President’s Column · By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation Pg. 7...

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(continued on page 2) Tom Mackell was redesignated as the Chairman of the Board of Directors of the Federal Reserve Bank of Richmond for 2008. In addition, he was elected to the Board of Directors of the Inter- American Dialogue, a think tank in Washington, DC that focuses on social, political and economic affairs in Latin America. President’s Column By Dr. Thomas J. Mackell, Jr., President, Association of Benefit Administrators, Inc. Pg. 4 Public Pension Funds and Divestment: The Controversy Continues, By Cheryl Hamer Mackell, Esq., Pomerantz, Haudek, Block, Grossman, Gross LLP Pg. 6 Do You Know Your Magic Number? By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation Pg. 7 The Issue of Health Care Fraud, By Jean Lyon, TC3 Health, Inc. Pg. 9 Disease Management Programs & Selection Considerations: Frequently Asked Questions, By Mike Colantuano, National Sales Manager, Focused Health Solutions www.assocbenadmin.com TRUSTEES’ RESPONSIBILITIES IN CHALLENGING TIMES The evolution of financial markets has witnessed creative innovation that has made fortunes and now on the flip side is wreaking havoc. In the fall of 2007, the McKinsey Global Institute released a study entitled: “The New Power Brokers Influencing Global Financial Markets: Oil, Asia, Hedge Funds and Private Equity.” These are the new global “masters of the universe.” They will dictate the way corporations behave in the global economy. We must recognize, however, that we truly are in uncharted waters that have left economists, analysts, investment wizards, governmental and business leaders scratching their heads. In this turbulent capital market environment, asset allocation for investors, individual or institutional, takes on a whole new coloration and the need for professional advice for individuals and the monitoring of managers by institutional investors mandates constant vigilance. I have never witnessed times as perplexing as these. Financial markets aside, skepticism about the American idea, the American Dream and America’s global stewardship has grown during the Bush years and the reasons vary: • the failures in Iraq • the abyss between U.S. principle and practice • the rise of other nations • the startling display of American international incoherence • the incompetence on varied domestic fronts • the economic vulnerability Americans have elected a band of incompetents to the highest office of the land and they tolerate corruption of state, county and municipal governmental leaders. The average American’s concern for sports, music, sex, and religion far outweigh even their concern for their kids and their kids’ future. The financial markets’ disarray will compound the perplexity of trustees at every turn. The asset C el e b r a t i n g 47 Y e a r s 1 9 6 1 - 2 0 0 8 VOLUME 13 / NUMBER 2 SPRING 2008 IN T HIS ISSUE . . .

Transcript of President’s Column · By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation Pg. 7...

Page 1: President’s Column · By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation Pg. 7 The Issue of Health Care Fraud, By Jean Lyon, TC3 Health, Inc. Pg. 9 Disease Management

(continued on page 2)

Tom Mackell was redesignated as the Chairman of the Board of Directors of the Federal Reserve Bank of Richmond for 2008. In addition, he was elected to the Board of Directors of the Inter-American Dialogue, a think tank in Washington, DC that focuses on social, political and economic affairs in Latin America.

President’s ColumnBy Dr. Thomas J. Mackell, Jr., President, Association of Benefit Administrators, Inc.

Pg. 4 Public Pension Funds and Divestment: The Controversy Continues, By Cheryl Hamer Mackell, Esq., Pomerantz, Haudek, Block, Grossman, Gross LLP

Pg. 6 Do You Know Your Magic Number? By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation

Pg. 7 The Issue of Health Care Fraud, By Jean Lyon, TC3 Health, Inc.

Pg. 9 Disease Management Programs & Selection Considerations: Frequently Asked Questions, By Mike Colantuano, National Sales Manager, Focused Health Solutions

www.assocbenadmin.com

TrusTees’ responsibiliTies in Challenging TimesThe evolution of financial markets has witnessed creative innovation that has made fortunes and now on the flip side is wreaking havoc. In the fall of 2007, the McKinsey Global Institute released a study entitled: “The New Power Brokers Influencing Global Financial Markets: Oil, Asia, Hedge Funds and Private Equity.” These are the new global “masters of the universe.” They will dictate the way corporations behave in the global economy.

We must recognize, however, that we truly are in uncharted waters that have left economists, analysts, investment wizards, governmental and business leaders scratching their heads.

In this turbulent capital market environment, asset allocation for investors, individual or institutional, takes on a whole new coloration and the need for professional advice for individuals and the monitoring of managers by institutional investors mandates constant vigilance.

