Category Archives: Uncategorized

Pensions Have Tripled Their Investment in High-Risk Assets. Is It Paying Off?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

https://www.governing.com/topics/finance/gov-public-pension-investment-returns-alternative.html?utm_term=Pensions%20Have%20Tripled%20Their%20Investment%20in%20High-Risk%20Assets.%20Is%20It%20Paying%20Off&utm_campaign=How%20Can%20a%20City%20Issue%20Pay%20Raises%20and%20Layoff%20Notices%20in%20the%20Same%20Week&utm_content=email&utm_source=Act-On+Software&utm_medium=email

Sign for Wall Street in New York City

A growing body of evidence shows that “alternative investments” may be lowering returns and costing state and local governments more.

Public pensions are more invested than ever before in high-risk and expensive assets like real estate and hedge funds. Yet research continues to show that this tactic is unlikely to improve their earnings.

According to Fitch Ratings, in the span of a decade, pensions tripled their average investment in these so-called alternative investments. In 2007, they averaged 9 percent of state and local public pension investment portfolios. By 2017, that number had risen to 27 percent.

During that period, median average returns on overall investments were 6.2 percent, according to Fitch. But during the longer period between 2001 and 2017, reflecting a time of less reliance on alternative investments, they were actually slightly better: 6.4 percent.

“If you look at trends and allocation to riskier assets and the returns we see alongside them, you clearly see that you can’t necessarily say you’re getting the bang for the buck over the last 17 years,” says Fitch analyst Olu Sonola, who authored the report.

The report adds to the growing body of evidence that alternative investments are not worth the extra cost and risk. In fact, they may be lowering pensions’ earnings and costing state and local governments more money.

Pensions’ average investment returns — overall, not just on alternatives — failed to meet expectations between 2001 and 2017, even though those expectations lowered from 8 percent to 7.5 percent. Plans that don’t meet expectations require state or local governments to put more money in pension systems. Even high-performing pension systems like Colorado, Oklahoma, Utah and Wisconsin have had to increase their payments or give up being fully funded for this reason.

Only South Dakota’s retirement system, which is fully funded and relies the least among all 50 states on alternatives and equities, met its own expectations over that time period. Seven states — Arizona, Connecticut, Hawaii, Maryland, New Hampshire, New Jersey and Rhode Island — missed theirs by 2 percent or higher, according to Fitch.

The reason alternative investments aren’t a safe bet, concludes Fitch, is because they tend to be volatile. But others dispute that idea. Andy Palmer, the chief investment officer for Maryland’s pension system, says their strategy of investing more in alternatives is to reduce risk and volatility.

Before the 2008 financial crisis, nearly 70 percent of the Maryland system’s portfolio was invested in stocks — now it’s less than 50 percent. Since then, Maryland has invested more in private equity, real estate and hedge funds.

“Reducing our risk in U.S. equities in particular and getting return from other sources, we believe, will protect us from those really sharp downturns,” says Palmer.

The system has also slightly lowered its expected rate of return over the years from 8 percent to 7.45 percent.

Palmer points to the average 9.5 percent investment return the system has earned over the last 10 years as of this March. While that exceeded state expectations, it’s not as good as some of Maryland’s peers. Palmer says that’s the result of unfortunate timing: The system shifted away from stocks at a time when the market went gangbusters.

But Jeff Hooke, a visiting fellow for the right-leaning Maryland Public Policy Institute who has been critical of pension systems that invest heavily in alternatives, argues the real winners in this larger trend are the Wall Street bankers who make money from the high fees associated with these investments.

“You can basically replicate all these alternative investment strategies through the public market and save yourself all the fees,” Hooke says.

Fitch’s report backs up Hooke’s claim. Passively managed portfolios (which are low-fee and leave Wall Street out of the equation almost entirely), have performed better than the average pension plan over the last 17 years.

 

 

Integrity Matters Most in a Leader!

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , • Leave a comment

https://www.linkedin.com/pulse/integrity-matters-most-leader-brigette-hyacinth/

In every aspect of our lives we depend on the integrity of others, and others do the same with us. That’s why it’s such a big deal when we discover someone we trust hasn’t been truthful or hasn’t been playing by the rules.

Although integrity is one of the most essential and admired leadership traits, in today’s world it seems to be lacking. What you see in leaders is not often what you get.

Here are 7 masks some leaders wear:

1. Orator (The Two Face mask) – Double tongued are they. They can sound so persuasive and so sincere. Fervent lips which sound so eloquent can hide true character. Behind the dazzling mask lies their real intentions of deception. Erroneous communications are a big cause of lack of perceived trustworthiness in bosses. Politicians are notorious and highly populate this category. However, their actions always expose them. We don’t take them at face value because we don’t know which face they have on.

