Category: Latest Thinking

By Monica Attanasi, AIC and Colleen Vallen, CPA, CFF

Loss events, no matter the type, are disruptive, complicated and burdensome for any company in any industry. In the aftermath of a catastrophic event like a fire, cyber-attack or major weather event, businesses need to focus on mitigating the impact of the loss, resuming operations, serving customers and supporting employees — not draining resources managing a claim.

Working with an insurance brokerage that has an integrated forensic accounting affiliate can be a game changer. While the role of the forensic accountant varies based on the claim and business needs, a forensic accountant working together with an experienced claim advocacy team eases the disruption and burden on the company, so it can focus on the business while the integrated claim team handles the complexities and maximizes the claim recovery.

What are Forensic Accountants?

Forensic accountants are involved in quantifying the full impact of an event — including analyzing the cost of repairs/replacements, business income/lost profits, and increased or extra expense. This is a complex process requiring an investigative and analytical mindset to accurately analyze, evaluate and project losses. Working hand in hand with claim advocacy consultants, forensic accountants analyze documentation and information, prepare financial modeling to develop a loss projection, and prepare comprehensive reports to provide an in-depth understanding of the business and loss impacts to the insurance carrier. Forensic accountants also aid in responding to complex requests for information, analyzing and evaluating calculations prepared by the insurance company’s accountants, and in some cases, serving as expert witnesses.

A Holistic Approach to Claim Resolution

Every business and loss event is different, so there is no one-size-fits-all approach. Calculating and documenting a claim is not a simple fact gathering exercise. It is a process that requires in-depth understanding of financial information, complicated financial analyses and modeling, effective communication, creativity and strategy.

Critical to this process is the ability to understand and analyze the financial impacts of the loss and articulate the story behind the numbers. In addition to preparing financial analyses, forensic accountants use their investigative skill set to gain an understanding of the business, market and the industry in which the business operates to present a holistic picture to the insurance carrier. For example, knowing the company was planning to add a new division, launch a new product or acquire a new location might not be reflected in the historical financial data, but this information is incredibly relevant to accurately quantify business income and other financial losses.

Forensic accountants, in partnership with seasoned claim advocates, go beyond the numbers, using their expertise and experience to marry the story of a business with its financial numbers. In large property and other types of claims, the forensic accountant’s skills validate the process and lend credibility to the numbers. This can make a significant, positive impact on the claim outcome.

Forensic Accounting in Action

Real estate is an industry where catastrophic losses are common, due in part to large portfolios with geographic footprints that span the country and include catastrophe-prone areas. For a national real estate development and management company, the claim advocacy team at Conner Strong & Buckelew and the forensic accounting team at J.A. Montgomery worked together to drive a successful claim outcome.

The Loss Event

One of the company’s properties, located in New Jersey, experienced severe damage in 2021 from Hurricane Ida — a devastating category 4 hurricane that caused $75 billion in damage across 22 states. From day one, the forensic accounting and claim advocacy teams worked together to manage the property damage, business interruption and extra expense components of the claim. This included managing submission of the building spend package and preparing business income and extra expense claim calculations.

Key Challenges

The forensic accountants addressed several complications during the process. On the building spend side, the ongoing building spend required numerous updates and reconciliation along with the review of thousands of invoices and an allocation process that required intensive document review and client discussion.

On the business income front, the increased demand for apartments in New Jersey due to the COVID-19 pandemic added complexity to an already challenging calculation. This required performing an in-depth review of the market to validate the significant increases in rental costs that was not captured in the company’s historical data. The forensic accounting team was able to bring that market analysis forward in the narrative and calculated losses submitted to the carrier.

The Result

Our integrated claim advocacy and forensic accounting approach yielded a favorable $10 million+ claim settlement for the company. This included claims for recoverable depreciation and business income totaling $3.5 million, which were complex, challenging to document and subject to thorough review and analysis by the insurance company. As a result of the integrated forensic accounting and claim advocacy approach, the claim settlement was approximately 25% higher than it would have been with a standard claim submission and processing approach.

Maximizing Claim Outcomes and Minimizing Work

Catastrophic losses can hit at any time and can impact companies in different ways. Working with a brokerage that fully integrates forensic accounting with claim advocacy from end-to-end can translate to a more favorable claim outcome to help your company get back to business.

At Conner Strong & Buckelew, we provide a holistic claims strategy that starts from day one and doesn’t end until the claim is resolved. By partnering with our owned forensic accounting affiliate, J.A. Montgomery, whenever possible, we’re better able to tell your full story and maximize your claim settlement.