I have never witnessed times as perplexing as these. Financial markets aside, skepticism about the American idea, the American Dream and America’s global stewardship has grown during the Bush years and the reasons vary:

• the failures in Iraq

• the abyss between U.S. principle and practice

• the rise of other nations

• the startling display of American international incoherence

• the incompetence on varied domestic fronts

• the economic vulnerability

Americans have elected a band of incompetents to the highest office of the land and they tolerate corruption of state, county and municipal governmental leaders. The average American’s concern for sports, music, sex, and religion far outweigh even their concern for their kids and their kids’ future.

The financial markets’ disarray will compound the perplexity of trustees at every turn. The asset

Celebrating 47 Years

1961-2008

Volume 13/Number 2 SPriNg 2008

In ThIs Issue . . .

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allocation decisions of the last few years have not necessarily averted significant losses throughout our markets and pension funds.

America is more indebted at the governmental, corporate and individual levels than ever before. Our country is more isolated and moving more into the notion of building barriers, as well as becoming more unequal. Our economy is weaker, our military is fractured and our people are rigidly divided.

Our markets are impacted daily by worldwide trends and events. There are lots of alarm flags that litter the globe initiating an extraordinary degree of uncertainty. No one has a crystal ball and therein lies the dilemma for investors.

There are, however, some certainties in an uncertain world. For example:

• The slowdown in the U.S. economy that is fast becoming a recession and some are referring to a more dramatic meltdown that smacks with the characteristics of the Great Depression.

• The Olympic games in Beijing — a guaranteed mega-event showcasing China as the new powerhouse of the 21st century.

• Popular concern about global warming that will not go away.

• The high prices of oil and gas, commodities and food are unlikely to abate if China and India maintain their rapid growth.

• The unpredictability of the Middle East.

• The race for the White House, compounded by the feebleness of George W. Bush’s administration as it limps to the end of its reign.

• The political risk map of the world is also littered with angry red alarm signs, with the greatest concentration in the Middle East, although Pakistan and Afghanistan require more urgent attention.

• The risk that looked most alarming — a U.S. assault on Iran — has slipped down the list for the moment.

• The lack of leadership on the world stage is glaring. Bush’s lame-duck presidency is only the most obvious example.

(continued on page 3)

aba officers & DirectorsThomas J. Mackell, Jr., Ed.D., President

(202) 297-1935 [email protected]

Gemma de Leon, Vice President Local 1102 RWDSU/UFCW

Executive Vice President (516) 683-1102

[email protected]

George L. Bueno, Treasurer OPEIU Local 153 Pension Fund, Director

(212) 741-8258 [email protected]

Bill Maye, Secretary IBT Local 282, Fund Manager

(516) 488-2822 [email protected]

Directors at largeCharles Hamilton, Funds Administrator

RWDSU/UFCW Local 338 Health & Welfare, Retirement & Dental and

Legal Services Funds (516) 294-1338

[email protected]

Dennis Horin (732) 506-6766

[email protected]

Peter Myers, Fund Administrator Iron Workers Local 580

(212) 695-5206 [email protected]

David B. Stewart, CEBS, Funds Director Empire State Carpenters Fringe Benefit Funds

(631) 952-9700, ext. 150 [email protected]

Past PresidentsIrving Baldinger

Murray Bergtraum Lloyd Jenkins David Sack

John Sokolowski Marvin Zalk

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SPriNg 2008 Page 3

• China and India still seem unready to take up a bigger role in global political leadership.

• Several of the African nation s’ leaders have left office, are about to, or are enfeebled. South Africa, Kenya and Nigeria are glaring examples.

• Europe is a crazy patch-work quilt with Nicholas Sarkozy seeking to overhaul the French bureaucracy-bound economy and rushing around the world selling nuclear technology and French initiative.

• Angela Merkel started dramatically playing a major role in salvaging the EU reform treaty and arm-wrestling the G8 into a minimal agreement to tackle global warming, but she then faced tough talks with Putin and offended the Chinese by granting an official audience to the Dalai Lama.

• Gordon Brown in the UK has yet to make a mark internationally and is distracted by criticism at home.

• The UK, Ireland and Spain’s residential markets have become the prey of the U.S.’s subprime mortgage debacle, but so far, Italy, France and Germany have escaped unscathed. However, wait until the revelations begin to unfold by the German banking institutions as to how much their portfolios are exposed to mortgage-backed securities.

• Energy security continues to be a critical issue for the EU, the U.S. and China and India will also be plagued by this for some time.

