H1: Introduction to Self-Insured Health Plans
This will be an introductory-level session designed to explain the basics of how self-insured group health plans operate, administrative options, claims handling and stop-loss insurance arrangements. Audience questions will be encouraged to facilitate an interactive learning environment.
Vice President of Health Strategies and Innovation
Health Plans Inc.
H2: How Self-insured Employers Can Find Value in the Face of Provider Market Power
In this session, attendees will hear from three leading experts on trends in health care provider consolidation, its impact on health care prices, and the market- and policy-based strategies that can be used to address the negative consequences of growing provider market power. Panelists will share the latest statistics on consolidation, describe the types of consolidation, and relate current findings on the impact of consolidation on health care costs and health care quality. They also will describe the strategies that leading self-insured employers and other health care purchasers are using to find better value in the midst of the challenges posed by provider consolidation, including use of price and quality transparency, reference-based pricing, Centers of Excellence programs, use of alternative low-cost providers (e.g. telehealth), direct contracts with providers as accountable care organizations or for specific episodes of care, and other narrow and tiered networks. In addition, panelists will outline how the federal government and states have been working to address provider market power through litigation, laws and regulations.
Suzanne Delbanco, Ph.D.
Catalyst for Payment Reform
Associate Dean and Professor of Law
UC Hastings College of the Law
Emeritus Professor of the School of Public Health and Goldman School of Public Policy
University of California, Berkeley
H3: Hot Regulatory and Compliance Challenges for Self-Insured Health Plan Sponsors & Their TPAs
One of the country’s leading attorneys specializing in regulatory and compliance issues for self-insured group health plans will provide updates and guidance on the hottest issues that health plan sponsors and administrators need to focus on now including: new health reimbursement arrangement (HRA) challenges and opportunities under final regulations; how to plan for agency audit initiatives related to ACA, ERISA, and HIPAA compliance; issues arising under wellness programs; and the latest on cross-plan offsetting and other claims practices litigation.
John Hickman, Esq.
Altson & Bird LLP
H4: What Brokers Need to Know about Working with Stop-Loss Carriers
Without the right stop-loss partner, self-insured employers can be exposed to excessive financial liabilities that could compromise the viability of their group health plans. Given that the stakes are so high, broker/advisers need to fully understand how stop-loss carriers operate and how to best work with them for the benefit of their employer clients. This session will feature representatives from leading stop-loss carriers/MGUs who will tell you what you really need to know to ensure that your clients have the appropriate risk transfer partners.
SVP, Sales and Business Development
East Coast Underwriters
Regional Stop-Loss Manager
Shaun Peterson , FSA, MAAA
Vice President Stop-Loss
H5: Living with Cancer: How Do Self-Funded Plans Adapt
Because many cancers are being detected early, and treatment options are improving, cancer is no longer a death sentence. Instead cancer is now being treated as a chronic disease, like diabetes or multiple sclerosis, in many cases. But the cost of such treatment can add up; in fact, cancer is the leading catastrophic claim condition for Sun Life Financial and HM Insurance, two of the major medical stop-loss carriers. This session will examine today’s state-of-the-art cancer treatment, which includes remote consultations with medical experts from around the country, management of specialty pharmaceuticals, and the use of integrated medical systems to coordinate care, eliminate redundancies and improve outcomes. How should self-funded health plans sponsors adapt their plan designs to ensure patients receive this advanced medical care, which in some cases also may extend beyond covering treatment to also include providing transportation, home assistance, and even medical marijuana to ease nausea during chemotherapy?
Dr. Stephen Parodi
Associate Executive Director
The Permanente Medical Group
Director of Clinical Services, Stop-Loss and Health
Sun Life Financial
President & CEO
The National Alliance of Healthcare Purchaser Coalitions
H6: Navigation Vendors: The New “Managed Care”?
According to Mercer’s National Survey of Employer-Sponsored Health Plans, 19% of large employers are offering enhanced health advocacy services to help employees navigate our complicated and confusing healthcare system. These so-called “Navigation Vendors” guide employees through the process of diagnosis and treatment, help them to understand their health benefits, compare costs and quality of care options, coordinate multiple providers and determine which providers can offer the best care. This session will explore how offering navigation services can help self-funded employers reduce health plan costs while improving their employees’ patient experience.
Principal & Consulting Actuary
Strategic Benefit Advisors, Inc.
Vice President of Business Development
H7: Value-Based Benefit Design Strategies for Self-Funded Employers
This session will explore how self-insured employers can use direct contracting, bundled payments, medical travel and other value-based design strategies to reduce healthcare costs and improve patient outcomes. What criteria should employers use to identify and contract with best-of-breed providers? What reimbursement models work best in such arrangements: fee for service, bundled payments, capitation, or a combination? How do employers ensure they are getting the most for their money?
the Zero Card, Inc.
