In this second discussion with Andreas Mang and Jon Camire of Blackstone, Stacey Richter has an advanced discussion on the intricacies of stop-loss reinsurance for high-cost claimants.

This show today, for sure, it’s for plan sponsors and anyone on or about plan sponsors; but also listen if you are serving high-cost claimants some other way. Because what you’ll learn here today is some insights relative to how plan sponsors go about making sure that they can pay you—like if you work for, for example, some clinical organization.

There’s a, I don’t know, 101 starting point of this conversation if you need it on stop-loss, which is episode 478 from a couple of weeks ago. This show is the, let’s say, 201-level conversation that I’m having with Andreas Mang and Jon Camire about, as I said, stop-loss insurance and stop-loss insurance considerations.

Emphasizing the importance of eligibility audits and aggregating buying power, the guests highlight best practices to avoid overpaying for coverage and ensuring comprehensive risk management.

This episode is sponsored by Havarti Risk, which I am so thankful for. The show, Relentless Health Value, actually does cost an unexpectedly large sum of money to create and produce; so I always appreciate when somebody offers to sponsor a show or help sponsor a show.

=== LINKS ===

🔗 Show Notes with all mentioned links:

https://cc-lnk.com/EP479

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07:47 What are the best practices for plan sponsors to use for stop-loss coverage?

10:11 What are the “unknown unknowns” within stop-loss coverage?

15:25 What are some policy provisions that plan sponsors should be aware of?

19:02 Why is it so important to do eligibility audits?

20:41 What are some common mistakes made with stop-loss coverage among the self-insured?

23:21 What’s a panel approach, and why is it important for negotiating stop-loss coverage?

Stacey Richter has a second take on the original episode 433 since it is so relevant right now. Stacey engages in a compelling conversation with Justin Leader, CEO of BenefitsDNA, about the opaque practices of third-party administrators (TPAs) and their impact on healthcare costs.

They discuss the hidden fees tucked into weekly claims wires, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA adjudication fees.

The episode emphasizes the need for transparency, understanding hidden costs, and ensuring fiduciary responsibility for self-funded employers. Additionally, Leader shares insights from a Health Affairs article and mentions ongoing legal cases that highlight the financial discrepancies in TPA practices.

=== LINKS ===

🔗 Show Notes with all mentioned links:

https://relentlesshealthvalue.com/episodes

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:

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🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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06:32 EP457 with Cynthia Fisher.

06:56 How is the claims wire typically explained to a plan sponsor?

10:49 What is the whole point of self-funding?

10:58 Why is it so vital to understand what you’re paying for?

11:53 What are the five “buried” items that wind up in these claims wires?

12:12 What is a shared savings fee?

16:14 “Rates are important, but so are your rights.”

20:13 What’s going on with prior auth fees?

22:44 What is prepayment integrity?

27:29 What is pay and chase?

28:46 EP428 with Julie Selesnick.

30:58 What is a TPA claim review?

33:21 EP285 with Dawn Cornelis.

34:16 EP379 with AJ Loiacono.

34:45 Is there medical claim spread pricing?

Host Stacey Richter discusses the intricacies of stop-loss coverage with Andreas Mang and Jon Camire from Blackstone. The episode focuses on defining stop-loss insurance and exploring its critical role in protecting self-insured employers from catastrophic financial losses.

The conversation delves into the nuances of individual and aggregate stop-loss policies, laser claims, and the importance of selecting an experienced consultant to navigate this complex landscape. The episode is essential listening for those managing high-cost claimants and exploring self-insurance options.

This is a two part show. The second show will cover major fails, mistakes that happen with stop-loss when somebody doesn’t understand or do everything that we talk about. So, tune back in for the next part of this conversation, in two weeks.

Thank you to Havarti Risk for sponsoring this weeks episode.
Havarti Risk empowers healthcare leaders like you to make smarter
decisions that increase quality and lower cost of care.
https://havarti-risk.com/

=== LINKS ===

🔗 Show Notes with all mentioned links:

https://relentlesshealthvalue.com/episodes

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:

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🫙 Support the podcast with a small donation to the Tip Jar:

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🎤 Listen on Apple Podcasts

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07:24 What is stop-loss?

08:27 What is reinsurance?

09:57 EP420 with Ge Bai, PhD, CPA.

10:10 Why has stop-loss been a barrier for smaller companies going self-insured?

13:55 Why self-insurance needs to be a joint decision between finance and HR.

15:38 What is aggregate versus individual within stop-loss?

19:51 Why is it important for companies to choose the right level of stop-loss coverage?

21:29 What is a laser claim?