2. Advocate (The 3 Musketeers mask)- “One for all and one for one.” They are all for me, myself and I. The love of power is their main motivator. They outwardly proclaim they are people focused, and their priority is with the team but behind closed doors they are self- seeking. Therefore when the opportunity is presented to prove it they cannot. They will do anything to make themselves look good, or maintain their status quo even at the expense of the team.

3. Philanthropist (The Robin Hood mask) – They give with the right hand but secretly take back with the left hand. Under this disguise these type of leaders give openly so others can think highly of them. If there was no fanfare they would not support charitable initiatives. Former Tyco International Ltd. Chairman Dennis Kozlowski improperly used company funds to promote himself as a generous benefactor. He committed more than $100 million of the conglomerate’s money to good causes however, his own foundation gave little to charity. He was accused of stealing $134 million from the company and served 8 years in prison.

4. Obdurate (The Iron Man mask) – They scarcely show their true feelings or human side. They think they need to have this public tough image. Marissa Mayer, former CEO of Yahoo came across as cold and disconnected to her employees. Her policies (maternity leave and long-term telecommuting) caused outrage. Adopting this persona alienates and pushes people away. By not showing any vulnerability, such leaders do not develop deep meaningful connections or build relationships with their team.

5. Meek (The Mister Fantastic mask) – They appear so humble and act down to earth when in fact they have an entitlement and superiority complex. However, their true colors are revealed in unguarded moments. I remember once working late and overhearing a manager speaking with a supervisor. He didn’t realize I was there and openly spoke to her. As I sat there I couldn’t believe that this is the person I thought I knew. When he came out of his office and saw me by my desk, he seemed really disoriented and shocked and asked if I had overheard him. Well, my whole perception of him changed from that day.

6. Proficient – (The Phantom of the Opera mask) – Some leaders conceal imperfections in favor of a polished image. The demands or expectations that society creates leaves them feeling mediocre and inadequate. They are uncomfortable in their own skin so they try to measure up and may even employ unethical methods to fit in. Lying on his resume cost former Bausch & Lomb CEO Ronald Zarrella $1.1 million in bonus after it was revealed he did not have an MBA as recorded. Company officials declined to accept his resignation. He remained in his role for another six years before retiring in 2008. Ironically, he probably didn’t need that degree. His prior job experiences were almost certainly enough. Still, like so many people, he seemed to have yearned for a status symbol.

7. Conformist – (The Shape-Shifter mask) – In this case, top management puts pressure on these types of managers to change their principles. Their style may not fit in with the changing culture. There is a shift between their preferred style of behavior and what the company wants. They play it safe to preserve their position and privileges. They just follow orders and exude no loyalty to employees. It’s demotivating working for a manager who does not stand up for their team. If you make a mistake they quickly turn into judge, jury and executioner. It’s hard to feel passion for a job when you experience this.

In the era of social media, where leaders’ personal and professional lives are often transparently intertwined, the mask eventually becomes apparent. Trust once lost is often hard to regain. Integrity requires humble introspection.

It requires you do what is right – not what is easy. Our actions must mirror our words in all facets of life. It all starts with keeping your word, making fair decisions, communicating honestly, taking responsibility, treating others with dignity and respect and giving credit where it’s due. There are many things you can lack and still steer clear of danger. Integrity isn’t one of them. If you don’t have integrity, people will not trust, believe or follow you. If you don’t have integrity, you have nothing.

 

 

 

Meet the Canadian Doctor Who Prescribes Money to Low-Income Patients

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

https://www.vox.com/future-perfect/2019/5/3/18524482/canada-health-doctor-prescribing-money-income-poverty?fbclid=IwAR1WrqjAWAz32DyqqNLpl9JbVaaqHS1LBUrM-PbUDf_GojvvM52lVATBa5o

 

 

Can States Fill the Gap if the Federal Government Overturns Preexisting-Condition Protections?

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , , , , , • Leave a comment

https://www.commonwealthfund.org/blog/2019/can-states-fill-gap-preexisting-condition-protections

Image result for state laws

Once again, the Affordable Care Act (ACA) is under threat, this time in the form of Texas v. Azar, a federal lawsuit challenging its constitutionality. This litigation, now under consideration by the Fifth Circuit Court of Appeals, took an unexpected turn in March when the U.S. Department of Justice (DOJ) sided with the plaintiffs, urging the Court to strike the ACA down in its entirety.

On May 1, the administration filed a brief in support of this action. But even before this suit, DOJ had refused to defend key provisions that guarantee coverage of preexisting conditions. If the courts agree with the DOJ, it would invalidate every provision of the 2010 law.

As many as 20 million people nationwide would lose their coverage, while millions more could face insurance company denials, premium surcharges, or high out-of-pocket costs because of their health status.

