Starmark Strategy Refresh

Transcription

1 Starmark Strategy Refresh

2 50,000 Foot Perspective on Starmark Starmark s *e to Trustmark s mission Saving small employers and their employees money relates directly to the financial security aspect of our mission Starmark s product features include many things that can lead to be<er care, be<er outcomes, and ul*mately be<er health The objec*ve for Starmark is to maximize margin (surplus) The Starmark strategy has been consistent, therefore Brainshark vs. breakout at Summit

3 Starmark PESTELS Managed Care arrangements Public and Private Exchanges Compe*tor Landscape Distribu*on Stop Loss Legisla*on

4 Starmark PESTELS Managed Care arrangements Compe*tors may move to an ACO *ghtly managed, deeply discounted or pay-forperformance network arrangement, making our fee-for-service model look outdated and uncompe**ve Reference-based pricing (RBP) is fairly common in the large group, self-funded market now poten*ally full network replacement

5 Starmark PESTELS Public and Private Exchanges Public li<le trac*on Private more buzz, e.g. Fidelity is aiming the exchange, called Fidelity Health Marketplace, at the fastest-growing segment of the market small and midsize firms Generally, watching the move to defined contribu7on arrangements through an exchange. This would enable employees to choose from any exchange plan offered and purchase that plan using their employer s contribu*on. Not seeing it much yet.

6 Starmark PESTELS Compe*tor Landscape Primary compe*tors have been: Allied Na*onal Assurant (Na*onal General) United HealthCare Cigna Newer entrants in the small to mid-sized employer stop-loss insurance market include: Aetna Anthem BC/BS BC/BS of MI BC/BS of IL BC/BS of TX Guardian Humana Medical Mutual of Ohio Priority Health BC/BS of NE

7 Starmark PESTELS Distribu*on SL recep*vity con*nues to grow Fewer smaller agencies more consolida*on SL Legisla*on Rela*vely quiet lately NM is latest one to watch / lobby

8 Porter s Five Forces Porter s 5 forces involves assessing the level of threats (low, medium or high) to the ahrac7veness of a business opportunity. Threat of New Entrants Supplier Power Degree of Rivalry Buyer Power Threat of Subs7tutes

9 Porter s 5 Forces Threat of New Entrants Brand not too important High Industry Reg., can be onerous Med Capital Req., significant Low Access to Dist., training tough Med Item characteris7c : impact on force Supplier Power Labor - Low A & C Networks Med Other Networks Low PBM Low ACOs Low Degree of Rivalry # of Rivals, more High Product/Price Diff Med SL market growth High Switching costs, low High Buyer Power # of buyers huge # Low Switching costs, low High Available subs*tutes High Threat of Subs7tutes Available subs*tutes High Switching costs, low High Inclina*on of buyer to shop High

10 Our Current Market Porter s Let s just get to the main points Large universe of smaller groups willing to explore any op*on that could lower their costs Buyer power not significant enough that we have to provide true customized solu*ons Degree of Rivalry increased to High due to increased compe**on in the SL marketplace however their entrance has validated our approach and increased acceptance with agents and employers The more an employer fits our profile (smaller and be<er risk), the lower the degree of rivalry and buyer power.

11 Broker Value Curve All Attributes, SF Plans Only CIGNA SF Assurant SF Starmark SF UHC SF

12 Starmark Current Strategy Arenas Staging & Pacing Economic Logic Vehicles Differentiators

13 Arenas Staging & Pacing Arenas Economic Logic Customers: Employers; including mul*-loca*on Small market: target lives 100+ life employers willing to be medically underwri<en Products: Self-funded medical (level-funded) with stop loss requiring individual underwri*ng Ancillary Differen*ators Where: States without legisla*ve barriers

14 Arenas Where we aren t Employers who aren t agreeable to individual underwri*ng Mid-size and large employers Self-funding without stop-loss Stop loss without administra*ve services

15 Vehicles Staging & Pacing Arenas Economi c Logic Differen*ators Distribu*on: Brokers via MBS and/or MGA rela*onships Products/Services: Core insurance products developed and built in-house Some ancillary services are borrowed: YourCare, CareChampion HCM services Key suppliers: Aetna & CIGNA networks CVS/Caremark PBM TelaDoc

16 Differentiators Staging & Pacing Arenas Economic Logic Differen*ators General Differen*ators: Trustmark integrity Medical plan choices Broker support and service Customer service Broker compensa*on Surplus op*ons Network op*ons Telephonic/online enrollment op*ons Addi*onal differen*ators against fully insured compe*tors: Ability to individually underwrite, resul*ng in pricing to the group s risk profile

17 Differentiators Categories of compe7tors: Fully insured: Carriers following the ra*ng requirements of ACA Self funded with stop loss: Large carriers (Aetna, CIGNA, UHC, BC/BS/Anthem) Now established in the small self-funded space TPAs with a stop loss carrier (Allied Na*onal) Marke*ng self-funded products for smaller groups Insurance carriers similar to Trustmark (Na*onal General) Compe*ng in our same space

18 Economic Logic Staging & Pacing Arenas Economic Logic Differen*ators Iden*fying the right employers: Self-funding viewed as a favorable op*on Individual UW and appropriately pricing the plan for the group s risk profile Divisional Capabili*es: Risk selec*on, risk management Cost containment & management Efficient & streamlined opera*ons Maintaining scale to leverage efficiencies

19 Staging and Pacing 2016: Return to targeted margins Staging & Pacing Arenas Economic Logic 2016: Claim cost controls (e.g. Grand Rounds) 2017: Take advantage of grandmother plan phased out 2017: HFit wellness offering, Ref based pricing op*on Differen*ators 2018:??? Administra*ve plaqorm / mainframe

20 2016 Strategic Initiatives Return Starmark to desired margins through pricing, benefit design changes and claim cost controls American Health Holdings, Inc. (AHH) Oncology Care Integra*on (OCI) oncology management for outpa*ent radia*on/chemotherapy Medical necessity reviews for all outpa*ent radia*on and chemotherapy treatments using na*onally recognized, evidence-based clinical criteria Clinical, financial and emo*onal support for members/ families and care coordina*on to reduce gaps in care Collabora*on with providers to improve treatment, coordinate care and manage side effects and reduce inappropriate u*liza*on and billing errors

21 2016 Strategic Initiatives Grand Rounds: remote expert second opinions and care coordina*on Medical guidance available 24/7 by phone, online or mobile U*lizers of Grand Rounds: 66% change in diagnosis or treatment, 20-25% fewer complica*ons, 30-40% lower mortality Partnering with HFIT to offer wellness program Would include package with new plaqorm, health assessments, heath advising, telephonic coaching, and challenges

22 The End