Healthcare, Surprise Billing & Politics: Claims, Cost and Policy Impacts
Federal price transparency and surprise billing activities, the debate around drug costs and PBMs, and access to healthcare data are becoming increasingly important from the perspective of cost and claims management.
6 Degree’s April Fireside Chat will feature Ryan Work, Senior Vice President of Government Relations for SIIA, along with our own President, Katy Brant and Chief Growth Officer, Heath Potter. During the discussion, they will explore the implications of these policy developments and how the debate takes place behind the scenes.
Previous Fireside Chats
Legal Advocacy: Protecting Plan Participants and Plan Savings
Christine Cooper, CEO, aequum
Join 6 Degrees Health and our guest Christine Cooper, CEO of aequum LLC, as we discuss how reference-based pricing plans can reduce plan participant noise while preserving plan savings through legal advocacy. During this Fireside Chat, we will discuss the components of a successful legal advocacy program built on a teamwork approach that includes the key stakeholders. We will talk about how medical providers react, as well as what plans and participants can expect throughout the process. We will also share significant metrics and results.
RBP Plans: Strategies for Successfully Resolving Balance Bills and Provider Payment Disputes in 2023
Scott Ray, Founder, 6 Degrees Health | Bonita Hatchett-Bodle, General Counsel, 6 Degrees Health
Reference-Based Pricing (RBP) Health Plans typically use a Medicare multiple to define the allowable payment amount, which is often significantly lower than provider billed charges. The disconnect between the plan’s allowable payment and the provider’s billed charges typically results in negotiations between the RBP vendor, like 6 Degrees Health, and the provider. When the parties cannot resolve the payment dispute, the member may be balance billed and the plan may be sued.
Self-funded plans are administered in coordination by a group of service providers. This includes TPAs, brokers and RBP vendors, each of which may have varying degrees of authority to resolve provider payment disputes. The cost-savings for RBP plans are no longer speculative, with average annual savings in excess of sixty percent (60%). The success of such programs, however, is largely dependent on the member experience, which can be impacted by the resolution of balance bills, member education and the coordination of services by TPA, brokers and RBP vendors.
Our Fireside Chat will address strategies for successfully resolving balance bills and provider payment disputes for RBP plans and the role of service providers in the resolution process. Please join us for this highly anticipated discussion with industry experts.