The following material was developed prior to RGA s acquisition on January 1, 2010 of the Group Reinsurance CLAIMS ADVISORY SERVICE IN THIS ISSUE: RESOURCE Reinsurance Outcomes and Service Experts VOLUME 15 NUMBER 4 FOURTH QUARTER 2005 1 Medical Case Management Benchmarks: ING Re Industry Survey 3 The National Marrow Donor Program: Improving Lives through Innovative Blood Stem Cell Therapies 5 Mark your Calendar Now for the 22nd Annual ROSE Seminar 6 ING Re Announces New Neonatal Consultant 6 Staff Directories Medical Case Management Benchmarks ING Re Industry Survey On October 6, 2005, ING Re launched a comprehensive medical case management survey to the medical/managed care industry in the United States. The purpose of the survey was as follows: ING AMERICAS Develop measurement standards for the managed care industry regarding medical case management and disease management operations. Determine baseline information on practices for calculating financial returns as a result of case management and/or disease management involvement. Present summary data in such a way that health plans can compare themselves to similar companies in the industry to determine their performance with case management operations among peer organizations. ING Re, along with five health plans (ING Re clients) formed a steering committee to determine the relevancy of proposed questions and response choices. All outside steering committee members held active case management operations or senior-level management positions within their organizations. The survey content was extensive with a total of 21 questions addressing outcome metrics in the following areas: Demographics (size, location, operational functions
page 2 BENCHMARKS (Continued from page 1) between case management and disease management, and accreditation) Vendor services Education levels Staffing (requirements, certifications, etc.) Caseloads (job responsibilities, etc.) Program savings (ROI, cost effectiveness) More than 100 medical/managed care health plans were invited to participate including both ING Re clients and non-ing Re clients. Participants were invited to respond free-of-charge regardless of their status as an ING Re client and were given approximately six weeks to respond. The following are some initial observations: A total of 27 companies participated in the survey (approximately 25 percent response rate) Trend for greater appeal to smaller health plans 55 percent of company respondents had less than 100,000 members. Seventy-four percent of respondents are current ING Re clients. The survey was administered through Arundel Street Consulting. An Executive Summary report, including all summary information will be sent to all participants before the end of the year. The summary of data will include data breakdown by company size (number of health plan members), membership type (commercial, Medicare/Medicaid, and other), and by region of the country. The results of the survey will not be published in any trade journals and only participants of the survey will have access to the results. This survey is intended to be reviewed and updated on an annual basis for redistribution to the participating companies on an annual or bi-annual basis for use in longitudinal comparisons, as well. Process improvement and best practices are logical steps for organizations to take in the analysis of outcomes measurements. The Benchmark survey, perhaps along with ROSE Program Operational Reviews, will act as catalysts to assist organizations to take this step or at the very least begin the communication. ING Re provides Market Research Services to its reinsurance clients as a means to access market information important to their organizational needs. A short questionnaire is created by ING Re and the client company, based on the client s identified needs. The survey is then distributed to the participating health plans across the country. The survey responses of each participating health plans are kept confidential. Only the survey participants receive the final summary of the survey results. For more information on how this service can work for your market information needs, please contact your ROSE Program Health Services Consultant at ING Re.
page 3 The National Marrow Donor Program: Improving Lives through Innovative Blood Stem Cell Therapies by Craig Conway, Manager of Payor Policy, National Marrow Donor Program During my travels to get to know payor organizations around the country, I have visited with case managers, benefits directors and even transplant medical directors. Everyone I have talked with confirms the specialized and complicated nature of unrelated donor stem cell transplantation. They also shared their need to learn more about the donor search and blood stem cell procurement (acquisition) processes as well as the latest clinical outcomes. The National Marrow Donor Program (NMDP) plays a unique role in bringing together the largest and most experienced blood centers and transplant hospitals in the world. We also provide a wide range of information, services and educational programs designed to help individuals and organizations carry out their role in the life-saving transplant process. Who we are The NMDP is the world leader in making life-saving blood stem cell transplants possible for people who do not have a donor in their family. We facilitate transplants by connecting patients, physicians and donors to the resources they need. Since 1987, we have facilitated more than 20,000 blood stem cell transplants. To help facilitate this large and growing number of transplants, the NMDP works within an extensive International Network. This Network, with headquarters in Minneapolis, MN, brings together the expertise of: Transplant Centers 163 (42 International). NMDP Network transplant centers are responsible for conducting the donor search on behalf of a patient, selecting a donor or cord blood unit, performing the stem cell transplant and providing post-transplant care and support. Donor Centers 80 (seven International). Donor centers recruit and educate volunteer donors, and manage donors through the steps of the search process and stem cell collection.