29:28 Why is it important to know what your brokers are getting paid on your stop-loss policies?

In this episode, Stacey Richter explores the impact of trust on healthcare outcomes, drawing from listener contributions and prior episodes of Relentless Health Value.

The discussion underscores how trust or the lack thereof affects patients, clinicians, and healthcare systems. Key points include the importance of building trusted relationships, the detrimental effects of antitrust behaviors, and the broader implications for healthcare delivery.

Stacey also highlights a bonus show featuring Charles Green on earning and maintaining trust. The episode concludes with an uplifting message about the collaborative and giving nature of the Relentless Health Value community.

=== LINKS ===

🔗 Show Notes with all mentioned links:
https://cc-lnk.com/EP477

🔗 Bonus Show - Show Notes
https://cc-lnk.com/Bonus477:

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🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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00:47 What is the new, emerging through line becoming apparent in healthcare?

01:54 Bonus Episode with Charles Green.

02:52 What is the impact of trust in healthcare?

02:55 EP475 with Peter Hayes.

03:11 EP473 with Kenny Cole, MD.

05:31 EP295 with Rebecca Etz, PhD.

06:07 EP326 with Rishi Wadhera, MD, MPP.

07:06 Why does trust grow through proximity, and why do providers need to integrate this into care models?

07:59 Why antitrust is so prevalent in healthcare.

10:00 What are two main contributors to the lack of primary care doctors?

13:27 Why collaboration builds trust.

In this bonus add-on to episode 477 of Relentless Health Value, host Stacey Richter revisits a decade-old conversation with trust expert Charles Green, founder of Trusted Advisor Associates. Green discusses the intricacies of building and maintaining trust in healthcare, emphasizing four key trust principles: client focus, collaboration, long-term relationships, and transparency.

The discussion highlights the challenges within the healthcare industry, compounded by conflicts of interest and transactional dynamics. Green underscores the importance of individual actions and leadership in fostering trust, advocating for empathetic listening and genuine curiosity about others as foundational behaviors.

=== LINKS ===

🔗 Show Notes with all mentioned links:
https://relentlesshealthvalue.com/episodes

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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🫙 Support the podcast with a small donation to the Tip Jar:
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🎤 Listen on Apple Podcasts
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01:45 Four trust principles that can help you earn your clients trust and come off as more trustworthy from first impressions onward.

04:31 Charles’s words of wisdom for rebuilding lost trust.

05:46 Where does trusted leadership start?

06:38 Why trust in leadership is about embodying trust in actions, not words.

07:26 Why does personality have an outsized impact in leadership and trust?

08:21 “If we want to improve our trust, we just simply need to work on ourselves.”

08:56 Why listening with a sense of curiosity and respect drives reciprocal behavior and improves trust.

09:14 What is the best technique to immediately improve your trust relationship?

In this episode of Relentless Health Value, host Stacey Richter sits down with Peter Hayes to discuss the major forces driving change in the healthcare industry. Hayes outlines three critical factors: changing public opinion, heightened transparency, and new regulations such as the Consolidated Appropriations Act.

He emphasizes the unprecedented convergence of these elements, creating a pivotal moment for healthcare transformation. The discussion delves into the erosion of trust within the healthcare system and the growing public unrest over high costs and inefficiencies.

Hayes also highlights the role of state-level initiatives as experimental laboratories for potential national solutions. The episode concludes with a call to focus on root causes and collaborative approaches to restore trust and improve healthcare affordability and quality.

=== LINKS ===
🔗 Show Notes with all mentioned links:
https://relentlesshealthvalue.com/episodes

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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🎤 Listen on Apple Podcasts
https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

🎤 Listen on Spotify
https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

📺 Subscribe to our YouTube channel
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=== CONNECT WITH THE RHV TEAM ===
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05:28 What things are adding to the urgency in this moment of healthcare?

05:55 The three things that have brought us to a tipping point in healthcare.

07:05 Why is now the real moment for this tipping point?

10:35 EP458 with Komal Bajaj, MD.

13:01 Article by (and tribute to) Uwe Reinhardt.

13:27 Hospital ratings by The Leapfrog Group.

14:08 EP358 with Wayne Jenkins, MD.

15:07 EP474 with Yashaswini Singh, PhD.

16:29 How is regulation changing in healthcare?

21:48 How the “trifecta” of change is working together to create this movement of change in healthcare.

23:54 What do we need to look at to address the problems pushing this change in healthcare?

25:44 EP465 with Chris Crawford.

30:04 Why is federal and state collaboration going to be important to this healthcare change?

31:51 EP455 with Beau Raymond, MD.