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Previous Fireside Chats

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.

 

Precision Reimbursement Approaches for Managing High Cost Therapies

Dr. Ronald Potts, Chief Medical Officer, 6 Degrees Health  |  Mark Trusheim, Founder & President, Co-Bio Consulting

NEWDIGS (New Drug Development Paradigms Initiative) Biomedical Think-and-Do Tank from Tufts Medical Center will discuss the “Precision Reimbursement” of directed therapies, platforms for building real-world evidence, disease-oriented learning systems, and more.

Our guest speakers will include NEWDIGS Senior Advisor and 6 Degrees Health Chief Medical Officer Ron Potts, MD, and Strategic Director for NEWDIGS, Mark Trusheim. They will have a conversation with our team about how self-insured employers can prepare for the portfolio impact of cell and gene therapies, how partnering with patients can ensure that Precision Medicine targets what matters, payer perspectives on value-based reimbursements, and other related topics of interest to our audience.

The Challenges of High Dollar Claims

Robert Page, Epic Reinsurance  |  Kristy Swailes, Swiss Re America Holding Corporation  |  Dr. Christine Hale, Lockton Dunning Benefits  |  6 Degrees Health: Katy Brant, Jodi Hammer, Staci Branham

In this Fireside Chat the expert panelists defined and differentiated high dollar vs. complex claims and discussed how to manage these kinds of claims through extensive review, payment, resolution and appeals activities. They examined the headwinds and challenges of complex and high dollar claims from the self-funded lens and highlighted why Clean Claim Reviews are so important. They further discussed solutions and strategies to intervene, and the role of vendors in these kinds of claims.

Stop-loss Pricing in Traditional and Alternative Risk Financing Strategies

Join 6 Degrees Health and our guest Joshua McGee, a 20+ year industry veteran who has experience as a broker with a large regional agency, and former Director of Underwriting and Strategic Pricing at Blue Cross NC. We will discuss how pricing strategies in a dynamic and increasingly unpredictable stop-loss market requires employers and consultants to take an “all of the above” approach to market options. During this Fireside Chat, we will highlight stop-loss options available, and define some best practices and creative approaches to underwriting, contract terms, and financing strategies.

America’s Best Kept Secret: Primary Care

Ernie Clevenger, President at CareHere, LLC, a Premise Health company

Join 6 Degrees Health and our guest Ernie Clevenger, President of CareHere and President & Publisher of MyHealthGuide as we discuss Primary Care and if it should be at the center of your self-funded health plan. We will go over the data, experience, and case studies that all point to Primary Care being critical to a health plan. In addition, we will discuss the effects Primary Care has on the longevity of life and healthcare costs.