Building a successful self-funded health plan demands skilled and efficient vendor partners that have the expertise to deliver on their promises. Identifying the best vendors can be challenging, and settling for substandard partners can lead to less-than-desirable outcomes. But how do you find the best partners?

On this episode of ClaimTalk, Emma Fox, CHVA gets brutally honest during the first half of a two-part conversation with Danielle Young, Bruce Hansen and Stephanie Mohr on the struggles that can arise with vendors. While a good portion of the discussion centers on the issues they've experienced with third-party administrators, they also discuss why it can be difficult to find the right partners, the strategies they use to identify dependable vendors, and why some of the most unreliable vendors continue to survive in the industry.

In 2022, Featherlite Trailers partnered with ClaimDOC to begin implementing a new reference-based pricing health plan for its employees. It's no secret that moving to an RBP plan can come with friction but, with Shannon Westin, SHRM-SCP leading its human resources department, Featherlite didn't just endure the change, they owned it. 

Westin joins Danielle Young and Amy Hansen on ClaimTalk this month to share how taking the time to truly understand the plan and being proactive in resolving potential issues caused watercooler talk to shift from uncertainty to appreciation. 

If your organization sponsors a self-funded health plan and cybersecurity isn’t part of your vendor evaluation criteria, it’s time to reassess. Protecting your own infrastructure is essential, but it’s not enough. Every vendor with access to your data must meet rigorous cybersecurity standards. Otherwise, you're not just accepting risk, you're creating it.

In this episode of ClaimTalk, Andrew Smith and Jeremy Schuller share with Danielle Young some of the threat tactics that cybercriminals are using today and discuss best practices in evaluating vendors to ensure your data will be secure.

Paying cash for healthcare services is not a new concept, but it's also an option that is not widely used. The reason for that is because many providers prefer to accept reimbursement from insurance. But cash pay does have its advantages.

On this episode of ClaimTalk, Danielle Young visits with Amy Pellegrin and Leah DeBartolo about the pros and cons of cash pay, how health plans can create service around cash pay, and what stands in the way of cash becoming a more popular payment option for healthcare.

For nontraditional health plans to work — whether they use reference-based pricing or another strategy — they often require customized solutions. As health plans evolve, vendors can't ignore new methods to give plan members what they need.

In this episode of ClaimTalk, Amy Pellegrin and Stephanie Mohr visit with Sharla Mallett, a member of our direct primary care team. They discuss how the DPC team works to give members a more personalized health plan experience and why making adjustments to health plans is crucial to providing a positive member experience.

Whether you're using a reference-based pricing strategy or some other alternative, there are many challenges in creating an effective direct contract. Much of the time, they boil down to the complexities of healthcare pricing in one way or another. Whether it's compliance with regulations, plan design or services billed by a third party, creating an effective direct contract requires a partner with the expertise to help you maneuver through all elements of the agreement.

This month, Jay Kempton, Shane Cerone and Brad Hansen return to ClaimTalk for the second half of an in-depth discussion on direct contracts and how to navigate inconsistencies in healthcare pricing. 

Healthcare access can be the biggest hurdle to successfully implementing a reference-based pricing plan. Sometimes it requires creating an agreement called a direct contract between a health plan and a provider to ensure access to that provider. Direct contracts are an effective tool for RBP health plans, but they can be more complicated than they sound. 

On this month's ClaimTalk, experts Jay Kempton, Shane Cerone and Brad Hansen discuss the complexities of direct contracts and their impact on the rising cost of healthcare.

Claim denials are a complex piece of the healthcare system, and they can cause frustration for patients and providers alike. There are many reasons claims can be denied, whether it's due to technical errors, subrogation or if it's deemed not medically necessary.

Experts Alex Arnet, Colton Casonand Carrie Kennedy join this month's edition of ClaimTalk to peel back all the layers of claim denials and share their insights on how its time to rethink this process.

A strong balance bill defense is essential to a successful reference-based pricing health plan. But what does that look like? And how do you know what you're being offered isn't just lip service? The answer is fiduciary responsibility.

ClaimDOC Balance Bill Manager Alex Deeter and Chief Legal Officer Amy Pellegrin join this month's edition of ClaimTalk to discuss why it's important to choose a partner that sees balance bill defense as an obligation rather than a service.

In the second half of a two-part episode on PBMs, experts Marc A. Sweeney, Trevor Daer and Mike Kroupa return to discuss some of the intricacies of the pharmaceutical industry. They tackle complex topics like international drug sourcing, specialty drugs, GLP-1s and more.