Contact a member of our team today to see how our holistic approach to claim management can help you be prepared when a loss occurs.

An Opinion Piece

By Joe DiBella

Overview

The No Surprises Act (NSA) took effect January 1, 2022, and was designed to protect patients from surprise medical bills, particularly in emergency and out-of-network (OON) situations. While successful in curbing balance billing for consumers, the implementation of the law has led to significant unintended consequences for employer-sponsored health plans, particularly those that are self-funded. The Independent Dispute Resolution (IDR) process, a core element of the NSA, has been marked by high volume, provider-favorable outcomes, and substantial administrative burdens. This summary outlines the law’s mechanics, its financial and operational impact on employers, and the urgent need for reform.

UNDERSTANDING THE NSA AND THE IDR PROCESS

Under the NSA, when a patient receives OON emergency care or services from ancillary providers at in-network facilities, the provider and health plan must negotiate reimbursement without billing the patient beyond in-network cost sharing. If no agreement is reached, either party may initiate the IDR process, wherein a certified arbitrator selects one party’s proposed payment. Initially, the “Qualified Payment Amount” (QPA) was intended to serve as the primary benchmark in IDR cases. The QPA represents the median in-network rate for a service in a geographic area. However, legal challenges and court rulings have allowed arbitrators to weigh other factors more heavily, such as provider experience and case complexity. Right or wrong, this has diluted the intended cost-containment role of the QPA.

THE DISPROPORTIONATE IMPACT ON EMPLOYERS AND PLAN SPONSORS

Employers and Plan Sponsors, and particularly those with self-funded plans, are bearing the brunt of NSA-related cost increases. The financial impact arises from both the direct cost of arbitration awards and the indirect administrative expenses tied to compliance and dispute resolution. Here are some data points that put the added costs into perspective:

1. Provider-Favored Arbitration Outcomes

• Providers win an estimated 85% of emergency-related IDR cases.
• Average payment awards in these cases are roughly 2.7x the QPA, with some cases reaching as high as 4x Medicare rates.

2. High Prevalence of Emergency Room Disputes

• Approximately two-thirds of all IDR disputes relate to emergency services.
• From Q1 2023 to Q2 2024, about 1.24 million surprise billing disputes were filed, over 40% of which resulted in arbitration.

3. Escalating Employer Costs

• QPA (benchmark): $600
• Typical Award: $1,620 (2.7x the QPA)
• Incremental Cost/Case: $1,020

• Annual Impact: $204,000 in additional claims cost
• IDR Fees: $315 to $1,300 per case = $63,000 to $260,000 annually

4. National Cost Exposure

• With an estimated 500,000 ER-related disputes resolved over 15 months, total added cost to the system could be as much as $500 million to $700 million annually.
• Administrative and certified IDR entity fees alone add another $105 million or more.

5. Administrative Burden and Compliance Risk

• Employers must ensure TPAs comply with IDR timelines and manage disputes. The costs of which are simply passed back to the employer.
• Compliance involves tracking QPAs, submitting documentation, and responding within strict periods.
• Legal volatility due to shifting federal court rulings has made consistent compliance difficult.

NSA REFORM PROPOSALS

There is growing recognition of the strain the NSA has placed on employers and plan sponsors. Legislative and regulatory proposals are emerging from Congress and the administration. H.R. 9572 in the U.S. House offers a series of fixes intended to rein in payments that are far in excess of the QPA which lead to increased financial exposure to self-funded plans. Below is a summary of some of the proposals in play:

Recommendations for Employers and Plan Sponsors

Employers and plan sponsors need to act and advocate for meaningful reform to the NSA. Left as is, the law may actually drive up providers leaving networks and increasing the probability of higher out-of-network usage overall. Conner Strong & Buckelew will be advocating for fixes to the law that does not undermine its intent but does fix the enormous new costs the law has shifted to employers and plan sponsors. Some immediate steps group health plans should consider include:

• Making IDR and QPA assumptions in budget models and reserves.
• Audit TPA processes to ensure IDR compliance.
• Consider network expansion and steerage strategies to limit OON exposure.
• Monitor federal regulatory updates and prepare to comment on proposed rules.
• Work with trade groups and lobbying organizations to advocate for legislative changes to fix the issues and flaws with the NSA.

Conclusion

The NSA has succeeded in reducing patient exposure to surprise medical bills, but at a substantial and rising cost to employer-sponsored health plans. The current IDR system disproportionately favors providers and leads to awards significantly above market benchmarks. Combined with administrative burdens and legal uncertainty, the system places employers at risk of financial strain and compliance errors. Employers and plan sponsors should actively advocate for reforms that restore the QPA as the primary benchmark, streamline the IDR process, and reduce fee exposure.

