jason Powers (00:18:05):
Yeah, and on the screen here, we’re talking, you guys always refund a hundred percent use claims dollars.
Thomas Stein (00:18:09):
Jason Powers (00:18:10):
And I think that’s another differentiator for premier share versus some of the other carrier models, is there’s always some catch where, the group had a great year and then they got a 10% increase and the only way that they can get the money out of their surplus is if they take it. It takes the 10% increase with BTA and AmeriShare product, that’s not true.
Thomas Stein (00:18:30):
Yeah, stock home syndrome. It’s what you’re really looking at is, “hey, it’s your money, but you got to give us more of it to get it back.” That’s hostage a little bit, we don’t do that, we never have. As long as the Stein’s in charge, we never will. That’s something that really goes back to a fundamental principle which is, it’s not our money. It plans money, it’s the business owner’s money, it’s not ours. So as long as we make sure that we keep that going, then we’re going to be better off long term. It would be nice for us to do that, but I don’t have a jet, I don’t need one.
Thomas Stein (00:19:04):
Well, you mentioned it too, it allows producer to build out a multi income strategy with those groups that do end up having a surplus at the end of good playing year, instead of having to bounce around yearly. And then reporting, we actually cover ATAs reports in our self-fund university part three. We actually take a deep dive into…
Jason Powers (00:19:31):
Thomas Stein (00:19:31):
Cool, all right. What’s the frequency on that?
Jason Powers (00:19:34):
So we do it quarterly, and remember on your claims reports, you’re going to have a thing called IVNR and I’m getting nerd here, I am nerd about this stuff. So really the first quarter, when you get that, you’re really only going to have RX on it, and then it basically catches up. That’s why you’re going to want to put your plans on longer than 12 month contract because you have that window.
Jason Powers (00:19:57):
When you start looking at those reports, the third quarter’s report, you can get a pretty good idea of where they’re going to be on their claims account utilization, and then from there, where they’re going to be for their [inaudible 00:20:11] So if you stay ahead of these things, life becomes so much easier and we give you the reports so you can’t, you choose to. And so ATA as a company, that we’ve talked about product a little bit, it’s mirror share, it’s always been a mirror share. Again, what’s the differentiator there in a product?
Thomas Stein (00:20:34):
In the product itself. So the big thing that we do is that we… This is a good and a bad thing. Everything’s a trade off. We underwrite medically to the individual, and I’ll hit the negative first. From the negative standpoint is, it’s a little bit more time consumed. From the positive standpoint is, it gives you a more accurate idea of where those claim dollars are actually going to go. And so by doing that, you have a more accurate price point and you have a imply loss ratio by state regulations, you have more money inside of those claims accounts. And so that’s a long-winded way of saying that we price it accurately, and because we price it accurately, that additional dollar, is going to come back to you because we refund a hundred percent.
Thomas Stein (00:21:23):
So if you do a little bit more work up front, pays in spades down the channel. That’s a huge deal on our product, it’s a huge deal on why people stay with us, is that that work up front pays dividends for years down the road. A couple other things that best fits for clients. We have a five minimum, a lot of states, some states it’s a little different, five is baseline.
Thomas Stein (00:21:50):
And this isn’t unique to ATA, but in level funding, you want to have somebody with moderate to good help. And then you also, when an average age of somewhere below 50, the further you get down, the better off you’re going to be. And then the other one is you want to have a stable company. Again, that’s important for looking down the road. A lot of the things that we do in our plan design and on our underwriting is trying to stay ahead of problems, rather than just saying yes and then buying problems 3, 6, 8 months down the road. We’d rather be a little bit tougher up front and then have a longer relationship with that client and that broker because at the end of the day, there’s always going to be issues if you don’t do the work front. So if you do the work upfront, you can stay ahead of so many and the life is so much easier.
Jason Powers (00:22:42):
Yeah. I’d say the other product, differential I think in the, in the marketer, AmeriShare is the flexibility in the plan. It’s not like some of the other carrier models where we get a grid of the plans that we can choose from. There really is a lot of flexibility in ATAs approach. And the refund piece is probably [inaudible 00:23:09] For agents that are selling self-funded in the market, knowing that ATA is going to do what’s right by the client by returning the plan assets back to the plan, instead of keeping a portion of that. That sells itself on a spreadsheet.
