[00:00:00] Paul Lucas: Hello everyone, welcome to use QBE North American A&H market to delve into the latest version of insurance company TV. Now, the company has released its 2025 accident and health market report that provides insights on current trends affecting self-funded healthcare programs. Key topics include the trend of medical stop claims, the growth of the professional pharmacy market and the factors that hinder healthier societies. Well, to discuss its discovery and so on, we welcome Tara Krauss, president of accidents and health at QBE North America. Tara, welcome to IBTV.
[00:00:30] Tara Krauss: Oh, thank you for having me today.
[00:00:32] Paul Lucas: So Tara starts the issue, let’s talk about reports of medical stop loss. What makes it an important part of a self-funded employer welfare strategy?
[00:00:39] Tara Krauss: Thank you, Paul. I think this is a very important issue, sometimes overlooked in a self-funded plan. Therefore, self-protection programs dominate today’s commercial market. More than 65% of health plans are self-sufficiency, and in fact more than 85% of the large employer population. That is more than 500 self-insurance. This is definitely the first choice for employers looking to control costs and have the ability to customize their plans. Stop loss is very common due to self-protection plans for a variety of reasons, and with the current current claim trends, it is becoming more and more important. Almost all small to market self-insurance plans will suffer stop losses, but as the market for large group has grown, it has become increasingly common. In recent years, we have seen the frequency and severity of claims increase, making stopping loss coverage really a wise choice to protect planned assets. In fact, our claim trend research may be possible today that we may understand something and find that our million-dollar claims have doubled in the past four years. So it is indeed a great asset and a safety net for self-protection programs. Current trends affecting self-funded healthcare programs. mp4
[00:01:46] Paul Lucas: Well, you almost brought me there. Let’s talk about some of the key findings in this year’s report. What should brokers and employers pay attention to?
[00:01:54] Tara Krauss: A good question. I think it is important that they continue to explore cost-effective point solution options, planning enhancements to mitigate the current claims trend we are going to discuss today. We have been paying attention to the importance of disease prevalence. The number of new approvals for specialized medicines and the number of new approvals that drive these chronic diseases every year and some rare conditions that are emerging in the market now, the spread of these claims is in the number of specialized medicines and the number of new approvals. Employers do need self-education. This is where we can rely on brokers to focus and educate consumers.
[00:02:28] Paul Lucas: Of course, the report highlights rising claims costs associated with cancer, circulatory disease and premature birth. So, what drives these trends and what impacts on the coverage of interest strategies and stop loss?
[00:02:40] Tara Krauss: There are a lot of things that drive the trend, but I’m going to say this and I’ll focus on cancer, the circulation system and some premature birth claims. I can give a brief introduction. Cancer is still the kind of elephant in the room in the healthcare field. This is the main driver of stop loss claims among our business books and many of my competitors. Regardless of the specification deductible, it will require nearly one-third to one-quarter of the excess loss requirement. Apart from the root causes, the costs of these claims are largely driven by treatment. These are really targeted and expensive treatments, and as we saw 20 to 30 years ago, you have a diagnosis and a treatment plan. There are multiple treatment plans, depending on the type of tumor, the stage of the tumor, the age of the individual, and the comorbidities they may have. Some of these targeted and expensive therapies include automotive T cells, immunotherapy. Stem cell transplants that might have been the third or fourth line of defense are now on the first or second line of defense in the treatment plan. These cancers may be treated more actively at an earlier stage due to the advanced stage of the initial diagnosis. Of course, we study and continue to look at the impact of delayed care in the pandemic. Many people stay at home. They do not have preventive care cancer. There is a chance to move into further stages and eventually obtain more expensive treatments. For example, our book frequency sees about 21 tumor-related claims per 10,000 employees in a health plan. The average of these claims is over 375,000, which is approximately 365. The circular explanation is another big claim. This year we did focus on a lot of things in our comments. This is related to heart failure, AFIB, valve disease, lung disease. These claims are largely driven by things like chronic diseases, comorbidities, diabetes, obesity, hypertension, and more. The costs associated with health care are expected to triple over the next 30 years. Therefore, in these cases, there must be many priorities in the medical field. The sedentary lifestyle, the frequency of our claims increases by about 60%. The American lifestyle has certainly contributed. Finally, you mentioned premature birth. So we haven’t really seen…the incidence of premature births increases, but we do observe that the increase in premature births, these birth abnormalities increase the severity of the claim because of the earlier and more aggressive interventions for this premature birth. Current trends affecting self-funded healthcare programs. Current trends in MP4 affect self-funded healthcare programs.