SOURCES:

• CMS.gov, IDR Quarterly Reports
• HealthSystemTracker.org, Kaiser Family Foundation
• ACEP.org, American College of Emergency Physicians
• CommonwealthFund.org, Health Affairs
• Academic.OUP.com, Oxford University Press analysis
• AHIP.org, Hall Benefits Law
• SLPHealthcareUpdate.com, Ogletree Deakins
• CBO, Congressional Budget Office Estimates
• Claritev.com, IDR Market Data
• FY2025 US Budget Summary (HHS Implementation Line Items)

By Jill Ambrose, MBA, BSN, RN and Simon Leung, PharmD

It’s an interesting time for the GLP-1 market. Now that Wegovy and Zepbound have been available for weight loss for a few years, early reports are being published on the outcomes of these drugs for both patients and their employers.

While GLP-1s are effective at promoting weight loss, there is still uncertainty around whether the long-term health benefits will be actualized by warding off high-cost acute events such as heart attack, stroke and complex diabetes management to name a few. Adding to that uncertainty is evidence of high discontinuation rates due to cost and adverse events. On top of that, the return on investment for employers will likely not be seen for a few more years. For organizations wondering what to do next, here’s a look at where the market is today and how to find an approach that works for your employee population.

A Complex, Evolving Landscape

The GLP-1 market is continuously evolving, and it’s becoming increasingly complex – making it hard for employers to make coverage decisions. In a survey from the International Foundation of Employee Benefit Plans, more than half (53%) of employers who cover GLP-1s for diabetes reported that they are not considering covering them for weight loss at this time. The survey also found that GLP-1s for weight loss accounted for an average 10.5% of total annual claims in 2025 compared to 8.9% in 2024. As many employers wait for prices to drop, there are a couple of market changes that need to take place first.

EXPANDING INDICATIONS

Manufacturers of GLP-1s are actively pursuing FDA approval for new indications of the drugs, many of which are linked to obesity. In 2024, the Food and Drug Administration approved Novo Nordisk’s Wegovy (semaglutide) to reduce cardiovascular risk in overweight or obese individuals, and approved Eli Lilly’s Zepbound (tirzepatide) to treat moderate to severe obstructive sleep apnea in adults with obesity.

Several manufacturers including Boehringer Ingelheim, Hanmi Pharmaceuticals and Kariya Pharmaceuticals are researching and trialing the benefits of GLP-1s for conditions with less clear links to obesity, like metabolic dysfunction-associated steatohepatitis (MASH), Alzheimer’s disease, Parkinson’s disease, obesity-associated cancers and substance use disorder. As GLP-1s are studied and approved for more indications, that should put some downward pressure on the market.

WAITING FOR GENERICS

Prices for GLP-1s have started to decrease, but not enough for most employers to consider covering them for weight loss. It’s likely going to take the introduction of generics to the market for there to be a meaningful decrease in price. While generics for older forms of GLP-1s like Victoza (liraglutide) have been approved for diabetes, generics for weight loss indications are not yet available. And generics for newer GLP-1s won’t hit the market any time soon. Novo Nordisk’s patent on semaglutide and Eli Lilly’s patent on tirzepatide don’t expire in the U.S. until 2032 and 2036, respectively.

Regulatory pressure to lower drug costs should have an impact on GLP-1s, but actualizing those reductions will take time. Right now, price cuts are focused on direct-to-consumer rather than health plans – with Novo Nordisk and Eli Lilly cutting prices for patients paying out-of-pocket.

The Big Question: Where Is the ROI?

It’s likely not the answer most employers want to hear, but the return on investment for covering GLP-1s for weight loss is not going to be realized in the short term. Employers should go in with the mindset that these drugs are a long-term investment in employee health and will not produce savings based on an annual budget.

In the near-term, employers might see gains in terms of increased productivity from employees using GLP-1s for weight loss, as obesity has been linked to higher absenteeism and productivity loss. But those returns are hard to measure.

Another key variable of ROI employers need to consider is what happens after employees reach a healthy weight and are weaned off GLP-1s? Research indicates that GLP-1s are most effective when combined with lifestyle and behavioral changes. For the best outcomes and maximum ROI, employees will need to have access to resources, like nutritionists and obesity medicine specialists, before, during and after GLP-1 treatment. Otherwise, as studies have shown, some members who stop taking the medication may gain back some or all of the weight they lost, putting them at higher risk for high-cost events.

