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.

There are several key vendor decisions brokers and plan sponsors must make when unbundling a self-funded health plan, including pharmacy benefit management. On a new episode of ClaimTalk, self-funding experts Marc Sweeney, Trevor Daer and Mike Kroupa will help you evaluate if you're making the best decision on your drug spend.

BUCAs may seem like the easy, all-inclusive choice, but they don’t offer the personal, one-on-one assistance most health plan members actually prefer. Plus, no plan sponsor should accept inferior member service — whether big network or reference-based pricing. In this month’s episode of ClaimTalk, Michelle Henaman and Heidi Martinez share the gaps in service you need to DEMAND get filled for your clients.

In this month's episode of ClaimTalk, brokers and industry experts Craig Gottwals and Mike Kerns are back for ADVISORS UNLEASHED — Part 2. They go even deeper into the benefits consulting industry, offering more brutally honest insights you won't hear anywhere else.

This month's edition of ClaimTalk is the first half of a two-part discussion with brokers and industry experts Craig Gottwals and Mike Kerns. They provide an inside look at the benefits consulting industry in a no-holds-barred conversation you won't want to miss.