[00:05:24] Paul Lucas: OK, the report also talks about the impact of poor social health, so can you share more insights on the topic and how it affects the claim?
[00:05:32] Tara Krauss: Of course Paul. So reinsurers won’t look too much at what drives these claims, right? We are paying them back. We think it is important to look at what is from a social perspective, especially in the current government focus. Therefore, the market will certainly see cancer diagnosis getting bigger and bigger, but especially in the breasts, colon, pancreas, lungs and younger ages, more aggressive stages. The diagnosis rate is higher for women associated with breasts and thyroid gland, especially younger women under the age of 50. This is actually related to genetics, but to environmental and lifestyle factors. Of course, better detect the risk of cancer in play, genetic factors, and your life factors. However, these trends do point out that environment and lifestyle are driving factors that contribute to these shocking trends. 90 to 95% of cancers are caused by what we consider like a modifiable factor that includes everything from tobacco use, alcohol intake, living a sedentary lifestyle, diet and obesity, with over 50% of our diet in the US being processed and 85% of what’s on the shelves having some questionable ingredients that could be contributing to chronic disease, inflammation in the body, our food supply, infected agents, and certainly Even the healthiest of pesticides sprayed with pesticides that are currently attracting attention in the United States. A study I have read shows that the global incidence of early cancers is expected to increase by 50% in the next few years. So we as people in a social and medical space should really get people’s attention and attention. Current trends affecting self-funded healthcare programs. Current trends in MP4 affect self-funded healthcare programs.
[00:07:12] Paul Lucas: Of course, QBE recently expanded its offerings to Taft-Hartley and multi-employer health plans. So, what makes this market unique? How does QBE meet the needs?
[00:07:22] Tara Krauss: certainly. We are excited to be in this space and offer this new product. We have a great team. Unions are indeed a unique position in the management of handling claims. Because of these two relationships, they are a very relationship-driven population and have strong consistency with their key components, namely those that leverage the program’s components. 95% of members of the union program have access to health care, compared with 65% in the general commercial market. These people are seven times more likely to seek regular health care through primary care. Apparently, seeking medical visits, you will get screening and prevention and will most likely make early detection in any of the things you do or guidance you may need to mitigate your lifelong risk. Trade unions also tend to implement better utilization management based on planned control. They implement things like reference-based pricing and centers of excellence to manage their costs. Their plan is very good. They have strong governance. In the speech of the stop loss insurance partner, we see higher rates of business, lower claims and loyal customer base. So once you have union clients, they tend to stay in touch with you for a long time. Current trends affecting self-funded healthcare programs. mp4
[00:08:34] Paul Lucas: Given the emphasis of the report, what advice will you give to your broker when helping clients plan their plans?
[00:08:40] Tara Krauss: From a stop loss perspective, I ask them to continue to share their knowledge with a wider client base to educate them about the lifestyle factors we are talking about because we tend to sit down. And I think this is something we all need to start to tend to really affect change. A reliable PBM management plan. It all starts with this, focusing wisely on transparent suppliers in the field. Some big players do lack transparency. So, focus on reducing waste, how to deal with kickbacks? The side of care control is in place. As for renewal of reinsurance, what education for employers is a leverage trend, and its importance, even with minor modifications, to the increase in employers, we call their specific deductions year-on-year, helping to alleviate their increase in renewals. Of course, working with a financially reasonable operator that does appear on the time of claiming, and in fact, losing long-term customers’ claim experience is only poor claim experience. Therefore, I think credibility, A rating, responsiveness and service leadership teams are crucial. Current trends affecting self-funded healthcare programs. mp4
[00:09:44] Paul Lucas: Yes, great advice. Obviously, there are many measurements from reports. If anyone wants to learn more, Tara, where can they find it?
[00:09:51] Tara Krauss: certainly. They can visit the QBE website QBE.com and search for the A&H page. We have a copy of the report there.
[00:09:58] Paul Lucas: Excellent. Once you’re over there, make sure you’re back to us, too. We will wait for the next time we meet you on insurance company TV. Current trends affecting self-funded healthcare programs. mp4