• Globalization and the fear of competition will become more acute and lead to the danger of protectionism that could be more pervasive and destructive than the fear of terrorism.

• The U. S. must devote a great deal more energy to our neighbors in Central and South America and re-engage their leaders in a dialogue that is healthy, productive and equal.

These geopolitical and economic realities will impact our markets and our portfolios in ways that we can only imagine today. The responsibilities of trustees and their professionals are profound and will require more attention and more education in order to protect and preserve other peoples’ money. Let’s hope that we are all up for the challenge.

Tom Mackell has written a book

entitled When The Good Pensions Go

Away: Why America Needs a ‘New Deal’

for Pension and Healthcare Reform. It was published by John Wiley & Sons

and is available NOW.

Advertising space is available in all issues of Insights.

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(continued on page 5)

2008 Schedule

of ABA eventS

luNCheoN meetiNgSThursday, June 5

Thursday, September 18 Thursday, November 6

Meeting Location: RWDSU Union Office

30 East 29th Street, 5th Floor New York, New York

All meetings start at 12:00 Noon

aNNual bruNChJames Duffy Memorial Brunch

Sunday, November 16 During the IFEBP Conference

in San Antonio, Texas

NiNth aNNual awarDS reCePtioN

Thursday, December 4 Honoring

James P. Hoffa General President

International Brotherhood of Teamsters

St. Regis Hotel New York, New York

publiC pension Funds and divesTmenT: The ConTroversy ConTinues

By Cheryl Hamer Mackell, Esq., Pomerantz, Haudek, Block, Grossman, Gross LLP

The Sudan Accountability and Divestment Act of 2007 was signed into law last December permitting state, local and municipal governments to adopt divestment measures aimed at certain companies that are the primary source of funding for Khartoum oil, mineral extraction, power production and military equipment. The Act affirms the right of employee benefit plans to divest holdings in companies active in those sectors of the Sudan. It also directs companies seeking federal government contracts to certify that they are not involved in the key business sectors of the Sudan.

Calls for country divestment are not new as the genocidal acts of the Sudanese army in the Darfur region of Sudan and allegations of state sponsored terrorism in Iran continue. They go back to the widespread divestment in America and elsewhere of South African companies in the struggle against Apartheid and beyond. Investments are potentially implicated in many issues involving serious moral and ethical questions, including a variety of human rights abuses throughout the world. Among those also include the Chinese occupation of Tibet and cases are being made for Nigeria and Myanmar, as well as investments that help to support certain policies and actions of the Israeli government with respect to Palestine.

Divestment is the sale of stock in companies most culpable of helping to fund human rights violations, such as genocide in Darfur and state sponsored terrorism. Divestment also includes a commitment not to buy stock in such companies until these acts cease. Boards of Trustees are forced to ask whether certain divestment policies conflict with

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IMPORTANT ANNOUNCEMENTTHE ABA IS PLEASED TO ANNOUNCE THAT CLASSIFIED

ADVERTISING SPECIFICALLY FOR EMPLOYMENT OPPORTUNITIES IS NOW AVAILABLE IN

ALL ISSUES OF INSIGHTS.

YOUR 31/2"w x 11/4"h AD WILL BE PROMINENTLY DISPLAYED IN A SPECIAL CLASSIFIED ADVERTISING COLUMN

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the fiduciary duties imposed on them by applicable law. It is generally considered that a board may adopt a divestment policy as long as the policy continues to provide that all divestment decisions are made subject to the board’s fiduciary duties. The board must consider both the well-being of fund assets and the preservation of fiduciary limitations imposed on a board for the protection of plan participants and beneficiaries.

The Save Darfur Coalition, for example, has urged state pension funds, universities, mutual funds, organizations, businesses, investment firms, and individual investors to divest. The Coalition has launched a campaign targeting companies such as Fidelity, Franklin Templeton, JP Morgan and Vanguard to divest in companies that activists say contribute to genocide in the Sudan.

USA*Engage is urging states to consider legislation that would require public pension fund managers to divest from businesses with operations abroad, in response to a proliferation of such measures at the state level and in light of the decision reached by the U.S. Supreme Court in the 2000 case of NFTC v. Crosby, which struck down a Massachusetts state law involving state sanctions against Burma.

Divesture triggers the delicate and complicated weighing of serious moral and ethical questions

against potential losses of fund assets. Trustees must consider their decisions carefully under the guidance and advice of their fiduciary counsel and counsel’s advice regarding the implications of the new law.