Chief Education Officer
SVP, Corporate Development
Francois De Brantes
SVP of Commercial Business Development
H8: Behavioral Health: Addressing Gaps in Access and Benefit Parity
It is said “there is no health without mental health” yet adequacy of provider networks, poor care coordination, and persistent stigma all contribute to the complexities of delivering better behavioral health care. And, is the investment cost effective? Service and cost parity is a third area where gaps have been identified, with a potential to put self- funded plans at risk. This session will explore how to evaluate better provision of services, identify new options for care delivery, and review recommendations for plan designs.
Allied National, Inc.
H9: Show Me the Money: Why Private Equity, Venture Capital and “Angel” investment firms are Investing in Healthcare
This panel of representatives from PE and VC firms and “Angel” investors will discuss the opportunities they see in healthcare and other entrepreneurial firms that service the self-insured marketplace.
H10: Promoting Healthy Businesses, Communities and Employees via Evidence-Based Policies and Practices
Self-insured employers continually seek ways to improve the overall health of their employee populations and lower healthcare costs. To achieve these goals, organizations increasingly use clinical evidence to prevent disease, identify health concerns early in their course, and address chronic conditions. In this session, we will explore ways clinical evidence can help:
Dr. Darla Holland
Assistant Regional Medical Director, Value Demonstration
H11: Using Reference-Based Pricing to Tame the Hospital Cost-Shift
Self-insured employers and private health plans paid hospitals 241% more than what Medicare paid in 2017, according to research conducted by the RAND Corp. in collaboration with the Employers’ Forum of Indiana. If employers and health plans participating in the study had paid hospitals using Medicare’s payment formulas, total payments would have been reduced by more than 50%, RAND researchers found in the analysis. The research was conducted to help self-insured employers adopt “reference-based pricing” strategies based on Medicare reimbursement rates, rather than negotiating a discount off hospital charges, as most currently do. This session will unveil the data that RAND collected and provide tips on how self-funded employers can apply it in their hospital reimbursement negotiations. A large self-funded employer also will share its experience with implementing reference-based pricing.
Associate Policy Researcher
Colorado Business Group on Health
Special Projects Coordinator
Montana Commissioner of Securities and Insurance
H12: How Data Can Power Value-Based Purchasing Programs for Self-Funded Employers
This session will explore how self-insured employers can use Big Data, Analytics and Informatics to make better-informed value-based purchasing decisions. The value equation is about more than just price transparency, it’s also about quality, safety and outcomes. Attendees will learn how to obtain and utilize nationally recognized, evidence-based data on both hospitals and surgeons to measure and identify high-performing providers; review strategies and tactics for designing higher-value provider networks; and ways employers can use these tools to bring the power of consumerism to the healthcare markets.
Senior Advisor, Leapfrog Group
Former VP of Health & Welfare
Vice President for Surveys and Research
Center for the Study of Services
Senior Advisor - Payer Strategic Solutions
IBM Watson Health
H13: Medical Stop-Loss Market Update
The increasing popularity of healthcare self-funding, coupled with the elimination of benefit caps under the Affordable Care Act, is fueling growth in the medical stop-loss market. The demand for this reinsurance to protect self-insured employers from catastrophic claims has almost tripled in the last six years, pushing the market from a $6 billion industry pre-ACA to more than $17 billion today. During this session, three industry experts who have been tracking the medical stop-loss market will share the data they’ve collected on premiums written, rising claims costs and their impact on renewal rates, and any other trends revealed in the data.
Senior Vice President
D.W. Van Dyke & Co.
Guy Carpenter & Company, LLC
Principal and Consulting Actuary
H14: Worksite Clinics: Improving Access to Primary Care and Chronic Disease Management
More than half of employers with more than 5,000 employees now have on-site or near-site clinics, and another 13% are considering them, according to a 2019 National Business Group on Health survey. While most early worksite clinics focused mainly on treating occupational injuries, today’s clinics focus on well-being interventions to improve employee health and productivity, reduce time away from work and improve access to primary and preventive care. This session will explore the financial benefits of onsite and nearsite clinics to self-funded employers and their employees and how to identify a clinic vendor and determine the types of clinical interventions they should provide. The session will also feature a case study involving a California employer that established its own worksite clinic.
National Association of Worksite Health Centers
Senior Manager - Integrated Health for the LifeConnections Centers
Cisco Systems Inc.
H15: Smoothing out the Stop-Loss Reimbursement Claims Process
Over the past year, SIIA TPA and stop-loss carrier members have been participating in organized discussions focused how business processes can be improved to reduce the friction that can be associated with stop-loss reimbursement claims, particularly high dollar claims. This session will feature a panel of TPA and stop-loss carrier executives who will share the recommendations that have been developed and invite audience feedback.
PANELISTS: To Be Announced
H16: What Brokers Really Need to Know About Working with TPAs
The broker-TPA relationship is critical to the successful establishment and ongoing management of self-insured group health plans. Given this importance, brokers/advisers need to fully understand the role of the TPA and how it interacts with plan sponsors, stop-loss carriers and cost management vendors. Particularly important on the front end is how brokers/advisers facilitate information flow between plan sponsors and TPAs. This session will feature top industry expertise who tell you what you really need to know to have a positive relationship with your TPA partners.
CWI Benefits, LLC.