Thomas Stein (00:23:27):
Yeah. Speaking on the spreadsheet, and we chatted about this beforehand, but I love this. All of our plans are customized and there’s over a million options if you put it all together for your plan design. Which, I’m not saying that you’re not one on a million, but come on. There’s a ton of options for you out there, and so we can find one that will work for their specific situation and from a sales standpoint, we can match what they currently have, that’s much easier from the sales process standpoint to say, “I’ve got out, stounds.”
Jason Powers (00:24:06):
So we hear and we probably talk about groups and their ability to get refunds. I know some agents look at some of the carrier model plans and don’t really talk about potential for refund because of the way its costed structure, with ATA we do, we talk about the potential for the refund and surplus dollars what’s the average… Well, you’ve got it up there, right.
Thomas Stein (00:24:29):
Right, and we’re very proud of this. What we have is, and this is 2019, there was a little bit better percentage, a little lower dollar amount. That’s a lot of money. If you look at a 20 man group and you go in to the business owner and you say, “all right, I’ve got 13 grand here for you.” That’s the difference between him having to change the amount that he’s paying for his employee benefits or could be him buying a brand new fork truck, I don’t know what a fork truck costs, but you know my point.
Jason Powers (00:25:01):
More then 13.
Thomas Stein (00:25:02):
More than 13, three jet skis. You’re putting something back in his pocket, from a broker standpoint, when you walk in with that amount of money, you’re no longer the guy selling him something, you’re a partner. You are delivering value that nobody else is even talking about. And if that guy doesn’t love you at that point, well, I don’t know how you’re going to get that guy to love you. That’s a huge deal. And on our traditional plans, we have, I believe it was 72% in 2019, which by the nature of run out, it’s the most recent data we have, and that’s credible.
Thomas Stein (00:25:39):
The amount of things that you can do from a secondary sales standpoint, the amount of things that you can do from building that relationship with a broker, with those dollars, that is a planes dollars, it’s their money anyway, you’re putting it back in their pocket. They get it directed, they get to add additional benefits for their employees. Everybody’s freaked out about employees leaving right now. Well, I would not change cash flow and them give them more benefits. This doesn’t…
Jason Powers (00:26:06):
I mean, if you think of what 13,000 represent in a small employee, who’s probably… On the generous side, the employer may pay $300 a month for an employee to have benefits. That’s three more employees they can afford to pay. What does that do for their growth? What does it do for their company to add three more employees that they’re providing benefits for without changing? I think the bottom line, instead adding those employees, maybe it increases production for them where they generate more.
Thomas Stein (00:26:43):
Or maybe it reduces turnover, which helps… ATA, we’re blessed, we have very long term employees. And some of that I think is… I think we take pretty good care of our people, and that makes us more effective. If you can get out there and retain the people that are already on your team, life is so much easier. And this is just another option for you to utilize. You don’t have to buy it against next year’s renewal or anything along those lines. It’s your money. Now you want to use it inside of the bit of trust agreements, whether technical stuff, but it’s your money.
Jason Powers (00:27:24):
Well, we talked, the AmeriShare is a flexible plan. And as a general agency, I think we see somewhere north of 600 RFPs a year, maybe more than that, quite a few cases that we’re looking. And one of the things that’s really easy to do with some of the other carrier models is just look at a plan grid, here are three options that fit what you’re looking for from a plan design. But with ATA, you mentioned a million and a half different variation, that’s a lot of planism. So I mean, it really is customized. There’s not a bronze, silver, gold, platinum kind of level plans, you can mix and match.
Thomas Stein (00:28:20):
Jason you’re a hundred percent right there. So you choose, easiest from a sales process, the easiest way to ago is if we have existing coverage. Let’s imagine let’s keep it, excuse me, really simple and say, all right, you’re with a fully insured carrier and you’re on X, Y, and Z. Well, if we move you over to a self-funded, level funded model, what’s the difference? And then you also have to keep on the Columbus account. That’s the easiest way to go from a new virgin group, which in these really small groups, there’s a lot of people who are having to offer health coverage to their troops, simply because they’re having that crazy turnover. And so you go into them and say, “all right, here’s what you have, here’s what you think it’s going to cost from the fully insured type. Let’s go ahead and produce something and let’s play with the plan design for what specifically goes on inside of that group.” And yes, it’s a little bit more research for the broker to go in and talk to the business owner.
