EP478: Stop-Loss Coverage, Part 1: How It Goes Right, And How It Can Go Horribly Wrong, With Andreas Mang And Jon Camire Relentless Health Value podcast

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EP478: Stop-Loss Coverage, Part 1: How It Goes Right, and How It Can Go Horribly Wrong, With Andreas Mang and Jon Camire

5d ago 31:58

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Hey, question for you. Can it ever actually be better for a claim to get lasered? If your knee-jerk reaction is, “Nope. No, not so much. Lasered claims are always bad,” and/or if you have no idea what I’m talking about, do continue to listen. This question gets answered.

For a full transcript of this episode, click here.

If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.

Also, if you are interested in high-cost claimants from almost any angle, this show is, in fact, part of the high-cost claimant run of shows. What you’ll learn 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.

This run of shows, by the way, about high-cost claimants includes episode 471 with Christine Hale, MD, MBA, which spills over into the Eric Bricker, MD, episode (EP472) about high-cost claimants, mostly from the hospital point of view. And yeah, in the same breath as any plan sponsor is gonna say high-cost claimant, they are also likely gonna say stop-loss coverage. So, you can see how this kind of fits into this trifecta here.

So, right, this show is about stop-loss coverage, and as such, maybe you’re thinking this topic sounds a little desperately boring. Like after 470 some shows, I’m scraping the bottom of the barrel. I mean, don’t get me wrong, lasers or laser claims has a cool ring to it and all, but stop-loss coverage? Well, it kind of needs a rebranding.

Stop-loss comes off as, I don’t know, not a ringer as far as compelling podcast titles go; but do not be fooled by its “nothing to see here” name. Stop-loss is, and I’m quoting Andreas Mang, one of my guests today who would know, Andreas says that for any given self-insured plan sponsor, stop-loss is one of the most important buying decisions. I take that to mean plan success or failure might hinge on how well the stop-loss decision gets made.

But danger, Will Robinson, because as Andreas says, a lot of times stop-loss decisions are one of the final calls that winds up getting made in any given plan year. So, it’s so easy to face these really, actually very big decisions while completely exhausted and inadvertently kind of phone it in. But yeah, don’t do that. Big mistake.

So, I gotta tell you, this episode on this topic was really a long time coming. I wanted to talk with someone who kind of didn’t have a horse in the race of selling stop-loss and also knows the stop-loss what the whats inside and out. This was no easy task. It was almost as hard finding someone for the show as it was to find someone to talk about 340B before I managed to find and shanghai Shawn Gremminger (EP448). But I digress.

I’m so pleased to be speaking today to Andreas Mang, who is senior managing director at Blackstone and CEO, Equity Healthcare. I am also speaking today with Jon Camire, who is also over at Blackstone. Jon is managing director and CFO, Equity Healthcare. Jon is an actuary, and he runs their stop-loss program. So, yeah, you can see I’m bringing the big guns here.

Alright, logistics. This conversation about stop-loss is gonna be two shows. This show that you’ll hear today will lock down the basic concepts, dispel some myths (including the nuances of laser claims), and wrap up with the hugest of huge “you better get this right or things can go horribly wrong”—which I’m not gonna keep you in suspense over.

The hugest of huge is pick a really, really good consultant and know how they are paid. It is easy to say this, and you might be yeah, yeah, yeah’ing me. I’ve heard this before so many times. But after listening to Andreas and Jon talk through some of the stuff that we talked through today, it can be a scalding, really expensive hot mess.

So, wow. Yeah, it just drives home why a really experienced unconflicted consultant matters with three underlines.

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 convo, as I said, in two weeks.

I will also mention the earlier show that I did with Andreas (EP419)—it was about a year ago—comes up a bunch of times in the show today. We reference it because, as I said, we talk a lot about the role of the broker in stop-loss and purchasing stop-loss; and we also talk at great length about brokers in that earlier episode.

Normally right now I say, “My name is Stacey Richter,” and then I say, “This show is sponsored by Aventria Health Group.” What I’m going to say instead today is that this show is also sponsored by Havarti Risk, which I am very thankful for. The show 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.

Havarti Risk empowers healthcare leaders like you to make smarter decisions that increase quality and lower the cost of care. Havarti’s cutting-edge approach combines deep industry knowledge and also actuarial expertise with advanced technology to transform how you manage risk and optimize performance.

Imagine having the power to (1) predict financial outcomes, both claim and admin, with confidence; (2) measure performance across value-based care contracts in real time; (3) validate ROI on health innovations, ensuring better care delivery at greater efficiency, like, for example, build a tracking mechanism to measure and validate ROIs (return on investments); and then (4) develop novel capital risk structures tailored to your organization’s unique needs.

So, do please support Havarti Risk. You can visit them at their Web site to take the first step toward greater visibility and control of risk outcomes in your business.

And once again, thank you so much to Havarti Risk for their financial support of this show

Also mentioned in this episode are Christine Hale, MD, MBA; Eric Bricker, MD; Shawn Gremminger; Blackstone; Havarti Risk; Ge Bai, PhD, CPA; and Keith Passwater.

You can learn more at blackstone.com. You can also follow Andreas and Jon on LinkedIn.

Andreas Mang is senior managing director, portfolio operations, and chief executive officer of Equity Healthcare, where he is involved in managing medical benefits spend across the Blackstone portfolio. Andreas brings 20 years of healthcare experience to Equity Healthcare, having held various roles in healthcare finance, operations, and strategy.

Prior to joining Blackstone, Andreas was the vice president responsible for national provider network operations at CareCentrix, a PE-backed, leading home health benefit-management company. At Blue Cross Blue Shield of Massachusetts, he held a variety of roles, including a leadership role identifying and implementing administrative cost savings opportunities throughout the organization and ultimately designing a new corporate business model. In addition, he held roles as the manager of strategic financial planning at Harvard Pilgrim Health Care and was a senior consultant with Deloitte Consulting’s Strategy and Operations group in Boston.

Andreas has a bachelor’s degree in healthcare management and policy from the University of New Hampshire and an MBA from the University of Rochester’s Simon School of Business Administration. He currently serves on the board of DECA Dental.

Jon Camire is managing director for Blackstone and the chief financial officer of Equity Healthcare. He oversees financial evaluation, benchmarking, and modeling of health plan performance optimization for existing and prospective portfolio investments including strategic benefit design alternatives, clinical programming, and innovation partner opportunities.

Prior to joining Blackstone, Jon served as vice president of financial modeling with Unum, spearheading the modernization of the actuarial and financial management capabilities across the enterprise. Prior to Unum, Jon operated his own health actuarial and healthcare reform consulting practice supporting payer, provider, employer, and government clients in navigating the risks and opportunities of the rapidly evolving health system dynamics. Earlier in his career, he held actuarial leadership roles with Blue Cross Blue Shield of Massachusetts.

Jon holds a bachelor’s degree in mathematics from the University of Massachusetts. He is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries.

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?

You can learn more at blackstone.com. You can also follow Andreas and Jon on LinkedIn.

Andreas Mang and Jon Camire discuss #stoploss in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation

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