TORCH Insurance Program Celebrates 15th Anniversary
It’s crystal, clear together we’re making rural stronger
by Brant Couch
15 years ago, HealthSure earned the opportunity to manage the TORCH Insurance Program.
As we begin a year of celebrating our crystal anniversary as program manager, I am humbled by looking back and acknowledging what a great privilege it has been to serve the rural and community hospital leaders of Texas.
But, while looking back, I am also looking ahead. Even though HealthSure has been the steward of a program that has achieved 15 years of growing success, we have only just begun. Opportunities abound thanks to the progress the program is making, the collaboration it inspires and nurtures, and the innovation and ever-increasing value it is creating for TORCH members.
My positive outlook is more than mere optimism. It is a belief deeply rooted in the powerful purpose shared by the TORCH management team, all TORCH members, and HealthSure’s leadership. Collectively we believe rural Texans deserve access to the best healthcare possible and together we are doing everything we can to make it so.
The past empowers the future
Looking back and looking ahead at the same time gives me the opportunity to acknowledge a few of the program’s most significant achievements and predict what lies ahead.
For example, as the amount of participation in the program continues to grow, its financial contribution to TORCH has become increasingly substantial. This contribution offsets growing expenses such as lobbying and helps the organization keep annual dues as low as possible.
The program’s financial contribution doesn’t end with the revenue it generates for TORCH. Through innovative solutions like our creative direct contracting strategies, CHIC (Community Health Insurance Coalition), and eMCA (Equipment Maintenance Contract Alternatives), the insurance program continues to go far beyond insurance to make a substantial and growing positive contribution to the balance sheets of participating hospitals.
Managed Care Contracting solutions for today and tomorrow
To be successful, managed care contracting requires clear, consistent, comprehensive, and concise contracts. It also can counterbalance the shortfalls currently caused by Medicare Advantage plans that do not reimburse nearly enough to cover the cost of care delivered.
Most times, rural and community hospitals struggle to win the manage care contracting game because they:
- Have no in-house expertise
- Lack time and resources for effective management
- Often do not know what they have
- Disorganized contract documentation
- Lack of clarity and transparency
- An inability to develop and leverage an effective contract modeling and payment integrity system
- Access to best practices and regional minimum reimbursement levels
- Coordinated group arrangements or contract parameters for individual arrangements using defined standards
- Opportunities to participate in VBC (Value-Based Contract) arrangements
- Contract review to spot potential renegotiations
- Review alignment of expected payments with allowed amounts
- Contract renegotiation
- New contract negotiation
- Outreach to plan contacts
- Communication coordination with hospital employees
- Assistance with payer-related bad debt and denials
- Evaluation of VBC opportunities from payers, either directly with payers or through provider systems Accountable Care Organization
- Reduction in patient bad debt
- Increased utilization and revenue thanks to employer benefit program design and communication that steers patients to the hospital
- Protection of current utilization, market share, and revenue by being proactive before other area hospitals implement it first
- Deeper relationships with local employers building stronger community support
- Reduced administrative denials, and payment delays
- Plan savings for the local employer and enhanced revenue for the local provider. (Both benefit instead of a national carrier keeping the margin.)
- Lower out-of-pocket expenses for employees
- Greater cost control
- Improved care for employees with complex healthcare needs
- Improved employee morale and health-related behavior
- Bonus: Reduction in instances of bad debt for a tertiary hospital
- Fixed cost means no more budget surprises
- A single contract reduces administrative burden
- You get to keep your current vendors
- You can save even more on parts and service
- Plus, you receive reimbursements for in-house repairs
- Improve employee satisfaction and engagement
- Negotiate and maintain stronger, more beneficial contracts
- Create new sources of revenue
- Gain greater technology ROI
- Implement creative cost control strategies
- Rex Jones, CEO Arkansas Rural Health Partnership
- Rebecca McCain, CEO Electra Hospital District
- John Henderson, CEO TORCH
- Brant Couch, CEO HealthSure the TORCH Insurance Program Manager
- Primary care doctors who can suggest further mental health resources
- Work-based wellness and employee assistance programs
- The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline, which is free, confidential, and available 24/7 by calling 800-662-HELP (800-662-4357)
- SAMHSA’s 988 Suicide & Crisis Lifeline, a three-digit dialing code offering free, confidential, and 24/7 call, text, and chat options with trained crisis counselors
This leads to significant challenges including:
Thanks to services available through the TORCH Insurance Program, a growing number of hospitals are realizing the benefits of managed care contracting, not least of which is finding new and hidden revenue sources. They are also reducing bad debt related to administrative denials and/or payment issues.