ACA Protections for People with Preexisting Conditions

  • Guaranteed issue. Health insurers are prohibited from denying an individual or employer group a policy based on their health status.
  • Community rating. Health insurers may not use an individual or small employer group’s health status to set premiums.
  • Preexisting condition exclusions. Health insurers and employer group plans are prohibited from refusing to cover services needed to treat a preexisting condition.
  • Essential health benefits. Health insurers selling to individuals and small employers must cover a minimum set of 10 “essential” benefits: ambulatory services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; and pediatric services, including oral and vision care.
  • Cost-sharing protections. Health insurers and employer group plans must cap the amount enrollees pay out-of-pocket for health care services each year.
  • Annual and lifetime limits. Health insurers and employer group plans are prohibited from imposing annual or lifetime dollar limits on essential health benefits.
  • Preventive services. Health insurers and employer group plans are required to cover evidence-based preventive services without any enrollee cost-sharing.
  • Nondiscrimination. Health insurers must implement benefit designs for individuals and small employers that do not discriminate based on age, disability, or expected length of life.

To help blunt potential fallout and prevent adverse effects for millions of individuals, several states are enacting bills to ensure that federal ACA protections become part of state law (see box). However, before the ACA, state efforts to require insurers to cover people with preexisting conditions resulted in large premium spikes and, in some cases, caused insurers to exit the market.

The ACA’s premium subsidies have had a critical stabilizing effect. If those subsidies are invalidated, states will have a hard time restoring them with state dollars. In addition, state regulation of self-funded employer plans is preempted under the federal Employee Retirement Income Security Act (ERISA), meaning the 61 percent of people with this type of job-based coverage can regain their protections under the ACA only if Congress steps in to restore them.

States Are Stepping Up, but Power to Fully Protect Consumers Is Limited

In a previous post, we found that at least four states (Colorado, Massachusetts, New York, and Virginia) had laws that would preserve key ACA preexisting-condition protections if the federal law is overturned. Since that time, seven more states (Connecticut, Hawaii, Indiana, Maine, Maryland,1 New Mexico, and Washington) have acted to preserve the ACA’s protections for their residents.

These bills take different approaches. Maine, New Mexico, and Washington passed comprehensive bills that would preserve all the protections listed above. The Connecticut, Hawaii, and Indiana laws are more narrowly focused. Hawaii and Indiana prohibit insurers from imposing preexisting condition exclusions; Connecticut aligns its benefit standards with the ACA. Maryland took a different approach, creating a workgroup to recommend ways to protect residents if the ACA is struck down. The governors of New Jersey and Rhode Island have issued executive orders directing their state agencies to uphold the ACA’s principles, by guarding against discrimination based on preexisting conditions and strengthening consumer protections to ensure access to affordable coverage.

Looking Forward

The Fifth Circuit Court of Appeals is expected to hear arguments in Texas v. Azar in July. Whatever that court decides, the losing party is likely to ask the Supreme Court to hear the case, and a ruling could come as soon as June 2020. With the future of the ACA hanging in the balance, at least 14 other states are considering legislation codifying some of the federal consumer protections during their 2019 sessions.

 

 

 

Affordable Care Act premium rates projected to increase by 10 percent

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

https://www.healthcarefinancenews.com/news/affordable-care-act-premium-rates-projected-increase-10-percent?mkt_tok=eyJpIjoiWkRnek5UZGlPRGsxTVRrMSIsInQiOiJPdWRXMnVoYWEyTTJmMDZxMEJGQ3ZCN3lxa1NYUTdjeWtRdlJSQUNQQmQzSStsK2RZZDJcL1NlTjVTaHd3ZzhPcHB3amloQWNUNUtWQVhIWlwvVXlKbEEzR3dNMllwaEZ4VlNTek44SVpcL0UweHdoc2IzMHhBRTg0ZDVvdXlPM05MOCJ9

An estimated 2 percent of the increase will be due to the return on the health insurance tax.

Insurers are projected to submit rate increases in the Affordable Care Act market of about 10 percent, which is higher than the roughly 6 percent increase for 2019, according to Dave Dillon, a fellow of the Society of Actuaries and senior vice president of Lewis & Ellis, Actuaries and Consultants.

An estimated 2 percent of the increase will be due to the return on the health insurance tax. Medical inflation will account for 4-8 percent of the increase, which Dillon called a normal annual trend reflecting the underlying growth in healthcare costs.

Another 1 to 2 percent will be due to the decrease in the level of the premium tax credits. A reduction in the exchange user fee for federal and state-based exchanges will allow for a .5 to 1 percent decrease in rates.

Many factors play a role in rate setting, making predictions somewhat of an educated guess. But Dillon believes one issue that won’t be a factor, unless the court hands up a decision very soon, is the question of the constitutionality of the ACA being weighed in the Fifth Circuit Court of Appeals in Texas.

The Department of Justice recently said the ACA in its entirety should be struck down, now that the individual mandate is gone.