Thomas Stein (00:29:22):
Again, we’re looking long term here, one more conversation can get something a little bit better. Stays ahead of noise, stays ahead of those issues that cause people chop. If they’re happy, they’re not moving. So let’s do the work up front and then keep them happy.
Jason Powers (00:29:37):
Well, we cover in one of our CE classes, we teach the basics of health. Another one is the group healthcare strategy. And both of those classes we teach the discovery, how critical it is to really be on the same side [inaudible 00:29:53] importer. What you draw from it in coming back to AmeriShare as a product adoption is, if an employer says, “employees love the plan, I just wish we could get a little bit lower out of pocket.” The deductible at 1500, that’s perfect. Gosh, can we get a plan that doesn’t have an 8,100 dollar out of pocket?” And if you’re looking at some of the carrier model plans, they’re predetermined at an actuarial value of bronze, silver, gold, platinum, whatever it is.
Jason Powers (00:30:26):
With ATA, AmeriShare, you could. You could go in and customize that out of pocket. You could drop the out of pocket. You could change the co-insurance levels. You can change the copays, you can put a different drug card in… You put a really rich drug card in with a really high deductible [crosstalk 00:30:43] through the opposite, you can… Again, a million and a half different variations. A lot of times when I say that to agents, they don’t grasp it. Knowing what we see in the quoting system, we can run it million…
Thomas Stein (00:30:56):
Yeah, there’s… You can continually try to build something that’s more accurate to the needs of the client. And that’s the end of the day. Like you want to build something as perfect to the client as possible. And so the better you get it, the more likely are they that they’re going to be happy, and the more likely that you’re going to have a long term relationship with that client, then year over year, you can go back and serve it. Everybody knows sales is easy, prospecting ridiculously. So if you have your clients, let’s help you keep them. Because… Yeah, you get the point. And it may not be a plan design issue. It may not be deductible oracle insurance, might be a network.
Jason Powers (00:31:38):
That’s another place where you guys fill in the blanks for us.
Thomas Stein (00:31:41):
Yeah we play with multiple different PPOs, it depends on where you are for which one works. We have… Oh man, I can’t tell you how many PPO contracts we have, but we have a bunch. And so you can plug and play wherever feels appropriate, feels like the best need for your client. That’s where the GA comes in because you guys are going to know the local data and know what that client needs right there. In addition to that, we also have RBP, which we’ve been doing RBP for a while. It is a very good solution sometimes and it’s very tough sometimes. But again, you set the table, it can be a great long term solution. The big issue is, how do you set the table and how do you stay ahead of the issues that are going to pop up? Speaking with a broker out of Jackson Hole, right? You wanted to look at an RBP option and was not a good fit simply because Jackson Hole doesn’t have RBP providers, so it’s a fool them once.
Jason Powers (00:32:48):
A lot of providers are in those rural, make it difficult. But I think, the tools that you guys have got available, we’ll talk about one of them here at a moment. Tools that you guys got available in the RBP space. The fact that you’ve been in that space, you’re not new in that space you’ve been doing it for a while now. Should give brokers that are just now coming around to the concept of RBP, which is taking away the now, reimbursing providers after the services are rendered at a percentage of medicare. And then if there’s pushback negotiating with the provider from there to really settle on what’s fair for that service in that market, versus starting with a PPO contract that’s predetermined and is some variation of a discount off of a rack.
Thomas Stein (00:33:47):
You have it actually perfectly correct. You have the PPOs, which is a negotiated contract at a time. And then it’s almost like a big circle, where innovation goes in a big circle in our industry and RBP is like indemnity on different price and structure. It’s not perfect but in some situations it works really well. Some it doesn’t and I wouldn’t do it, but if you know ahead of time, stay ahead of it. Again, you’re looking for long term service with clients and that’s what we’ve got on… I think we’re going to cover the amino, right?
Jason Powers (00:34:17):
Yeah. Cool new feature that I’m super excited about is those are the kind of questions that we get from agents, “wow, I know.” What providers are going to be [inaudible 00:34:27]
Jason Powers (00:34:28):
You mentioned indemnity, which is funny because I can nerd out about why would we never want to quote an indemnity plan, but here we are quoting, RBP which is a variation of an indemnity plan.
