Previous Fireside Chats
Stop Loss Group Captives: Concepts vs. Reality
Berkley discusses the value prop concepts of group captives and what their 10+ years in the business have actually demonstrated in terms of results, cost mitigation, and best practices.
Medical stop-loss group captives are designed to reduce the volatility of self-funding for employers and to provide more control and transparency in order to more effectively manage the risk of the health plan. As captives become a more common strategy for employers, how can employers validate that these concepts are coming to fruition?
Berkley conducted analysis across its block of stop loss group captive business to help support the value proposition of captive participation and will share some of the highlights of that analysis in this discussion.
In addition, Berkley will discuss the key attributes and best practices that produce the best results across its program portfolio. Join senior members of Berkley’s Business Development team for a deep dive into the powerful outcomes that stop loss group captive employers are realizing.
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.
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.
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.