Shift Shapers Podcast

18 Jul 2016

Ep #119: Strategies and Tactics for Self-insured Plan Success – Part 2 – With Peter and Stacy Borans

David Saltzman 0 Comments


It’s all about risk management! Learn how today’s successful plans incorporate clinical expertise, financial understanding, and cutting edge cost containment strategies to deliver outstanding year-over-year results.

Peter and Dr. Stacy Borans, provide the tools, techniques, strategies and tactics self-insured plans and their advisors need. The founders of Advanced Medical Strategies, they have over a decade of experience including independent medical reviews, claims cost containment, hospital negotiations, oncology services and claims repricing.

On this two-part series Peter and Stacy begin with a discussion of how the self-funded landscape has changed and what opportunities that provides for advisors – even those working in the smaller mid-market segment. We explore the high-level concepts and strategies that clients are finding successful and the concepts needed to have that initial and on-going self-insurance discussion with first-time self-insured groups.

Then we dig into a look at the biggest cost drivers: high-dollar claims, chronic disease and pharmacy spend. We also look to the future – a day when we will be doing more prospective than retrospective review, where predictive modeling will be far enough in front of potential claims so illness can be managed by looking out the windshield rather than viewed through the rear-view mirror. We also touch on the growing impact of reference-based pricing and the future of networks as we know them.

Join us on this second part of the conversation as we discuss how the fully insured vs. self-funded landscape is changing, as well as the essential concepts advisors need to understand in that arena. Don’t miss this opportunity to find out how you can deliver more value by bringing together clinical expertise, financial understanding, and cost containment.

What You’ll Learn From this Episode:

  • Whether the fully insured vs. self-funded landscape is changing, and how.
  • What concepts advisors need to understand.
  • How a plan can handle high-dollar claims.
  • The impact of chronic disease.
  • How closely advisors should watch drug spend and what drives that component of claims costs.
  • How we can start looking out the windshield rather than out the rear view mirror.
  • How reference based pricing and narrow networks will impact claims.

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