Additional benefits include:
Similar to what we do with contracting directly with employers and tertiary hospitals, the TORCH Insurance Program provides:
Direct Contracting: It’s not what you think it is
Leveraging the collective experience of TORCH Insurance Program participants, and with a little outside expert assistance, a growing number of member hospitals are finding new ways to protect and grow their hospitals.
For example, by contracting directly with regional employers, more of the money spent on healthcare stays in the community with significant benefits going to the hospital, businesses, and the people. These benefits include:
Program participants are also creating win/win outcomes for their hospitals and employees by contracting directly with tertiary hospitals. The benefits of these contracts are many, some of which are:
For both types of direct contracting, the TORCH Insurance Program provides guidance, proactive support, and direct involvement in identifying opportunities, communication with employers and tertiary hospitals, contract negotiation, TPA management, and ongoing contract management and updating.
The CHIC that’s laying golden eggs
Thanks to CHIC, a medical stop-loss reinsurance company, a growing number of hospitals are paying less for their insurance. They are also improving benefits program performance and receiving their share of a significant annual surplus cash distribution. This year, CHIC is on track to hit over $3 million in cumulative distributions to its owners.
Every year since its inception in 2018, CHIC owners have received their share of a cash distribution. When we designed CHIC, we knew it could empower rural hospitals to take back ownership of their insurance… and it is doing just that.
CHIC is designed exclusively for rural and community hospitals already self-funding their employee health benefit programs. It provides protection against large, unexpected claims that self-funding is unable to cover. Instead of going it alone and individually paying a large carrier for stop-loss insurance, CHIC participants pool their risk in an insurance company of their own.
eMCA creates yearly budget bonuses
eMCA (Equipment Maintenance Contract Alternatives) reduces the cost of contracts by 15 to 22% every year. The program is super simple to get into and delivers benefits including:
We start simply by reviewing your existing maintenance contracts to immediately show you how much your annual maintenance and service budget will be reduced.
Where to from here?
If there is one thing that will ensure your insurance program continues to deliver exceptional results like the ones I’ve described, it is the driving principle behind everything we do: Never Go It Alone.
By looking ahead together, collaborating intentionally and effectively, leveraging our collective buying power, and sharing our wisdom, we will continue to create new opportunities. For certain, the family of TORCH hospitals will continue to do everything possible to ensure rural Texans have access to the best healthcare possible.
We look forward to celebrating this anniversary with you.
“Never Go It Alone” is more than a slogan; it’s what the most successful rural hospitals take to heart when strategizing how to best serve their communities.
Join a panel of innovative rural hospital leaders to learn how they’ve tapped into the power of collaboration to leverage programs that are new and some that have been in existence for 15 years. Launched by TORCH, and available to all members, these programs are a springboard for sharing creative ideas and tactics that are empowering long-term success.
Audience members will be encouraged to interact with the panel and more fully explore how to leverage a variety of TORCH programs and be better able to:
The COVID-19 pandemic worsened underlying mental health issues for many Americans. However, mental health care and treatment barriers have existed for some time. One of the most significant barriers is the lack of mental health professionals. Experts predict that within the next year, the United States will be short between 14,280 and 31,109 mental health professionals.
The latest Health Resources and Services Administration data estimates that 122 million Americans (37% of the population) live in areas with a mental health professional shortage. It would take an additional 6,398 mental health providers to
fill those gaps. Mental health shortages range in severity across the nation but are most commonly found in rural areas.
Although many Americans are currently dealing with strained healthcare resources, there are still some ways to receive mental health support. Telehealth is a great place to start receiving virtual mental health care, especially if you live in a rural area. Additional support resources include:
Remember to check in with yourself and reach out for help if needed.
During its 2022-2023 term, the U.S. Supreme Court will hear and decide several cases that could have a significant influence on the workplace. Even though labor and employment laws and regulations change every year, the current Supreme Court term will likely have a greater impact on employers than previous terms. It can be difficult for employers to stay informed of these cases and their potential impacts on the workplace; however, it’s vital that employers are aware of them and understand how their organizations may be affected.
This article highlights the topics in Supreme Court cases that may impact workplaces in 2023 to help employers prepare for potential changes and navigate the evolving labor and employment law landscape.
On Feb. 22, 2023, the Supreme Court held in Helix Energy Solutions Group Inc. v. Hewitt that employees must be compensated on a salary basis to qualify for the highly compensated employee overtime exemption under the Fair Labor Standards Act (FLSA). The case involved an oil rig worker who earned more than $200,000 per year and was paid daily rather than on a salaried basis. The employer claimed that the employee was exempt from overtime under the FLSA’s white collar exemptions that apply to highly compensated employees. The Supreme Court disagreed, ruling that the FLSA plainly requires highly compensated employees to receive a salary; this requirement is not met when an employer pays an employee by the day.