Steps Employers Can Take Today

Right now, there’s no one-size-fits-all approach for employers to follow when it comes to covering GLP-1s for weight loss. Part of the challenge is the lack of a cost-effective approach for discontinuing the use of GLP-1s for both diabetes management and weight loss, so it’s hard for employers to predict how long employees might be using these high-cost drugs. And if they do stop, they’ll likely need programs to help them keep the weight off and maintain a healthy lifestyle.

LEVERAGING EMPLOYEE POPULATION DATA IS KEY

What employers can do today regarding GLP-1s for weight loss is take a closer look at their employee populations. Those with access to data warehouses can leverage clinical data annually to estimate how many employees might qualify for GLP-1s for weight loss (i.e. obesity diagnosis with no diabetes). This data can help employers determine the risk and potential reward of offering GLP-1s for weight loss in their employee benefits package.

MOVING FORWARD CAUTIOUSLY

The best advice for most employers is to continue to practice patience. Employers currently covering or contemplating adding coverage for GLP-1s for weight loss should consider utilization management strategies that might help contain costs, such as tightening controls on coverage eligibility or durations and mandatory nutrition and lifestyle coaching.

Employers that have chosen to sit it out for now should consider what, if any, alternative weight loss programs they may want to offer.

Your Partner in GLP-1 Strategy

No matter where your organization stands with GLP-1s, working with an experienced employee benefits consulting partner who understands and is following the evolving landscape is key.  There’s no perfect answer or single approach that’s right for every employee population. A good partner will work with you to determine an employee benefits program that will work for your company. At Conner Strong & Buckelew, our Consultants, Population Health and Pharmacy practice groups are working on the frontlines of GLP-1 adoption. We can help your company stay up to date in the rapidly evolving landscape and work with you to build custom solutions for your employee population. Contact us now to learn more.

By James Hanrahan, Michelle Leighton and Andrew Still

As the construction industry continues to boom amidst a tight labor market and increasing regulatory scrutiny, companies are facing a perfect storm of rising claims, costly verdicts and growing insurance premiums. Today’s risk environment demands a more proactive and strategic approach to safety and liability.

The Impact of Nuclear Verdicts and Social Inflation

Construction companies today are feeling a lot of pressure in the general liability and vehicle liability marketplace. Social inflation — which refers to the cost of insurance claims rising faster than the general economic inflation rate — is causing premiums to soar. Key factors contributing to this social inflation are increased litigation, third-party litigation funding and inflated awards of $10 million or more to claimants.

In an industry like construction where injury is a matter of when, not if, and fatality rates remain high, these nuclear verdicts pose a growing threat. A U.S. Chamber of Commerce study on trucking-related litigation found that the average award for plaintiffs’ verdicts between June 2020 and April 2023 was upwards of $31 million. Even more alarming, in 2023, a Dallas-based real estate developer had to pay more than $860 million in damages to the family of a woman who was killed in a crane collapse.

With the possibility of an attractive settlement, workers and other injured parties are more likely to pursue general liability and vehicle liability claims, and attorneys are capitalizing on the moment. For example, according to a report initially published by ABC News, some insurance groups are claiming NYC construction site workers are faking injuries hoping to collect large settlements.

Today’s litigious environment, coupled with higher medical costs, rising vehicle repair costs and large punitive damage awards are driving up premiums, but there is even more at stake. Beyond the monetary implications, the limelight that comes with a big claim or nuclear verdict puts construction companies at risk for reputational damage which could stunt new business growth and recruitment. With a lot at stake, construction leaders need to rethink their risk mitigation strategies.

6 Strategies for Proactive Risk Mitigation

In this volatile landscape, construction companies need to shift their approach to risk from reactive to proactive. Here are six strategies that can help prevent claims and help companies be protected should claims arise.

1. Implement a Centralized Incident Reporting Protocol

When an incident does occur, it’s crucial that construction companies have a streamlined process for reporting in place to ensure consistent documentation, timely carrier notification and early opportunities for claim advocacy and resolution. Incident response protocols should involve robust accident investigations that include root cause analysis to dissect what happened and why. By centralizing incident reporting, companies can eliminate gaps in communication and ensure all claims are handled efficiently.

2. Monitor Patterns and Take Steps to Prevent Recurrence

After a claim is resolved, it’s important to reflect on the “what, how, why” and any lessons learned during the claim advocacy process. This step can be instrumental in preventing future losses of the same nature. Trend analysis of prior claims is a valuable tool to uncover patterns and key insights. Claims history tells a story and looking back on previous cases can help construction companies determine targeted risk control strategies to prevent future losses and improve overall safety practices.

