HM Insurance Group's Industry Insights Blog

Industry Insights

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Don’t Doubt the Expense of Gout

By: Jamie Holowka February 5, 2020
We’ve all heard about gout. It’s that sharp, hot pain and swelling that most commonly afflicts the big toe. One of the world’s oldest recognized diseases, gout was first identified by the Egyptians in 2640 BC and has been viewed as a lifestyle disease of the rich and affluent, primarily because of its connection to certain more expensive dietary habits. This “disease of kings” has been problematic for ages, with little change in the treatment options that first were identified thousands of years back – until a few years ago.
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Integrating RxOps for Cost Management Solutions

By: Jamie Holowka March 27, 2019
As a pharmacist, in the past 20-plus years, I’ve owned my own pharmacy, worked for a PBM (pharmacy benefit manager), served as a consultant to health plans and more. Now, I find myself in the operations department of a Stop Loss carrier. As pharmaceutical costs continue to rise and new drugs debut with million-dollar price-tags, the market is seeing greater catastrophic claims expenses – and I’m working to share my industry knowledge and understanding of pharmaceutical costs and use across the client population.
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Problem-solving with Reflection and Resolution

By: Tom Doran December 13, 2018
I love solving problems. That’s the best part of my job. Lucky for me, we’re in a thought-provoking industry – one that’s become even more challenging with the growth of high-dollar claims. As a reinsurer, paying those claims is the most important thing we do. The challenge lies in creating the right solution for each client, appropriately pricing business to ensure obligations can be fulfilled and finding ways to help contain claim costs for everyone involved.
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Reference-Based Pricing Brings Transparency to Health Care Costs

By: Dan Cloyd June 20, 2018
Adding a reference-based pricing component to an employer’s health plan brings an element of clarity to benefit costs by determining, from the start, what is to be paid for medical services and procedures. It’s no surprise that reference-based pricing is a hot topic in the market today, especially when claims exceeding $1 million are more and more common. Reference-based pricing is part of a greater movement toward transparency, helping to establish some type of a standard for what is paid for medical care.
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Taking Action Against High Cost Claims

By: Dom Palmieri September 11, 2017
Well, the Stop Loss industry seems to be a rousing one these days. Claim incidences and expenses are on the rise (with no end in sight) – and we have to figure out how to contain the costs to protect everyone’s bottom line. Our sleeves are rolled up at HM. Who else is in? This is going to take a pretty big effort from all of us if we are to minimize the risk.
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