Previous Fireside Chats
Unveiling the Groundbreaking Metric Transforming Health Plans into Catalysts for Unparalleled Health Outcomes
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.
Mental Health Parity
This webinar will take a deep dive into the world of Mental Health Parity compliance and explain what a NQTL analysis is, what a QTL calculation is, who is subject to these provisions, how reporting works, and many more nuanced pieces of this Mental Health Parity puzzle.
The Mental Health Parity Act of 1996 was passed nearly three decades ago, but that statute did not become permanent until the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in 2008. This passage of the MHPAEA began a decades-long struggle to enforce the statute that is now colloquially referred to as the Mental Health Parity Law. Over ten years later, the mental health parity testing requirement for group health plans within the Consolidated Appropriations Act of 2021 has bolstered these MHPAEA enforcement efforts. Under the MHPAEA, parity analyses are performed separately on quantitative treatment limitations (QTLs) and non-quantitative treatment limitations (NQTLs).
What are QTLs and NQTLs? Both analyses seek to ensure that more restrictive limitations are not being placed on mental health/substance use disorder (MH/SUD) benefits than they are on medical/surgical (M/S) benefits. Quantitative treatment limitation (QTLs) calculations include items like copayments and annual visit limits and are based on real claims experience. Non-quantitative treatment limitation (NQTLs) analyses are performed on more abstract limitations, such as prior authorization requirements or formulary design.
Tree Top’s RBP Success Story
Our September Fireside Chat will feature Scott Washburn, VP of Human Resources at Tree Top, with 25+ years of executive leadership and HR experience.
A glimpse into the story and data around Tree Top’s decision to implement Referenced Based Pricing (RBP) and the specific results they achieved.
The New Process: Creating Health Plans not Health Insurance
Designing your health plan for small groups over a multi-year strategy with a crawl, walk, run mindset.
No longer “What can I do to pay the lowest today” but how do we decrease the overall spend for 3-5 years without just transferring additional risk to my employees when they need healthcare the most?
How you can unbundle the black box that health insurance carriers have built for us but not just chase “shiny nickels.” Building a sustainable ecosystem that can provide efficiency and the ability to service understanding the small to midsize group market.
How Stop Loss Carriers look at the risk and overall financials is a key part being one leg of the three-legged stool being Admin, Stop Loss, and Claims. 30 years of experience with one of the largest reinsurance carriers in the world and managing 30,000 plus employees gives us a different insight into the model that is sustainable and fully transparent, aligned with employers and employees. Many products have been built and are being built with the level funded / self-funded products being hot again in the market. How not to get caught up in what is just a hot topic.
What are the different strategies, the pros and cons, along with the different levels of savings that can be achieved by different approaches, i.e. Networks, RBP, Fee Negotiation, etc?
How using a combination of RBP and Networks, while blending in Negotiations when necessary, can optimize either Professional or OON Savings.