3. Advocate for Contractual Risk Transfer

There are tools that help companies transfer risk away from their insurance program and balance sheet. Construction companies should review subcontractor contracts and incorporate additional insured, indemnity and hold harmless provisions as well as insurance requirements that clearly assign liability to the appropriate party. When losses occur, clean contractual language allows for more efficient recovery and minimizes disputes.

4. Invest in Additional Safety Controls

With insurance premiums rising, investing in loss control can help construction companies reduce claims and realize insurance premium savings. Specifically, technology tools for incident reporting, analytics and telematics are another layer of protection construction companies can use to enhance risk management.

There are a few tactics that can be implemented quickly and at scale:

• Wearable technology that enables workers to stay on top of their health can help reduce the risk of health-related incidents. For example, a smartwatch can notify drivers when their heart rate slows, meaning they could be too tired to drive.
• Camera systems in vehicles and throughout the construction site are helpful to monitor workers and provide a record should incidents occur. In large vehicle fleets, this technology can also help drivers navigate better and see blinds spots.
• Drone footage can be used to analyze incidents and inspect the full worksite from top to bottom and spot any risk areas, such as potential slip, trip or fall hazards.
• Reviews of motor vehicle reports (MVRs) before hiring and regularly thereafter can help companies spot potential risks early.
• Regular driver training can also help ensure drivers maintain safe driving habits.

5. Ensure OSHA Compliance and Training

All construction companies should have compliance plans for OSHA standards that include regular training and inspections to ensure adherence. With younger, less experienced workers being brought onto sites, safety training is especially important to reduce risks. Some key OSHA standards construction companies should focus on are fall protection (which was the most frequently cited OSHA standard in FY24), personal protective equipment and confined space protection. Working with an insurance broker who has safety expertise can help companies get a leg up on OSHA compliance.

6. Foster a Culture of Risk Awareness

When safety is embedded from the top down, incidents decrease and fewer claims help lower the overall cost of insurance. A culture of risk awareness needs to start at the top with executives and senior leaders who value and promote safety throughout the entire organization, getting buy in from managers, supervisors and workers. To do so, leaders must switch their success mindset from that of just how quickly and on-budget a project can be completed to include how safely it can be done. When safety is tied to success, the entire organization is more likely to get on board.

Partnering with an Expert in Risk Control and Claim Management

With the frequency and cost of claims rising, construction companies need to refocus their safety and risk mitigation efforts. Collaborating with dedicated claim management and risk control advisors is more essential than ever.

At Conner Strong and Buckelew, our Property & Casualty group is comprised of experts in both claim advocacy and risk control, providing a full range of services to ensure clients are covered before, during and after a claim. Our risk control team specializes in designing and implementing complete safety and risk control programs — and works hand in hand with our claim advocacy team to provide guidance on proactive measures that can help reduce your total cost of risk and maximize your recovery should a claim arise.

An Experienced Broker Partner Should Check all the Boxes

When choosing claim management and risk control advisors it’s important work with a company that has deep expertise and resources in key areas, including:

• Coverage Gap Identification
• Industry Comparisons and Benchmarking
• Claims Trends and Frequency Analysis
• Root Cause Analysis
• Subcontractor Risk Management
• Regular Program Reviews
• Safety and Risk Management/Mitigation
• Alternative Insurance Solutions (e.g., captives, self-insured retentions)
• Designated Claim Advocacy Consultants
• In-house Team of Safety & Risk Management Professionals

If you’re exploring ways to improve site safety and manage claims more effectively, we’d be glad to connect and share insights. Contact a member of our team today.

By Michael Hanley

The employee benefits space is undergoing a transformation. With financial headwinds and new employee needs, many employers and plan sponsors are rethinking their programs and looking for ways to maximize savings.

Here are four key trends we’re following right now and some tactics employers and plan sponsors can take to address them:

1. Weight loss and GLP-1 drugs

What to know: About 40% of U.S. adults are obese and that number is expected to near 50% by 2030. Obesity is a medical condition that will continue to affect employee populations for the foreseeable future. The demand for weight loss drugs like GLP-1s has skyrocketed and some employees are demanding that their health plans cover these medications.