Branch Offices:Chicago, IL, Washington, DC,

San Francisco Bay Area, CA and Columbus, OH

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do you Know your magiC number?By Bonny L. Brill, Executive Director, The Evelyn Brust Foundation

A perfect storm is looming. More than 80 million baby boomers are set to retire, and an estimated one-third will retire on half of what we currently earn — or less. The latest forecast is that 75 percent of Americans born after 1945 will face financial hardship in retirement.1 It is troubling that most of us (1) have no clue about how much income we will need in retirement, and (2) know that our financial plans for retirement are inadequate. With Social Security and Medicare2 in peril and traditional pensions shifting to 401(k) plans — we are looking into the eye of a something profoundly catastrophic.

The 2007 Retirement Confidence Survey (RCS) conducted by the Employee Benefit Research Institute (EBRI) and Mathew Greenwald & Associates validated once more that millions are in denial about the retirement savings crisis. (Read the report again if you have not in awhile.3) More than half of American workers have not even taken the time to determine our Magic Number — the amount we need to save for retirement. That we are saving blindly simply defies logic.

How well are we preparing for retirement? Not well at all. Consider the facts: Half of us have less than $25,000 in investable assets and one-third of us are not saving at all. Yet almost half who fall into the “I don’t save” category still feel confident of having a comfortable retirement. This does not jibe with reality. Even a $50,000 nest egg, which for many is a lot of money, will only allow $3,505 a year to spend in retirement.4

Why are we not saving — in fact, why are we saving less than we did during the Great Depression? We can blame it on the younger generations’ penchant for debt and big mortgages or the sheer number of soon-to-be retirees, but the underlying culprit

is consumers’ lack of financial sophistication. We obviously cannot stop the aging of America, but through education, we can disrupt the perfect storm threatening the retirement future of many millions of us. The workplace is a great place to start, and benefits administrators can play a pivotal role in turning the tide for baby boomers and the generations that follow. We need ongoing opportunities for noncommercial investment education at our place of work.

Take, for example, the Florida Sixth Judicial Circuit. Managers recently organized a Take Control in-service day. Employees learned how to improve their health — both physical and financial. Similarly, the Southern Employee Benefits Conference held a one-day seminar for plan sponsors and fiduciaries. Attendees focused first on improving their own financial fitness, then moved on to topics that were more conventional. Both programs were easy to deliver and took relatively little time out of the 2,080-hour work year — a small price to pay for financial security.

The Evelyn Brust Financial Research and Education Foundation is raising awareness of the importance of saving for retirement. We partner with like-minded people and organizations — state securities regulators, American Library Association, AARP Foundation, Investor Protection Trust, and your peers — to empower individuals to take responsibility for their own financial wellness. Our legions of volunteer certified financial professionals deliver investment education the way people want to learn — completely free of commercial interests. Libraries, churches, community colleges, and employer in-service training sessions make ideal venues for Evelyn Brust Foundation programs such as Investor Education @ your library® and Take Control of Your Wealth®. Based on participant evaluations, we are making a difference — one classroom at a time.

(Endnotes)1 Retirement Weekly, www.marketwatch.com.2 EBRI has projected retirees will need $300,000 in additional

savings to cover out-of-pocket healthcare expenses.3 EBRI Issue Brief No. 304, April 2007, www.ebri.org.4 How long will my money last?, www.smartmoney.com.

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The issue oF healTh Care FraudBy Jean Lyon, TC3 Health, Inc.

The United States spends more than $2 trillion on health care every year. The National Health Care Anti-Fraud Association (NHCAA) estimates that at least $60 billion each year is lost to fraud. The federal and state governments believe the number is even higher. These statistics, which don’t even account for abuse, are indicative of an epidemic that directly impacts every stakeholder through higher health care costs, insurance premiums and taxes. Health care fraud also harms patients who may become victims of unnecessary or unsafe procedures, loss of benefits, medical record corruption and/or potential identity theft. The problem is so rampant and widespread that virtually no health care specialty is excluded or has a monopoly on submitting questionable claims. In recent years, organized crime has also been introduced into health care fraud, since it can be more lucrative than other major crimes and the likelihood of being caught is substantially less. Proceeds are often laundered and hidden through financial institutions or moved offshore. Even if the perpetrator is caught, severe sentences are rare, thus giving crime rings a significant incentive to commit fraud.

Most states have enacted legislation that requires private payers offering insured plans or contracted with government-sponsored programs to investigate, document, report and recover fraudulent claim payments. However, these mandates do not apply to every claim paying entity. Many organizations, particularly self-funded ERISA plans, have been slow to seek protection because they are not compelled by federal law to implement anti-fraud programs.