Thomas Stein (00:34:39):
It was no contract, right?
Jason Powers (00:34:40):
I don’t know on the front end, but now we got a tool to negotiate with those providers on the back end and success in using that tool. As a general agency, we’ve got multiple pieces across that are using RBP or they using it successfully. They do have [inaudible 00:34:55] but you get ways. Speaking of nerding out, I can nerd out about self-funded. The other thing that I really like about the customization in the AmeriShare world is that it’s not just a one size fits all level funded program. Now, brokers that are out there that are just getting comfortable with level funding, you have the ability to build, we have the ability to build that product in a level funded space, but that’s not all you could do.
Thomas Stein (00:35:23):
Yeah and that’s it. And when we go back to… We had the slide up there a minute to go with the refunds. And so those dollars are inside of an income benefit [inaudible 00:35:34] So how do you utilize those dollars in the most effective way? This is where most people start to look at true or self-fund with stop loss programs, where they’ll do their claims as needed or as incurred. And so what you have is a different way to run the exact same plan where you can use last year’s dollars in this current year expenses. And that’s incredible.
Thomas Stein (00:36:01):
It’s real simple, but it’s called minimum funding. And I don’t want to scare anybody, it’s a simple program. You’re using money from previous years in most of the time, or if you have a client that is financially savvy enough. So think CPAs, then financial services firms, they understand accrual accounting and you can run it as a minimum base. And then if they, as long as they put that money, it’s a portion of its size, it’s like a unfunded liability that they’ll fund on their own books. Then you’ve got a way to move forward through it without having to have all those dollars go to the plan.
Thomas Stein (00:36:36):
So there’s multiple options to do these things and we open them up to the client. And again, it goes back to the broker and how deeply they want to serve the customer and how much the need is there for them to realize cash flow certain times. Again, we’re open to it. Our chassis is open.
Jason Powers (00:36:58):
Yeah, so we talk about it in our self-funded university that there’s different models, the level funded versus say an ASO or pay as you go model. Minimum funded capability in air-share really speaks to that page. It could be cash flow, could be a number of reasons that an employer will be sophisticated enough to want to go down that path. Level fund is almost that train like the self-funding on training wheels and moving into the pay as you go model that is AmeriShare’s minimum funded options. It’s a great tool to build out a long term strategy with client versus being stuck in that again. Are you being held hostage to that self-funded plan because there’s a refund coming only if you take the increase at the end year. And that’s certainly a big differentiator for… So we hinted at it and I’m excited about it because I do pay attention on it. You release notes to the field on LinkedIn and it caught my eye because it was something new about RBP and I know you guys are really out front being innovators in that space. So talk to us about Amino.
Thomas Stein (00:38:16):
Jason Powers (00:38:17):
Victoria’s not here to bail you out.
Thomas Stein (00:38:18):
I know, right? She’s our in-house expert for those of you who saw us on LinkedIn. Yeah, Victoria Armstrong, she’s great. In fact, I believe you hired her.
Jason Powers (00:38:27):
Thomas Stein (00:38:28):
So she’s sticking around, don’t you dare. But she walked us through the immuno program and we’ve got a couple RBP providers. This one is with Zealous and they use the Immuno program. And what we can do is, ahead of time, like the broker that was working with Jackson, we can look and see if it’s going to be a decent fit or if it’s going to be one that we probably want to avoid unless there’s absolutely necessity on cost. And so whenever you’re looking at a group and let’s say that they are very price sensitive, they need lower cost.
Thomas Stein (00:39:06):
Okay, RBP is one of those options that can be a pretty big cost production. But you want to stay ahead of it from relationship standpoint from a broker because RBP can be very noisy. So if you look at a tool like at Amino, when you jump on there and you type in the zip code, you say, “all right, I’m looking for X, Y, or Z.” You can see which providers in that geographic area have already accepted an RBP reimbursed. They’re not contract, no. But these are ones that it’s basically like almost saying a safe harbor. If you go here, you’re going to be okay. And if you communicate that with your employees, from the business standpoint or from your clients, from the broker standpoint, then they’re going to have less noise overall. You’re going to have better and they’re going to have a longer retention, which I know I talk about retention all the time, that’s our business model. You retain events.