What to do: The reality is that only about 25% of group plans are currently covering GLP-1s for weight loss. While there is early research showing that GLP-1s can help employees lose weight, for most employers and plan sponsors the return on investment (ROI) from covering GLP-1s for weight loss is too far down the road. Additionally, without supplemental nutrition and lifestyle management, the vast majority of employees who stop treatment experience weight gain again. The best practice today remains to only cover GLP-1s for type II diabetes and not cover them for weight loss. Other tactics include tighter utilization protocols such as stricter requirements for eligibility, setting an annual or lifetime limit on how much the plan will cover and having employees work with a nutritionist and health coach before turning to GLP-1s. In time, as the cost of GLP-1s comes down, it may be reasonable to consider covering GLP1s for weight loss. For now, there is simply no ROI.

2. Large claims

What to know: There are a few health conditions driving large claims for employers and plan sponsors. Top among them is cancer, which when diagnosed at a later stage can be considerably more expensive. Cancer survival rates are rising, and emerging oncology drugs that provide life-saving treatments come at high price points. Maternity and newborn care continues to have the potential for large claims today, and we are also seeing employees with chronic conditions like diabetes or hypertension having upticks in hospitalizations due to improper management.

What to do: Focusing on prevention is key. Using a data warehouse is one way employers and plan sponsors can proactively identify large claims at earlier stages and use that information to conduct outreach to members who need help managing conditions or receiving preventive care. Another route is to offer care navigation programs that connect employees with advocates who can personally guide them through their care and help them avoid preventable costs.

3. Rising healthcare costs

What to know: Inflation is impacting the cost of medications and health services. In particular, the healthcare labor shortage has driven a competitive talent market, dramatically increasing labor costs for hospitals and health systems. Labor accounted for 60% of hospital expenses in 2023. As hospitals are dealing with higher operating costs and tighter budgets, they are passing those increases on to consumers.

What to do: We’re seeing growing interest from employers and plan sponsors in using indexed pricing (sometimes referred to as reference based pricing) to try to right size premiums and copays for their employees. Instead of relying on carriers to negotiate with hospitals on costs, indexed pricing uses a benchmark like Medicare to determine the price of medical services. This method protects employers and plan sponsors from inflated prices. Another alternative employers and plan sponsors might want to familiarize themselves with is the idea of Individual Coverage Health Reimbursement Arrangements (ICHRA). This approach puts the pressure of choosing a health plan on the employee, giving them a fixed amount to spend and letting them choose their benefits.

4. Pharmacy pricing and disruption

What to know: With prescription drug costs also rising, employers and plan sponsors are increasingly frustrated with the lack of data and transparency in pharmacy pricing. At the same time, they’re growing more concerned over the threat of fiduciary lawsuits. In the last year, companies including Johnson & Johnson, Wells Fargo and JP Morgan Chase have all been sued by employees alleging that they breached fiduciary duties under the Employee Retirement Income Security Act (ERISA) by failing to control drug costs.

What to do: Employers and plan sponsors can’t ignore pharmacy benefits. In this evolving landscape, it’s important to stay on top of what’s happening and understand the cost containment strategies available that generate meaningful savings. We are seeing the transparent pass-through pricing model with pharmacy benefit managers (PBMs) gain momentum as a way for employers and plan sponsors to increase transparency and potentially cost savings. Another avenue is joining a pharmacy coalition or buying group that provides employers and plan sponsors with greater negotiating and purchasing power to help them decrease their annual pharmacy spend.

The Conner Strong & Buckelew Advantage

The employee benefits space is experiencing severe financial headwinds. Employers and plan sponsors need to take a proactive approach to protect themselves and their employees from surging healthcare prices. Conner Strong & Buckelew’s Employee Benefits team works with employers and plan sponsors to recommend programs that are tailored to their unique needs. With population health and pharmacy experts on our team, we are at the forefront of new strategies and tactics to lower costs, improve employee health and reduce risk.

Get the most out of your employee benefits program. Contact a member of our team today at 1-877-861-3220 or [email protected].

By Kenneth Bogdan, Eric Voight, and Maxx Hofmann

Inflation, rising property values and natural disasters have had a significant impact on the habitational real estate market. All these factors have caused a hardening of the insurance market with higher premiums, stricter underwriting standards and more limited and restrictive coverage. As carriers continue to heavily scrutinize habitational insurance coverage, commercial residential property owners need to take a renewed focus on their safety and loss control strategies to ensure they are proactively protecting their property and residents.

How Property Owners Can Mitigate Common Risks

Exposures and risks vary depending on the region where properties are located. But across the board, more and more commercial residential property owners are seeing an increase in claims stemming from three key areas – security issues, amenity spaces and environmental hazards. While these trends persist, there are steps property owners can take today to help limit their exposure.