Health care fraud is an intentional deception or misrepresentation that a person or entity makes, knowing that the misrepresentation could result in a payment or benefit to which the person or entity is not entitled. Health care fraud is like a chameleon; it blends in with its surroundings, making it difficult to discover. The same types of schemes continue to be perpetrated over and over again by newcomers,

who employ increasingly stealthier and discreet techniques that take many forms. These include:

• Billing for services not rendered.

• Upcoding — billing for a more expensive service than was provided.

• Unbundling or fragmenting — billing for multiple components of a service that should have been included in a single fee.

• Billing for services that were not medically necessary to increase revenue.

• Billing for services by unlicensed or improperly licensed individuals.

• Misrepresenting uncovered cosmetic procedures as though they were covered (Rhinoplasty and Septoplasty).

• Recruiting patients for unnecessary or uncovered cosmetic procedures.

If detection and punitive sanctions were more robust and severe, these same schemes would soon become outdated. However, they continue to flourish. Fraudulent billers often study payers as targets much like a burglar cases a home or business before breaking in. Many submit claims under certain dollar thresholds to maintain a low profile, change their name, address and/or federal TIN, or modify their billing habits when payers become aware of the latest trend or strategy devised to game the system. An understanding of the issue and a commitment to an anti-fraud strategy is required to confront this menace. The following tools are needed:

• Analytical tools to detect fraud that would otherwise be untraceable.

• Edits that will stop and pend questionable claims, until they can be investigated and either paid or denied.

• Trained investigators who have the knowledge and expertise to recognize suspicious claims and providers, and can apply the appropriate techniques in order to investigate and resolve the matter.

• Clinical personnel who can review medical records and detect misrepresentation.

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David Ourlicht took on the position of Senior Vice President and Director of Sales, Marketing and Cl ient Serv ice wi th Amalgamated Bank of New York in April 2007. He was previously affiliated with another asset management firm.

Esquire Bank is proud to announce the addition of Jacob Ivry to their team as Senior Vice President of Client Relationship Management. He is a member of the Turnaround Management Association, Nassau Lawyer’s Association, Garden City Chamber of Commerce and is also proud to be involved in the non-profit organization Habitat for Humanity.

Should any Association of Benefit Administrators member be interested in announcing a career change in this column, please contact Jacquelyn Dragone at Perfect Forms and Systems, Inc. at (631) 382-4968.

• When pre-payment avoidance is not an option, a robust recovery program is necessary to identify and seek reimbursement for overpayments

Fortunately, the market is responding with increasingly more advanced solutions to enable payers to detect fraud and abuse. Sophisticated software can be purchased and deployed internally or outside specialty vendors can be hired to review and investigate suspect claims. The decision to internalize or outsource is typically based on the payer’s size, capabilities and resources. These new technologies will not only help detect fraud and abuse, but will assist in the recovery of lost funds. Payer organizations should take advantage of these new solutions to help build the business case for implementing an automated fraud and abuse detection offering to minimize losses and reduce healthcare costs.

on the worldwide web at: assocbenadmin.comClick on the “News-Alert Signup” link to add your name to our e-mail list.

ABA WEBSITE

Dear Tom,

I recently finished reading your comments in ABA Insights Fall 2007 issue and as usual you always hit the nail on the head. We have a leadership crisis that is beyond belief in our country and I see no definitive action to reverse course. Bush has been a disaster and our prospects for President offer little hope in moving us in the right direction. We are faced with a choice of the lesser of the evils as our new leader.

Tom, I am personally convinced that these problems will not be corrected until the office of President is not for sale. Having been involved for many years as Chairman of Legislative Committee for N.C.’s 700 car dealers, I can assure you that our leaders’ primary focus is raising the money for the next election. They want to avoid any long-term issues that could stand in the way of their election. I see little hope for the right change.

We both feel like the lone voice in the wilderness but maybe someday the light will hit before another disaster strikes.

Jim R. Lowry North State Communications

to the editor

Please visit

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(continued on page 10)

disease managemenT programs & seleCTion ConsideraTions: FrequenTly

asKed quesTionsBy Mike Colantuano, National Sales Manager, Focused Health Solutions

1.) Is there really a need for disease management?