Jason Powers (00:40:04):
You’re you’re building intelligence. You’re taking what the market’s giving as far as feedback on the RBP model and building out from a user experience, PPO model, what is the user supposed to do? “Make sure you stay in network. Well, how you do that? While you got to go to this website, you got to look up the providers.” So as an industry, we’ve conditioned members over the last 25 years to go to a website, look up your providers, that’s who you can go to. And then our RBP model, we said, you can go anywhere, you don’t have to worry about [inaudible 00:40:40] you can go anywhere.
Jason Powers (00:40:42):
And what happens is then we get market feedback from the provider community saying, “well, we’re not going to agree to 125% of medicare or a 150% medicare. We want 220% of Medicare.” Or some other variation. With Amino, what we found is that… Josh go ahead and pull that up. So you can actually go in, register for an account, which I’ve already done and look up providers by locations. So just for… Go to primary care. I’ve already done this, if you need help as a broker out there in the community doing it, we can certainly can get you connected. Not a difficult process whatsoever took me all in three minutes, by the time I verified my email. So Josh is pulling up here, primary care providers in the Lenexa area, where I’ve got… Here’s some providers right here that are A-rated on the RBP scale, meaning that they’ve already experienced an RBP reimbursement model and they’re open to it, and they didn’t push back.
Jason Powers (00:41:47):
B in this rating scale is they gave a little bit of pushback, they didn’t take the first offer, but they did end up settling at a more reasonable offer than PPO and then you’ve got some other graded scales in there. And it doesn’t matter what service you’re looking for. I picked on primary care, but there’s other services you can look at. You can look by location, you can look at by type of provider and you can do this out the country. It is a continue, as amino continues to build that data…
Thomas Stein (00:42:15):
It only gets richer, it only gets better.
Jason Powers (00:42:17):
What does it become? It becomes a grant. It’s not saying that a contract, there’s still a possibility that an A rated RBP provider in this search will come back and balance bill, but the likelihood is…
Thomas Stein (00:42:31):
Jason Powers (00:42:32):
Yeah, so they’re not contracted, that goes against the RBP model.
Thomas Stein (00:42:37):
A bigger deal from a long term standpoint, from industry standpoint, is the more that we steer consumption to these primary care providers, the more they’re going to be familiar with it, the more they’re just going to accept it as a practice. And so it’s almost as if we’re building a PPO network without having to pay for these PPO fees that crank up the cost of the plant and without having to reimburse these higher levels, which again, crank up the cost of the plan for the plan owner.
Thomas Stein (00:43:07):
So by doing the steerage, it makes it richer over time for the end user or the member and it gives you less noise at a better cost. So again, RBP can be perfect, it also can be very troublesome, depends on where you are. So use the tool ahead of time and then figure out if it’s going to be good for your client.
Jason Powers (00:43:30):
And if you’re thinking about RBP on the quotes, that quotes with RBP from us here at Legacy, particularly when you’re using ATAs AmeriShare product, don’t forget to register for Amino so that you can do some front work. Do some work on the front end to educate members about how to use the tool, where they can go, what providers would give them less noise and less pushback. And even on my side, I was able to look up my provider and realize that the doctor that I go to and the PPO model, I would probably give some pushback based on the clinic affiliate level. So it gives me pause to consider, well maybe there’s a reason for me to look at RBP later for my own healthcare providers.
Jason Powers (00:44:26):
I’ve got a question from Mark Williams. What percentage of providers typical market are open to this model? Do we have any data on that?
Thomas Stein (00:44:35):
I don’t have a hard answer to that. Open to it or accepting it on Amino are two separate things. Amino is not going to be a perfect catch, so if you have penetration in there where you’ve got a list of provider for the Metro area, like Lenexa, which is a suburb of Kansas city, those of you who’s not familiar, others 26, I believe listed. That seems rich to me. If you are in… Mark, where are you?
Jason Powers (00:45:05):
Thomas Stein (00:45:06):
Springfield. Would you mind?
Jason Powers (00:45:08):
Yeah. Mark, can we bring you on? Oh, doing a search from Springfield. So go back.