It’s unlikely that many employers will have to change their payroll policies and procedures for highly compensated employees in response to the ruling in this case. However, this decision is a clear signal that courts may require strict compliance with FLSA overtime exemptions. As a result, employers should review their exempt employee classification process to ensure they meet duty qualifications and salary requirements.
Two cases in this term could affect religious accommodations in the workplace. The first is 303 Creative LLC v. Elenis, which was heard on Dec. 5, 2022. This case challenges the public accommodation provision of Colorado’s Anti-discrimination Act, which prohibits places of public accommodation, such as businesses, from denying services to individuals based on a protected characteristic (e.g., sexual orientation). In this case, the owner of a graphic design company wants to design wedding websites; however, she is opposed to same-sex marriage on religious grounds. The owner wants to deny services to LGBTQ customers and announce her intentions to do so on the company’s website. The question raised in this case is whether a state can prohibit a business from denying services to customers on the basis of a protected characteristic when the denial is based on a religious belief. While this case does not directly affect employers, the Supreme Court’s ruling could have employment-related ramifications regarding anti-discrimination policies and religious exemptions in employment.
The second case is Groff v. DeJoy. This lawsuit was brought by a U.S. Postal Service mail carrier after being disciplined for refusing to work on Sundays due to religious reasons. The Postal Service argued that accommodating the employee would create an undue hardship on the organization and burden other employees by requiring them to work more weekends. Title VII of the Civil Rights Act (Title VII) requires covered employers to reasonably accommodate employees’ sincerely held religious beliefs, including when an employee’s religious observance conflicts with work requirements, unless doing so would create an undue hardship on the employer. There is no statutory definition of “undue hardship” under Title VII; however, the Supreme Court held in Trans World Airlines Inc. v. Hardison that requiring an employer to bear more than a “de minimis cost” is considered an undue hardship when accommodating an employee’s religious beliefs.
The Supreme Court’s ruling in Groff could significantly limit an employer’s ability to deny employee requests for religious accommodations even if those requests burden the employer. Additionally, during the COVID-19 pandemic, many employers saw an increase in employee requests for religious accommodations, such as being excused from vaccine mandates. A Supreme Court ruling expanding religious accommodations for employees that applies retroactively could create significant operational challenges for employers. Oral arguments on this case are scheduled for April 18, 2023.
On Oct. 13, 2022, the Supreme Court heard oral arguments on two cases brought by the activist group Students for Fair Admissions addressing affirmative action in university admissions. These cases will likely be the most consequential cases the Supreme Court will decide this term in terms of altering existing legal precedent.
In Students for Fair Admission Inc. v. President & Fellows of Harvard College and Students for Fair Admissions Inc. v. University of North Carolina, the Supreme Court will review the legality of considering race in university admissions for private and public institutions. In doing so, the court will reconsider its 2003 decision of Grutter v. Bollinger, which allows universities to consider race—among other factors—in university admissions because diversity in education is a legitimate aim. Students for Fair Admissions is asking the Supreme Court to overrule this existing legal precedent, claiming it discriminates against Asians and whites based on their race.
While the Supreme Court’s ruling in these cases will likely not directly affect employers, it could impact workplace diversity, equity, inclusion and belonging initiatives, including the ways organizations promote and implement them in the future as well as employer affirmative action programs.
National Labor Relations Act
On Jan. 10, 2023, the Supreme Court heard oral arguments in Glacier Northwest Inc. v. International Brotherhood of Teamsters Local Union No. 174. This case will determine whether the National Labor Relations Act (NLRA) preempts a common law state tort claim against a labor union for intentionally destroying an employer’s property during a labor dispute. Glacier Northwest sells ready-mix concrete, and during collective bargaining agreement negotiations in August 2017, its drivers went on strike for a day without providing notice. As a result, concrete that had already been mixed for delivery was wasted.
Under the NLRA, workers’ right to strike is protected; however, they must take reasonable precautions to protect their employer’s property from foreseeable hazards resulting in sudden work stoppages. In the past, the Supreme Court has ruled that the NLRA preempts state law claims. If the Supreme Court rules in favor of Glacier Northwest, it could establish legal precedent making it easier for employers to sue and recover damages from labor unions that damage an employer’s property during a labor strike.
These cases’ rulings could have major impacts on employers, altering established labor and employment laws and workplace practices. Being aware of these cases and their potential effects on workplaces can help employers prepare and feel confident in their abilities to navigate any changes.
For more workplace resources, contact us.