Interesting yet frightening facts:

• A Rand study revealed that most patients living with chronic conditions receive substantially less care than recommended and typically those patients are not in compliance with their Rx Treatment Plans. (Rand study: Low back pain — 31.5% less care received than recommended, Coronary Artery Disease — 32% less care, Hypertension, Asthma — 46.5 % less care, Diabetes mellitus — 54.5% less care)

• Diabetes is increasing at epidemic rates and persons with Diabetes are at risk for: Amputations, Blindness, ESRD (End Stage Renal Disease) and Coronary Artery Disease. Complicating risks can be reduced by up to 50% yet 30% of people either doesn’t know they have Diabetes or they may be aware but they don’t manage their condition correctly. (Hypertension and High Cholesterol display similar findings about: risk, lack of awareness and non-compliance.)

• Approximately 100,000 people die every year in hospitals due to preventable medical errors

• Approximately 1,500,000 people are injured annually resulting from Rx errors

• 80-90% of healthcare costs come from 10-20% of people. Studies show as much as 50% of costs is preventable. Often these avoidable costs are attributable to: 1.) choices we make, 2.) our lack of awareness about the existence of problems, and 3.) a failure to comply with recommended medical treatment plans. Bottom line is that by successfully

working with a small percentage of members you can significantly impact costs.

How does the Fund and the member really benefit?

Preservation of money and benefits: Studies show medical costs and utilization reductions when an effective Disease Management program is deployed. ER Visits, Inpatient Visits, Hospital Days and Outpatient Visits all decrease resulting in positive ROI. Other areas favorably impacted include: time on the job, productivity, short and long term disability and workers compensation.

Additionally members gain a benefit and an advocate. Improved health and reduced out-of-pocket costs result in member participation, acceptance, satisfaction, improved quality of life, reduced stress within the family and general goodwill.

What should I look for in a vendor (partner)?

• Disease Management Commitment: Core Business or “bolt-on” program?

• Demonstrate Flexibility

• Willingness to customize programs and enrollment strategies

• Contractual flexibility: Terms, Conditions, Service Level Agreements, Length, At Risk Fee’s etc.

• High Touch & High Access Model in addition to standard Wellness offerings

• Analytics and Drill Down Reporting Capabilities

• Size of Vendor: Will You Matter?

• Member Centric/Member Advocacy Culture

• Conflicts of interest with pricing models and/or provider contracts

• Beware of hidden program costs

What should be included in my contract and service level agreements?

• Fee’s At Risk

• Details of all aspects of programs and program components

• ACTIVE PARTICIPATION DETAILS

• Member disenrollment or “churn”

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• Analytics and Reporting by type and frequency

• ROI/Savings/Trends

• Metrics/Measurement Methodologies Clearly Defined

• Utilization (Inpatient/Outpatient, ER, Hospital Days)

• Work Days Missed

• Clinical Indicator Improvement

• Reduced Severity Levels

• Member Satisfaction Results

• Enrollment Activities (Letters, Calls, On-site activities, Financial Incentives & Administration)

• Call Frequencies and Levels

• Member Support Materials: Kits, Telemed Devices, Educational materials, WEB Portal, HRA’s

• Targeting and Selection Criteria and Data Sources

• Use of Incentives

• PEPM vs. PMPM vs. Case Rate and/or Threshold Combination Pricing

Can programs be un-bundled?

Yes, to a great extent you should be able to pick and choose program offerings. An example might be a program that offers Diabetes and CAD disease management services but does not include Asthma or Back and Neck or other Disease Management offerings. New programs can always be added.

What should my Fund expect to see in terms of Return On Investment (ROI)?

ROI is impacted greatly by many variables including but not limited to the items noted in the previous two responses. Typically there is marginal ROI in year one with years two and three showing significant ROI increases. ROI forecasts without both data and program design information should be viewed with skepticism.

Final Thoughts: The reality is that a rapidly growing number of organizations countrywide are expressing disappointment and skepticism with the inconsistent and/or marginal results of previously deployed Disease/Condit ion Management

Programs. The “one-stop shop” approach and “low touch” approaches have in large part fallen well short of expectations. The good news is that many lessons have been learned that you can benefit greatly from. Organizations seeking to either implement Disease Management and/or Wellness programs for the first time or looking to replace existing programs may wish to consider some or all of this information as you perform your due diligence process.

The bottom line is most experts agree that there are many positive results that will come from having a well designed and deployed Disease Management offering. The key is selecting a partner that is committed to you, has a track record of success, can support your analytical needs and realizes this is YOUR program!“……wouldn’t you want someone on your side, looking out for your health and your best interests and your getting better?”

Ellis Boughton Union Leader and Retired Past President (15 years)

Mutual Benefits Association IBEW

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Attention All members!!!

