Editor’s note: This is Part 1 in a series about self-insured plan success stratgies and tactics. Read part 2 here.
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 more than a decade of experience including independent medical reviews, claims cost containment, hospital negotiations, oncology services and claims repricing.
In 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 advisor — 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 ongoing 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.