page 4 NATIONAL MARROW DONOR PROGRAM (Continued from page 3) Recruitment Groups nine. Recruitment groups work with donor centers to educate and recruit donors. Cord Blood Banks 16 (one International). These banks educate expectant parents about donation. They also collect and store cryopreserved umbilical cord blood units. Collection Centers 101 (17 International). These hospitals are responsible for collecting stem cells from marrow. Apheresis Centers 89 (seven International). Responsible for collecting peripheral blood stem cells (PBSC). What we do Bring together patients, donors, and resources The NMDP provides products and services bringing patients and donors together through life-saving technology. Each year more than 35,000 individuals are diagnosed with life-threatening blood, immune system or genetic disorders for which a blood stem cell transplant may be a treatment option. Seventy percent of patients who need an allogeneic transplant must receive their blood stem cells from an unrelated donor. The NMDP offers many valuable resources for patients, the medical community, donors and payors. One of these valuable resources includes the Office of Patient Advocacy (OPA). The NMDP established the OPA in 1991 to comply with the 1990 Transplant Act and the 1998 Reauthorization Act requiring a system of patient advocacy services separate from donor services. For patients without a matching donor in their family, the search for an unrelated donor or cord blood unit adds additional stress to the situation. Patients and their families need information, resources and support to help them understand their treatment options and make informed decisions about their care. The Office of Patient Advocacy is staffed with trained case managers with a variety of backgrounds such as clinical social work, public health and education. They provide one-on-one guidance throughout the transplant process from diagnosis through survivorship and in some cases act as direct liaisons, connecting patients to other valuable resources. The National Marrow Donor Program (NMDP) Office of Patient Advocacy recently launched a new Patient Resources web site to provide information and resources to transplant patients and their families. The Patient Resources site (http://www.marrow.org/patient) includes information that can help patients and their families: Talk with their doctors Choose a transplant center Understand the role of the caregiver Manage financial or insurance matters Prepare for life after transplant Connect with other organizations that can help Increase access to transplant The NMDP works to increase access to unrelated donor stem cell transplants by: Offering services to patients to help eliminate potential barriers Educating patients, donors and medical professionals about advancements and opportunities for unrelated stem cell transplants Developing and promoting research aimed at increasing opportunities for and improving transplant outcomes Manage the world s largest registry We manage the world s largest, most diverse Registry of more than 5.5 million potential blood stem cell donors and more than 40,000 cord blood units. And, through our International Network, we have access to an additional four million potential donors. To learn more about us and stay abreast of treatment and disease information, visit our Web site at www.marrow.org. You can also contact me directly at payorpolicy@nmdp.org or call the NMDP s Office of Patient Advocacy at 1 (888) 999-6743. Craig Conway joined the National Marrow Donor Program in November 2001. He focuses on improving patient access to blood stem cell transplantation through work on national coverage and payor education initiatives. Mr. Conway has more than 15 years experience with financial and administrative issues affecting oncology and transplant services, in a variety of healthcare settings.
page 5 Mark your calendar now for the... 22nd Annual ROSE Seminar Minneapolis, Minnesota July 19 - July 21, 2006 We are in the process of planning for the 2006 Seminar. It will feature a variety of topics for medical management and claims management professionals. The ROSE Seminar is complimentary, by invitation only, for ING Re clients. Please share this reminder with your co-workers who may be interested in attending and then bring them along to the Seminar. Please watch for registration materials in the New Year! We look forward to seeing you in Minneapolis the summer of 2006!
ING Re Announces New Neonatal Consultant ING Re welcomes Jeanne Mrozek, M.D. to the ROSE Program team of medical consultants. Dr. Mrozek is board certified in pediatrics and neonatology. She is a practicing neonatalogist and assistant medical director of the NICU at Children s Hospital and Clinics Minneapolis. She is also a fellow with the American Academy of Pediatrics. Dr. Mrozek has authored several articles and abstracts in addition to being an invited speaker throughout the United States. Her special interests are neonatal nutrition, neonatal sepsis, liquid ventilation and the use of surfactant. Dr. Mrozek is available to ING Re clients to consult on individual neonatal Jeanne Mrozek, M.D. cases, or for neonatal program development. There is no charge for this service of the ROSE Program. Additionally, Dr. Mrozek is providing quality review support and physician consultation for the ING Re ROSEBUD specialty case management program. Dr. Mrozek replaces Dr. Rob Payne, who is resigning effective 1/1/2006 from his consulting position with the ROSE Program, due to increasing demands at the hospital. To access Dr. Mrozek, contact your ROSE health services consultant at 1-800-767-3509. ROSE STAFF PHONE 800.767.3509 DAN ABRAMOWSKI Vice President ING Reinsurance daniel.abramowski@ing-re.com KATHY AMLAW Senior Health Services Consultant kathleen.amlaw@ing-re.com MARY KAY GILBERT Health Services Consultant marykay.gilbert@ing-re.com JANE JOHNSON Director, Medical and Managed Care Services jane.johnson@ing-re.com KAREN KELLY Senior Health Services Consultant karen.kelly@ing-re.com NAN MARJAMA Administrative Assistant nancy.marjama@ing-re.com MARY PAQUETTE Senior Health Services Consultant mary.paquette@ing-re.com BECKY STANLEY Case Management and Claims Systems Specialist rebecca.stanley@ing-re.com ROSEBUD STAFF PHONE 800.535.7673 PATTY BUCK Senior Neonatal Nurse Consultant patricia.buck@ing-re.com COLLEEN QUIRAM Office Support Clerk colleen.quiram@ing-re.com MARY LITTLE Senior Perinatal Nurse Consultant mary.little@ing-re.com BONI MILLER Perinatal Nurse Consultant bonita.miller@ing-re.com KAREN TESTA Senior Perinatal Nurse Consultant karen.testa@ing-re.com ROSE RESOURCE The purpose of the ROSE Resource newsletter is to provide clients of ING Re with information on a wide variety of topics related to catastrophic medical case management. Case histories, facility highlights and similar articles are intended to serve general information purpose and do not constitute endorsements of facilities, programs or persons by ING Re. The information contained in the articles represents the opinion of the authors and does not necessarily imply or represent the position of the editors or ING Re. Articles are not intended to provide legal, consulting or any other form of advice. Any legal or other questions you have regarding your business should be referred to your attorney or other appropriate advisor. Copyright 2005 ING North America Insurance Corporation. All rights reserved. ING Re includes the reinsurance business of ReliaStar Life Insurance Company of Minneapolis, Minnesota, a member of the ING family of companies.