The Admin Fee Is a Distraction
Every year the spreadsheet shows up. You scan the PEPM column, brace for the usual back-and-forth, and get ready to grind out a dollar or two in savings....
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Every year the spreadsheet shows up. You scan the PEPM column, brace for the usual back-and-forth, and get ready to grind out a dollar or two in savings....
I've sat through dozens of reference-based pricing pitches, and they all sound the same after a while. Medicare multiples, stop-loss triggers, provider...
The cost of employer stop-loss coverage is on a steep upward trajectory, driven by a confluence of forces reshaping the self-funded health plan landscape....
I've spent the better part of my career untangling the invisible wiring that connects a health plan's promise to what actually happens when an employee...
Every fall, the ritual kicks off with a familiar ache. Consultants project medical trend at 8%, maybe 10%, pointing fingers at the usual villains-specialty...
Value-Based Insurance Design is one of those ideas that sounds like a no-brainer. Make insulin cheap. Make mental health visits free. Nudge people away from...
Step therapy is one of the most widely used utilization management tools in employer-sponsored pharmacy benefits, and its impact on employer healthcare...
For years, ERISA health plan reporting felt like a dusty annual ritual. Your TPA would drop a Form 5500 on your desk, maybe a Schedule A, and you’d check...
Pharmacy benefit managers (PBMs) are the often-unseen architects behind your employees’ prescription drug coverage. They sit between employers, health...
A colleague of mine spent the better part of a year designing a value-based insurance plan that would have made any actuary weep with joy. Zero-dollar...
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