Thomas Stein (00:45:14):
We doing quick search.
Jason Powers (00:45:16):
Edit location. Oh, you got to click that edit location button.
Thomas Stein (00:45:27):
And we haven’t done this, this is our first one here. Springfield. If we look at Springfield, we have 37 total, five none.
Jason Powers (00:45:39):
No A rates. We got B rates. So they at least…
Thomas Stein (00:45:45):
They have accepted it.
Jason Powers (00:45:45):
They’ve accepted it. Maybe not first pass, but they certainly…
Thomas Stein (00:45:50):
That’s right. So on this one. Yeah, I think Springfield would be something that I’d be open to if I was in Springfield, just by looking at the PCP, or primary care providers, if you have specific other needs, the Amino will look for that as well, but yeah that’s basically a hurdle, is that if you can get over the first hurdle yeah. And say, “hey, Springfield’s pretty good.” Another way to think about it in general. This is a way before Amino, that thought about is, if you have multiple hospital systems in one town, then you’re going to be better off. If you only have one provider, in general, it’s not a good fit.
Thomas Stein (00:46:30):
Just historically with ATA that’s where we’ve seen the most noise, and there’s only one game in town. And it’s a tough thing to negotiate with because would say, well, where are you going to go?” So use the Amino and from a hospital system, I’d really recommend having at least two hospital systems. You can play them off each other.
Jason Powers (00:46:49):
Which is great for Springfield there are… [crosstalk 00:46:52] They are across the street from each other.
Thomas Stein (00:46:53):
They love each other too that’s what I hear.
Jason Powers (00:46:56):
That’s a great question. So outside of RBP and Amino, I guess ambition, something that you teased on the last time you were here was this new pilot. Level funded pilot, and we couldn’t really talk about it too much, we kind of teased about it. And it’s out there, we have access to it here at Legacy, which means that our brokers have access to it. What can you tell me about this new level funded pilot, now that I have logged…
Thomas Stein (00:47:28):
This is my baby. So I’ve been working on this for quite some time. And what the pilot does is it produces a couple of things that are very actionable for the plan owner or the broker. And we try to make it as simple as possible. So all the information that the business owner should would have at their disclosure, right there without having to go to the memos. So you enter the census, you ask a couple of questions and again, some of these are trying to stay ahead of problems down the road. You figure out their SIC, their zip, and if you… There you go, you put these in there and you ask a couple of questions, like have they had medical insurance? What we’re really looking for there is a diversion group. Is the workforce stable? What we’re looking for there is massive participation changes. Like lawn care companies, not a good idea.
Jason Powers (00:48:22):
You looking for turnover. [crosstalk 00:48:25] The revolving door of employees coming in three months.
Thomas Stein (00:48:27):
Is it? Yeah, just continually cycling. So these are all questions that business owner and the broker can answer there themselves. We’re trying to reduce the amount of unrealized work that the broker does. So then you ask that one question, which is how healthy is the employees? And when you produce all of this together, it produces a level funded score. That level funded score also produces a report that goes to the broker and the business owner and says, “hey, you’ve got these conditions and it’s all dynamic, right? It all reads what you put into it. You have these conditions, you have this zip code, you have this industry, you have a fairly good score of working with public funded or you’re a terrible candidate.”
Thomas Stein (00:49:11):
Well, we’re not pulling punches here, we’re letting the broker know which candidates are best fit for level funding and which ones should probably be on the furniture. Again, we’re trying to save them time. And then, this is the big one, it loads an indication forward that goes out to the broker where it says, “here’s what it’s going to be.” Or roughly where it’s going to be. You still need to do underwriting, but it allows them to say, “all right, with this load, this industry, characteristics, everything else, here’s the rough score, and here’s where we think they’re going to land.” Then you know as the broker, “hey, do I chase this rabbit? Or are they already better with where they are?”
Jason Powers (00:49:50):
It’s a great kind of pre qualification. Think of it in terms of a credit score, you’re talking about a level funded score now. This doesn’t mean that it’s been medically underwritten, they still have to go through the apps. They still may have telephone interviews depending on what underwriting comes back with that reviewing applications. But so many times I get asked, do you think this group would be a good prospect for level funding? Or I get the broker telling me, “I think this is be a great prospect for level funding.” Well, let’s put to the test and see what ATA system comes back with because there are certain things that… Why is industry important?