EACH ISSUE OF INSIGHTS FEATURES A COLUMN DUBBED

“SPOTLIGHT”THIS COLUMN IS OPEN TO

ALL REGULAR AND ASSOCIATE MEMBERS OF THE ABA.

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CAREER IN THEIR RESPECTIVE FIELD AS EITHER A FUND ADMINISTRATOR

OR SERVICE PROVIDER.INTERESTED MEMBERS

SHOULD CONTACT TOM MACKELL AT (202) 297-1935.

Save the date!The Executive Board of the

ABA is proud to announce that

JameS P. hoFFa GENERAL PRESIDENT

INTERNATIONAL BROTHERHOOD OF TEAMSTERS

will be our distinguished honoree at the

NINTH ANNUAL AWARDS RECEPTION

taking place on Thursday, December 4, 2008from 6:00 to 9:00 pm at the

St. Regis Hotel, New York, NY

SpotlighthowarD SaVliCkFund administrator, amalgamated lithographers of america, local one gCiu/ibt trust Funds and Fund Director of local one Photoengravers Pension and welfare FundsHoward Savlick has served as Fund Administrator for ALA Local One since January 1997. Local One represents the printing industry in the New York Metro area as well

as Connecticut and Vermont. Mr. Savlick has been actively involved in the labor movement since 1976, having served several trade unions as fund administrator, labor negotiator, auditor and partner in a TPA firm which had labor and all its interests as its client base.

During his involvement in Fund Administration for over 30 years, he has witnessed the fund office workload evolve from a manual operation

to a highly advanced technical mode. Mr. Savlick states “it has been interesting watching how the enactment of ERISA has changed the scope of operations of the fund office and in conjunction with the advancement made in technology, the fund office of the future will be even more interesting and challenging”.

Married with two children, and recently a grandparent, he grew up and still resides on Long Island, where for the past 25 years he has served as an officer in Little League and Director of Operations for PAL Basketball. Golf is a passion whenever possible, and Sunday morning fast pitch softball will continue as long as there is a game to be played.

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Page 12 SPriNg 2008

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SPriNg 2008 Page 13

Photos pictured on pages 13 through 15 were taken at the AbA eighth Annual Awards reception on november 29, 2007, honoring John Connolly, executive Director of Actors’ equity Association.

Tommy Mackell III (Senior Vice President, Institutional Sales, BNY ConvergEx Group ; Jim Manley (Managing Director, Jim Manley Associates) and Tom Mackell, Jr. (ABA President)

Honoree John Connolly (Executive Director, Actors’ Equity Association) and Rod Diamond (Secretary-Treasurer, UFCW Local 770)

George Bueno (ABA Treasurer; Director, OPEIU Local 153 Pension Fund); Perry Ciccotelli (Marketing Representative, Total Claims Review & Management, Inc.) and Jackie Dragone (Director of Business Development, Perfect Forms and Systems, Inc.)

Erin Towers (Account Executive, Vision Service Plan); Joseph Messana (President, Perfect Forms and Systems, Inc.) and Jacqueline Gada (Senior Account Executive, Vision Service Plan)

Phyllis Miranti (Marketing Director, D.D. Services, Inc.) and Greg Auteri (CPA/Partner, Buchbinder, Tunick & Company, LLP)

Honoree John Connolly, Executive Director, Actors’ Equity Association, addresses the group.

Mary Boarman (wife of Bill Boarman, President, Printing, Publishing & Media Workers Sector — CWA)

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Page 1� SPriNg 2008

Proudly celebrating the outcome of the TPU Local One Stagehands recent Broadway strike: Toby McDonough (Treasurer, TPU Local One); Ed McMahon (Business Manager, TPU Local One); Mark Zimmerman (President, Actors’ Equity Association); Jim Claffey (President, TPU Local One); Honoree John Connolly (Executive Director, Actors’ Equity Association); Robert Score (Recording-Corresponding Secretary, TPU Local One) and Tom Mackell, Jr. (ABA President)

Honoree John Connolly, Executive Director, Actors’ Equity Association

Ed McMahon (Business Manager, TPU Local One); Jim Claffey (President, TPU Local One) and Toby McDonough (Treasurer, TPU Local One)

Honoree John Connolly (Executive Director, Actors’ Equity Association) accepts his award from Tom Mackell, Jr. (ABA President)

Jim Claffey (President, TPU Local One) and George Bueno (ABA Treasurer; Director, OPEIU Local 153 Pension Fund)

Joseph Messana (President, Perfect Forms and Systems, Inc.) and Anne Maloney (President, Sele-Dent, Inc.)