“While there’s a lot of topics going on, they’re not necessary ones that affect 2020 rates,” Dillon said. “The Texas case hangs over everybody but not as an actionable item right now.”

Neither is the Medicare for All debate likely to influence premiums for 2020, he said.

WHY THIS MATTERS

Insurers are getting ready to file their 2020 premium rates for the on-exchange market of the ACA.

Depending on the state, such as Vermont and the District of Columbia, which have deadlines this month, the filing season kicks into high gear during the first and second weeks of June. Other states, such as Arkansas, have a deadline in July, said Dillon, who works with about 10 states on rates.

Off-exchange rates are due later in summer.

Rates will vary by state and would be influenced by a state’s implementation of 1332 waivers to allow for less expansive plans. So far, no state has taken advantage of the waivers that the Centers for Medicare and Medicaid Services began offering last fall, according to The Washington Post.

TREND

ACA premium rates stabilized for 2019 and insurers returned to the market or expanded their coverage areas.

In making his prediction for rates for 2020, Dillon looked at medical loss ratios and profit margins from the 2018 season. These were stable compared to 2017 when insurers were filing two sets of rates depending on whether cost-sharing reduction payments would be continued under the Trump Administration.

President Trump did end the CSRs. However, to make up for the loss to insurers and to lower premium increases, the Department of Health and Human Services allowed insurers in the 2019 season and again for 2020, to silver load premium increases onto silver level plans. Since most beneficiaries get the benefit of federal subsidies for health insurance through the ACA, the federal government is still bearing the cost of allowing insurers to offer lower rates.

Unlike other years, Dillon said he’s not hearing a lot about the market, which he interprets as a stabilizing trend. Insurers aren’t coming in and out of the markets as much. Regional companies may be expanding into other states, but there’s been no talk of another large insurer getting in, he said.

“I think we’re on the path to gaining some traction and stability,” Dillon said. “Obviously the ACA has put us at lowest uninsured rate ever.”

ON THE RECORD

“Consistent with previous years, insurance rates will vary widely across individual states and marketplaces,” Dillon said.

 

 

SSM Health is offering $25 virtual visits to all Wisconsin, Missouri residents

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

https://www.beckershospitalreview.com/telehealth/ssm-health-is-offering-25-virtual-visits-to-all-wisconsin-missouri-residents.html?origin=rcme&utm_source=rcme

Image result for virtual visit

St. Louis-based SSM Health is upping the ante for providers in Wisconsin and Missouri by offering all residents — established patients or not, health insurance or not — $25 virtual visits within an hour of requesting an appointment.

The service will be available Monday through Friday 9 a.m. to 7:30 p.m., and Saturday and Sunday from 10 a.m. to 4:30 p.m. Residents who wish to use the service log onto SSM’s virtual visit platform, complete a questionnaire and within 15 minutes to an hour, will receive a video or phone call from an SSM Health clinician.

The service is available for patients ages 2 to 75 for nonurgent health conditions like flu, pink eye or bladder infections. Parents or guardians must complete visits for minors.   

SSM Health will charge a $25 flat fee for a virtual visit. However, if the issue cannot be resolved online and a follow-up visit in person is necessary, the virtual visit is free.

The health system plans to roll the program out in Illinois and Oklahoma later this year.

 

Washington health system files for bankruptcy, cites issues with revenue cycle vendor

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

https://www.beckershospitalreview.com/finance/washington-health-system-files-for-bankruptcy-cites-issues-with-revenue-cycle-vendor.html?origin=cfoe&utm_source=cfoe

Image result for hospital bankruptcies

Astria Health, a three-hospital health system based in Sunnyside, Wash., filed for Chapter 11 bankruptcy protection on May 6.

Astria plans to use the bankruptcy process to restructure its finances, enter into a plan of reorganization with its creditors and replace its billing company, according to TV station KIMA.

In a press release issued May 6, the health system said it is facing a significant shortfall in cash flow due to issues with the company it contracted with to manage its billing in August 2018. Astria said the unidentified company failed to process a significant number of accounts receivable, leading to a backlog of unpaid claims, according to the Yakima Herald-Republic.

“Although hospital leadership has actively managed the supply chain to ensure necessary supplies for patient care, this delay in cash collections has now become severe enough to potentially disrupt the organization’s ability to pay for crucial items in a timely matter,” Astria Health wrote in its news release, according to the Yakima Herald-Republic.

Astria said it has secured debtor in possession financing and the bankruptcy filing will not affect operations at its hospitals or clinics. They will remain open as the health system moves through the bankruptcy process.

“As one of the largest healthcare providers and employers in the Yakima Valley, we believe this step was necessary in order to protect the Valley’s hospitals and its local economies,” Astria Health President CEO John Gallagher told KIMA. “We believe it will protect and sustain the three hospitals for the future.”

Astria aims to emerge from bankruptcy by the end of 2019.