Off-Network: Value-based Payment Strategies

July 29, 2020

Preferred provider networks have traditionally been favored by employers for providing broad provider access to members across large geographies. However, provider networks are not necessarily built to manage costs and quality given fee-for-service reimbursement arrangements and the inability to steer to high quality providers in the network. Innovative purchasers focused on driving higher quality and lower costs in their health plans are actively seeking ways change how providers and hospitals are paid to ensure that incentives exist to lower costs and drive high quality patient outcomes.

Join us and special guest Lester Morales of Next Impact as we expose the reasons why traditional forms of healthcare purchasing are ineffective and may actually be contributing to higher plan costs. We’ll discuss alternative payment strategies that align incentives to promote greater value in the form of higher quality and lower costs for healthcare.


Off-Network Value-based Payment Strategies
Topics: Webinar Healthcare Navigating Toward Value

Direct Primary Care: From Loss Leader to Quality Care Catalyst

June 24, 2020

Arguably one of the greatest dysfunctions of the U.S. healthcare system is the demoted position of primary care. Unfortunately, primary care has been relegated as a sort of “loss leader” in the healthcare delivery system, designed to serve as a referral source to higher cost specialists or facilities rather than allowing doctors enough time to treat patients holistically on the front-end. The Affordable Care Act rightly promoted the importance of primary care by eliminating cost for preventive services, but this is not adequate by itself.

Join us as we explain the importance and value of primary care and outline strategies that promote its use through plan design and direct care arrangements.


Direct Primary Care From Loss Leader to Quality Care Catalyst
Topics: Webinar Healthcare Navigating Toward Value

The Six Percent: Managing High-Cost Outlier Claims

May 27, 2020

Did you know that, for most health plans, a mere 6-8% of covered members account for 80% of total claims spend? One of the foundational strategies behind value-based purchasing is focusing on reducing the frequency and severity of high cost claims. In other words, focus on the 6% of your members driving the majority of your costs and claims volatility in your plan.

Join us as we expose this prevalent challenge and debunk the myth that employers are helpless when it comes to managing the risk of high cost outlier patients.


The Six Percent Managing High-Cost Outlier Claims
Topics: Webinar Healthcare Navigating Toward Value

Prescribed Savings: All Things Pharmacy

April 29, 2020

Recent scandals and public scrutiny have started to shine a bright light on the opaque business practices of big pharma manufacturers and pharmacy benefits managers. Despite this scrutiny, the cost of prescription medications continues to rise as manufacturers focus on developing high cost specialty medications and lack of regulation permits various players to arbitrarily inflate the cost of prescriptions year over year.

Join us as we shine a light into the “black box” of prescription medications. We’ll explain how prescription medications are sourced and procured, how PBMs get paid in oftentimes hidden ways, and how you can better manage your pharmacy spend.


Prescribed Savings All Things Pharmacy
Topics: Webinar Healthcare Navigating Toward Value

The Healthcare Financing Spectrum

February 26, 2020

The first step to taking control of your benefits spend is to ensure that your funding and administrative mechanisms allow for flexibility and control. Healthcare financing is ultimately a matter of risk tolerance, but the most appropriate funding mechanism will maximize the reward for an acceptable amount of risk given your business needs and characteristics.

Join us as we walk you through the entire spectrum of funding options available to employer benefits purchasers. We’ll outline the features of each option and explain the benefits of advancing down the spectrum towards optimal alternative risk financing strategies.


The Healthcare Financing Spectrum
Topics: Webinar Healthcare Navigating Toward Value

Intro to Value-Based Healthcare Purchasing

January 29, 2020

Over the past decade, we’ve experienced incredible disruption in benefits from the ACA and the major trend towards healthcare consumerism. Over the next decade, we will experience another significant disruption, not necessarily through new mandates or penalties, but through a wave of innovation in purchasing and plan design strategies that address the root causes of healthcare purchasing risk: variance of price and quality in healthcare.

In this webinar, we introduce you to the concept of value-based purchasing and learn how these next-gen strategies can improve patient experiences, deliver high quality care outcomes, and ultimately control your benefits spend. Find out how other employers are taking control over their benefits programs by managing their health plan like other areas of their business.


Intro to Value-Based Healthcare Purchasing
Topics: Webinar Healthcare Navigating Toward Value