In this Fireside Chat, Ryan Work will dive into updates in health care policy, the implications of these policies, the current political landscape, and what to expect in 2024.

Reference-based pricing has many benefits, including cost management and member engagement. But what happens when a member receives a balance bill, is sent to collections, reports a credit issue, or providers push back in other ways?  Christine Cooper will discuss how to use legal advocacy to address and avoid these concerns and achieve success in an RBP Plan. She will share stories that highlight the outcomes for both the plans and their participants when a proper legal advocacy strategy, like MediShield, is implemented. 

Referenced-based Pricing is a great tool to contain costs while fairly reimbursing claims, but without the proper payment integrity programs how do we know the claim is correct before repricing? Payment Integrity expert Katy Brant explores the ways high dollar bill reviews can enhance the overall savings in reference-based pricing. Katy will provide case study examples of complex claims and how a deep dive clinical review can uncover significant errors which can be leveraged in balance bill settlements with challenging providers.

How has the 2024 sales game changed for the industry? With renewals winding down in 2023, it is time to start planning for 2024 with an actionable mindset shift for selling. 10 things/ways to maximize your sales goals in 2024.

How do benefits pros use the first objective mark of value of health plans to deliver world-class health outcomes?

The Plan Grader has been 5+ years in the making. Healthcare’s modus operandi has been to drive down the healthcare road looking in the rearview mirror. If one knows anything about the distribution of healthcare spending and individual claimants, that’s not terribly useful. We tested/refined the Plan Grader for 3+ years to prove it was predictive of a high-performance health plan. In other words, the first leading indicator of high-performance health plans when the industry norm has been to look at lagging indicators.