Thomas Stein (00:50:31):
So industries, again, we’re kind of nerdy, but…
Jason Powers (00:50:37):
Go for it.
Thomas Stein (00:50:37):
I’m on it.
Jason Powers (00:50:37):
Thomas Stein (00:50:39):
So you have your SIC, and what that says is the ratings either up or down, over manual, for the risk inside of that industry. An easy way to explain it would be, if everybody’s a CrossFitter, Billy’s a little overweight. Well, what’s that mean? Oh, he’s got an extra six pounds. Okay, that’s one thing. My example here, I’m not picking on anybody. Or, Billy’s a little overweight in the trucking industry. That’s a completely different mental picture, and that’s a great way to think about how the SIC affects, basically what the industry standards are and how that affects how the business owner’s going to answer that final question as well, which is, what is the health of the group? Everybody compares it to their own cohort. And again, I’m getting nerdy on underwriting. But if you ask the questions and you frame it and the right, and the friend that they’re currently in, you get more accurate information and we can save a broker more time on targeting the specific clients that are going to be able to be served and win by going with level fund. That’s the grail man.
Jason Powers (00:51:43):
Yeah, and it’s not that the broker or the employer has to go out and ask a lot of questions on the front end, this is all stuff they should have access to right away. If it’s a broker that’s current, that this is their current client, you probably know some things. Is your phone ringing off the hook on this group in their current fully insured plan because someone’s having trouble getting prior authorization on $6,000, monthly medication. It’s probably not a good prospect, self-funded. It could be depending on the right PBM tools that implement…
Thomas Stein (00:52:17):
Client design, everything else.
Jason Powers (00:52:18):
Client design. But generally speaking, that would be something we want to know on the front end to see if they are a good prospect. Because going through that underwriting process, it’s tough. And so I love this idea, I love the fact that we’ve had access to it. And I love the fact that we’re introducing and rolling it out to our brokers here in 2022. So if you’ve got a prospect, who you’re looking at today and you’re thinking, is this a good fit for level funding, ask for the new level fund of pilot for PTA, we’ll produce the scores and get you an idea what that looks like. So you have something tangible, now you can go back and talk to that group about why you think they’re good fit level funding or why probably shouldn’t go through this process instead of you looking at some of the…
Thomas Stein (00:53:05):
Yeah. That’s the other ways that you could also use it to protect yourself from the brokers standpoint, “hey, I’ve got 50 clients. I’ve only done fully insured in the past, let’s see which ones are a good candidate.” Well, everybody talks, you move 15 over and somebody talks to John and says, “I saved 20% this year. Why didn’t you move me over?” “Well, we talked about it. Here’s your report. Here’s why it’s not a good fit.” It’s a credibility piece as well to the broker and protecting themselves against being BOR, which is the Bane of every broker system.
Jason Powers (00:53:40):
Yeah. So a reminder of what a good prospect looks like, what a good fit for ATA. We’re looking at that smaller group space.
Thomas Stein (00:53:49):
That’s right. So five to 50, generally good health, and we need a company that is stable in terms of its workforce. Again, we’re trying to stay ahead of problems. We try to look for the very long term and if we can stay ahead of these issues, you’re going to like us more as the broker, and so does the plan on. So if you hit those three things, run through the pilot and see what the score is, and then we can shake it down the tree.
Jason Powers (00:54:18):
Love it. Lot of exciting stuff, just in the last few weeks that we’ve talked about, I know in the turn of the fourth quarter we’ve got a new stop–loss carrier, new PMM. What’s on the horizon for ATA.
Thomas Stein (00:54:34):
The futures on the horizon. What we’re working on, and I’ve got a couple of things that are going to be improvements to the pilot that I’m still working on daily, that will I’ll allow for even better efficiency for the brokers, where you can know which cases are going to be more help able and less help able. Additionally, we have a couple of other things on plan design standpoint that will… You mentioned one with some RX stuff.
Thomas Stein (00:55:05):
Again, this is in the future, but if you can’t get excited about the future, what would you get excited about.