1. Security Concerns

Insufficient surveillance coverage or an inability to manage surveillance systems can get property owners in hot water during accident investigations. Here are some proactive steps to take before an incident occurs:

• Place surveillance equipment and appropriate lighting in all common areas and amenity spaces.
• Conduct regular checks and inspections to ensure all surveillance systems are operating and recording to capture and retain evidence.
• Establish relationships with local police departments and create a neighborhood watch.
• When using a security company, ensure all officers are bonded with clean background checks.
• Offer discounted rent to local police officers provided they park a squad car at your property.

2. Amenity Spaces

As demands for more robust amenities grow, these spaces introduce new risks and exposures for property owners. From dog parks and playgrounds to pools and gyms, here are preventative steps to help reduce liability:

• Ensure all rules and necessary signage is posted in amenity areas, including hours of operation.
• Inspect all equipment regularly.
• Have easily accessible phones or emergency communication mechanisms in amenity areas.
• Install fences with passcodes for entry in areas like pools, dog parks and sport courts.
• Make sure you have surveillance cameras covering pools, playgrounds, fitness centers and other amenity spaces.

3. Environmental Hazards

Weather and environmental issues will always create liability exposures for property owners, but today, they are becoming increasingly complex and harder to predict. Take these steps to get ahead of environmental and weather hazards:

• Adopt technology, like IoT sensors, for early warning detection of signs of fire or water leaks.
• Have a restoration contactor on standby.
• Hire general contractors who can make quick repairs.
• Ensure that contracts with snow removal and other contractors and vendors include explicit indemnification language and detailed insurance requirements.
• Establish mutual aid should residents need to move to temporary housing.

Prioritizing Safety and Loss Control with a Trusted Partner

No two property’s safety and loss control programs are going to look the same. Risk mitigation strategies must be tailored to the region, property classification, style and type of residents living there and more. Working with a highly experienced broker partner who understands the multitude of safety risks can help give property owners peace of mind. Conner Strong & Buckelew’s Safety, Risk Control and insurance experts can help property owners navigate today’s underwriting challenges and determine the risk mitigation strategies that will work best for their property and their budget, while ensuring compliance with local ordinances and regulations.

If you’re ready to improve your property’s safety and loss control program, contact a member of our team today.

By John Manion

The financial strain put on higher education institutions during the pandemic continues to have a deep impact on the industry. As operating costs have escalated and the number of students seeking college degrees drops, many institutions, primarily smaller, private, independent colleges, face significant financial headwinds.

The current trends are reshaping how higher education views employee benefits. While benefits in the higher ed space have historically been very robust, financial pressures have pushed colleges and universities to pivot towards operating more like other industries where leadership with CFO backgrounds drive key decisions.

With employee benefits often being the second largest expense after payroll, smaller, independent colleges will need to be agile and adopt strategies that make the most of their budgets. Taking a proactive approach can help higher education institutions lower costs while maintaining or improving employee satisfaction.

Proactive Strategies for Employee Benefits

As healthcare costs balloon, higher education institutions should consider the following strategies to curtail spending and improve benefits for their employees:

1. Engaging in Pharmacy Benefits Management Coalitions

Prescription drug spend continues to be a top contributor to health benefit plan costs and the pharmacy benefits managers (PBMs) offer modest rebate programs to help offset pharmacy spend. Pharmacy coalitions do much more, ensuring employers have the best contract terms and rebate structures possible and employees have access to high-quality, low-cost medications. Conner Strong & Buckelew’s pharmacy coalition covers over a million lives and brings unparalleled leverage strength to the institutions that join.

2. Tapping into Data Warehouses

Data warehouses and analytics can help employers uncover cost drivers and gaps in care in their employee population. With a data warehouse, employers can see who in their population is utilizing care, what the prevalent trends are and where there are gaps in care. Armed with such data, institutions can begin to develop proactive solutions to avoid costly claims before they develop.

3. Monitoring Disease Risk

Advancements in medicine have made early disease detection and diagnosis far more accessible. Employers can offer programs to understand their employee populations’ risk of developing diseases like cancer through DNA testing. Detecting these diseases before they emerge or at their earliest stages is critical to reducing costs in the long term. Additionally, employees with disease markers can then be actively monitored so any sign of the disease can be addressed much more cost effectively.

4. Preventing Hospital Readmissions

Employees with chronic conditions or managing multiple healthcare issues at once can quickly turn into high cost cases if their conditions are not properly managed. Introducing programs that connect these employees with resources like care managers or health coaches can help employees better navigate the healthcare system and ensure they are taking the necessary steps to manage their conditions and avoid visits to the emergency room.