Bronni Stein (wife of Honoree John Connolly)

Gemma de Leon (ABA Vice President; RWDSU/UFCW Local 1102 Executive Vice President)

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SPriNg 2008 Page 1�

Roberta Reardon (President, AFTRA New York) and Lainie Cooke (AFTRA New York Local Vice President/AFTRA National Vice President)

Bob Lichterman (President, Syntonic Systems, Inc.) and Anne Maloney (President, Sele-Dent, Inc.)

John Corr (Partner & Director of Taft-Hartley Sales and Client Service, Lord, Abbett & Co.) and Maureen Kilkelly (Executive Director, American Federation of Musicians & Employers’ Pension Fund)

Bob Samuel (Director of Taft-Hartley Marketing, American Realty Advisors); Cheryl Hamer Mackell (Esq., Pomerantz, Haudek, Block Grossman, Gross LLP) and Christina (Mackell) Lynch Burgdorf

Tom Mackell, Jr. (ABA President); Cheryl Hamer Mackell (Esq., Pomerantz, Haudek, Block Grossman, Gross LLP) and Tom Acosta (Independent Advisor to Atalanta Sosnoff Capital)

John DeMartino (Secretary-Treasurer, RWDSU/UFCW Local 338); Jack Caffey Jr. (Director ATC, RWDSU/UFCW Local 338) and Nelson Resto (Organizer, RWDSU/UFCW Local 338)

Tom Mackell, Jr. (ABA President) and Cheryl Hamer Mackell (Esq., Pomerantz, Haudek, Block Grossman, Gross LLP)

Gary Gallelli (retired) and David Stewart (ABA Director; Fund Manager, Empire State Carpenters Fringe Benefit Funds)

Bill Maye (ABA Secretary; Fund Manager, Teamsters Local 282) and James Mazzarella (Fund Manager, Local 342 Insurance Trust)

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Page 1� SPriNg 2008

Printed by Perfect Forms and Systems, Inc. (631) 382-4968

The Newsletter of the Association of Benefit Administrators, Inc. OPEIU Local 153 Pension Fund 265 West 14th Street, 6th Floor New York, New York 10011

PRESORTED STANDARD

U.S. POSTAGE PAID HUNTINGTON, NY

PERMIT NO. 14

WelCome neW members!!!Stuart Caine Express Scripts

One Express Way St. Louis, MO 63121

Stan Clymer Express Scripts

400 Gunston Halll Circle Alpharetta, GA 30004

raymond edmondSon FPPTA-Florida Public

Pension Trustees Assoc. 2946 Wellington Circle E

Suite A Tallahassee, FL 32309

John Felder Comprehensive

Professional Systems, Inc. 11 Hanover Square

8th Floor New York, NY 10005

loiS FuSCo Sheet Metal Workers

International Association Local 137

21-42 44th Drive Long Island City, NY 11101

miChael GalliGan KMR Systems Corporations 6800 Jericho Turnpike 207E

Syosset, NY 11791

hank kim NCPERS

444 N. Capitol St, NW Suite 221

Washington, DC 20001

Paul koSara MAP Management, LLC

11 Racquet Road, Suite 2 Newburgh, NY 12550

linda loCkwood US Bank

One US Bank Plaza St. Louis, MO 63101

Pat mcelliGott NCPERS

444 N. Capitol Street NW, Suite 221

Washington, DC 20001

leonard neuhauS Assoc. Third Party Admin.

575 Madison Avenue 10th Floor, Suite 35 New York, NY 10022

robert PodGorny NCPERS

444 N. Capitol Street NW, Suite 221

Washington, DC 20001

thomaS ryan Local 74 SEIU

2409 38th Avenue Long Island City, NY 11101

JoShua Sanilow Taft Hartley Sales

Wachovia Bank, NA 1525 WT Harris Blvd. Charlotte, NC 28262

thomaS SCotto Thomas Scotto Consultants LLC

203 Giffords Lane Staten Island, NY 10308

riChard Stierwalt Assoc. Third Party Admin.

1640 South Loop Road Alameda, CA 94502

miGo terJanian Credit Suisse

Eleven Madison Avenue 24th Floor

New York, NY 10010

riCk VolP Atlantic Asset Mgmt.

Clearwater House 2187 Atlantic Street Stamford,CT 06902

PhiliP weyhe Private Investment

Management Lehman Brothers, Inc.

399 Park Avenue New York, NY 10022

douG yanow Inter-Tel Technologies, Inc. 450 7th Avenue, Suite 502

New York, NY 10123