Jason Powers (00:55:11):
You don’t have to spill any secret here. We can talk out. I know there’s some good stuff you’re working on, excited about it. ATA has always been a company that I feel serves a need in the industry that isn’t filled in some of the bigger carrier model plans. And groups that we’ve got that have been through… Most recently, a group that went through renewal, had surplus, got a fair no change renewal on their claims exposure, actually have a little bit of a reduction on the fixed cross side of things, which is unheard of in most cases, when you’re talking about weaponize. And then to know that they’ve got that surplus coming back as a refund. Refund is the max fund of their liability. Choosing to use that, to really offset what they’re putting in this year. They’re not putting in as much, now now they have switched to minimum funded and then using the surplus kind of circumvent their liabilities and only fund as needed. But those are strategic, creative things that do in [inaudible 00:56:19] you just can’t do with some these program.
Jason Powers (00:56:22):
So super excited to continue our partnership and work toward launching whatever may come out of the ideas inside that range.
Thomas Stein (00:56:34):
Well, we continue to get better, we enjoy working with you guys and that’s good. It’s good.
Jason Powers (00:56:41):
At this point, this kind of wraps up our presentation here. If you’ve got questions, feel free to ask those now, raise your hand or throw them in the Q and A, if you raise your hand, we’ll bring you on live and let you ask Tom directly. If you have questions after today, don’t forget to reach out to me. You’ve got my contact info on the screen. Be sure to follow us on LinkedIn, we’ll post snips of this actual career product update on our LinkedIn. We’ll actually post a link back to our website for the full video. You can also leave us a five star Google review, can’t stress that enough. Love those Google reviews. Be sure to check out our website for additional resources where we’ll post additional marketing materials that are definitely beneficial in your efforts when you’re selling ATAs share-product. We got one final question for everyone out there. Josh will launch that here.
Jason Powers (00:57:40):
And this one is, how can we connect after today? Just let us know if you want to be contacted in some capacity after today, we’ll be sure to reach out. Otherwise, be sure to join us for our next carrier product update coming up. Again, event registration link on our website. We’re going to be talking to Joe Conrossi from Bean Dental, will be the first time he’s ever visit in Kansas City, I’m excited to have him in. And then we go straight into our CD series, self-funded university starting April 13th. All right, and go ahead and end that poll for me, Josh.
Jason Powers (00:58:23):
Tom, again, always a pleasure to see you. Thank you for the gift that you brought in on the front end. I totally forgot about our conversation about that. Look forward to seeing what’s coming from ATA in the future. If you want to take a look at an AmeriShare proposal or you want to look at the level funded pilot score on your next prospect, be sure to reach out.
Jason Powers (00:58:46):
Otherwise, we’ll see you… Oh, we do have another question coming in. Are there any facilities in Kansas City that will not accept RBP? Yes. There are facilities that do not accept, reference based pricing, it’s always good to know who those are. I couldn’t list them off to you individually, but there are facilities across the country that are not accepting reference based pricing. And what’s critical, I think, in the product on your side of things is that, you’ve got the back of the employer so you’re working with third party companies like Zealous, like Six Degrees, like these RBP adjudicators, to then go and negotiate those services after they’ve been rendered with those facilities that don’t accept…
Thomas Stein (00:59:44):
Jason Powers (00:59:46):
And when we say they don’t accept RBP, all we’re saying is they’re not taking the first off. There’s a negotiation back and forth with facility to settle on what they’ll accept this payment. Oftentimes where you end up with a facility like that is probably right back at PPO.
Thomas Stein (01:00:02):
Yeah. And there’s always different widgets that you can use to unwind that position. To the question of, “are there facilities that are not used?” Yes. You can’t force someone to take money, but after the services are rendered, there’s a fair standards we have ethically negotiate. You ethically negotiate. At the end of the day, it’s still business and they want to get paid. And so you just come to a number and that’s that. But it’s a lot easier if you just go to the ones that you know are already accepting it. Because the balance bill noise is the noise that really affects you as the broker.
Jason Powers (01:00:47):
Great question. Again, finishing up, if you have any prospects you want to take a look at and see an AmeriShare, full AmeriShare proposal or a prospect that you’d like to see a level funded pilot score or evaluation on, send those over to us. Until next time on our next carrier update. I’m Jason Powers and this is Tom Stein.