The CSB Advantage

Most higher ed institutions cannot afford to be reactive. Proactively reducing risks that can lead to costly claims requires more than standard wellness programs. Conner Strong & Buckelew has assisted a number of colleges in deploying proactive strategies that offer a strong return on investment.

With our out-of-the-box thinking and in-house population health and pharmacy experts, we are able to help institutions find unique solutions to their employee populations’ specific needs and challenges. Our employee benefits services, including data analytics, pharmacy benefits management and population health solutions, help drive down costs while enabling improved health for your employee population.

If your institution is ready to take a proactive approach to employee benefits, please call us at 1-877-861-3220 or email [email protected].

By Raymond O. Burke and Dominic Micali

Stop-loss insurance can be a powerful tool to help employers with self-funded health insurance plans limit their overall risk. Under a stop-loss policy, losses in excess of a set deductible limit (“attachment point”) are covered by the stop loss carrier, protecting the employer from the financial impact of large, catastrophic claims. There are two types of stop-loss coverage; Individual (or specific) stop-loss, which deals with claims associated with a specific member, and aggregate stop-loss, which covers the totality of an employer’s claims spend in a given time period.

As the dynamics of healthcare and the demand for stop-loss protection evolve, here are three trends that could continue to impact the stop-loss market.

1. More small and mid-sized organizations adopt self-funded models

Fully insured organizations continue to face significant premium increases with little transparency from carriers as to what’s driving them. Beyond claims experience, things like premium taxes and the carrier’s rising administrative expenses also factor into rate hikes. And while high claims typically result in sharp premium increases at renewal, those higher premiums do not go down after a year with low claims.

While self-funding has long been common among larger firms, as premiums for fully insuring continue to rise, more smaller and mid-sized firms are discovering the financial and control advantages of moving to a self-funded model supported by stop-loss protection to limit their risk.

2. Rising frequency and severity of catastrophic claims

New and costly cutting-edge treatments and specialty medications are saving lives and improving outcomes for members with cancer or chronic conditions. However, they are also driving up the frequency and severity of large, catastrophic claims. Previously, a $1 million claim would be an exception to the norm. Today, it is not unusual for organizations to see several multi-million dollar claims a year — making the need to have the right stop-loss protection in place more important than ever.

3. Employee benefits captives continue to emerge as an attractive option

The trends discussed above have caused demand for stop-loss insurance to grow significantly. However, many employers are also deciding to participate in employee benefits captives to gain even more transparency and cost control. These innovative solutions allow like-minded employers with 100 to 500 employees to form and manage their own insurance entity. Rather than paying premiums to an insurance company, the employers contribute to a shared pool for stop-loss coverage.

As members of a captive, employers retain the profits when claims are low and share the financial impact with other captive members when claims experience is higher than expected. However, since the stop-loss premiums are based on the claims experience of a pool of employers, rather than a single employer, organizations in captives may benefit from best-in-class stop-loss contractual terms (including no-new lasers and rate cap provisions) and are not likely to experience the drastic stop-loss premium volatility that can occur when self-insuring on their own.

Brokers continue to add value to ease this transition

For employers transitioning from fully insured to self-funded models with stop-loss protection, an experienced broker partner is essential to navigating the process. Securing stop-loss coverage can be a complicated process and experienced brokers can offer guidance to ensure the policy is written in the employer’s best interest.

For example, organizations must be aware of the different vehicles and structures a stop-loss carrier will write into their contracts. Brokers with experience handling policies for a wide range of employers can flag potential areas for review, such as aggregate deductibles, lasers and other policy language that can significantly impact the amount of risk an organization assumes.

The Conner Strong & Buckelew Advantage

As the stop-loss space continues to evolve, the trends outlined above will be important to monitor as organizations continue to move from fully insured to self-funded. At Conner Strong & Buckelew, we have assisted countless clients with this transition, so they too can reap the cost-saving benefits. Additionally, we have deep experience helping employers who are already self-funded find better stop-loss solutions.

Today, over 80% of our clients are self-insured because of the unparalleled value we can provide under this structure. Our self-insured clients benefit from access to enhanced control of spending through data transparency, industry-leading pharmacy coalitions and rebates, population health and cost containment strategies, catastrophic claims screening technology, risk management expertise and much more. Combined with strategic stop-loss coverage placement, the culmination of these resources and expertise can create thousands of dollars in annual savings for your organization while maintaining employee benefits satisfaction.

If your organization is considering the self-funded route or is already self-funded and would like to learn more about alternative stop-loss options, please call us at 1-877-861-3220 or email [email protected].