Join Our Webinar:
Strategies to Stem the Rising Tide of High-Cost Medical Claims for Self-Insured Employers
Date: October 9, 2024
Time: 2 PM EST | 11 AM PST
The rise in high-cost medical claims is an alarming trend that poses a significant threat to the financial stability of self-insured health plans. These claims, often tied to complex and chronic conditions such as cancer, cardiovascular diseases, and neonatal care, can escalate to millions of dollars, jeopardizing the fiscal health of the organizations that bear the burden.
Claims exceeding $1 million have grown by 50% over the last three years. And as the percentage of self-insured employers facing claims over $1 million continues to rise it’s clear that innovative solutions are urgently needed.
Capture these strategies and learn how they can be applied to your health plan by joining our upcoming complimentary webinar. Hosted by industry leaders Kari Niblack, JD, President, Blackwell Captive Solutions, and Anna Quarum, President, WellRithms, this webinar will provide actionable insights and practical tools to protect your plan from high-cost claims.
Understanding the Threat
The consolidation of healthcare systems, coupled with the acquisition of medical groups and surgery centers by private equity firms, has driven an increase in these exorbitant claims. Moreover, regulatory changes such as the Affordable Care Act and the No Surprises Act have altered the landscape, placing additional pressure on employers to manage these escalating costs effectively.
For self-insured employers, the financial exposure is direct and severe. Unlike fully insured plans, where the insurance carrier absorbs large claims, self-insured plans bear the full brunt of these expenses. Without a robust risk management strategy, the viability of these plans can be seriously compromised.
A New Approach to Risk Management
To combat this rising tide, WellRithms developed a unique, first-to-market captive solution that indemnifies plan sponsors from overbilling. This innovative approach combines advanced captive strategies, comprehensive medical bill review, and precise repricing methods to provide a shield against the financial devastation of high-cost claims.
Beyond WellRithms captive focused on individual payors and discrete bills, captive insurance arrangements bringing together a number of self-insured organizations are becoming increasingly popular among employers as a way to mitigate risk. By pooling risk with other similar organizations, employers can stabilize costs and reduce the volatility that comes with unpredictable high-cost claims. This approach is particularly attractive to small and mid-sized employers who may lack the financial resources to absorb large claims on their own.
Real-World Success Stories
The effectiveness of these strategies is evident in real-world examples where employers have seen substantial reductions in claim costs:
- Newborn Care: A hospital billed $119,245 for five days of care in a Level II Neonatal Special Care Nursery. After a thorough review, the bill was repriced to $14,810—just 12.5% of the original charges.
- Surgical Procedures: A podiatrist’s assistant surgeon billed $169,410 for two common procedures performed on a single patient. Following clinical bill review, the charge was reduced to $632.
- Oncology Surgery: A surgeon billed $99,380 for three mastectomies performed on a cancer patient. After review, the bill was reduced to $3,072.
These examples highlight the transformative impact that WellRithms’ advanced bill review and repricing can have on a health plan’s bottom line.
Webinar Highlights
- How to save your clients, yourself, and plan participants millions of dollars every year.
- The most precise applications of advanced captive strategies, medical bill review, and repricing methods available.
- The latest advances in technology, AI, and clinical bill review.
- How to protect brokers, plan sponsors, and participants from illegitimately inflated cost claims.
The financial stability of your health plan depends on your ability to manage high-cost claims effectively. By embracing innovative solutions like stop-loss captives and rigorous bill review processes, you can safeguard your organization from the financial pressures of escalating healthcare costs.
Don’t Miss Out! Register now for this complimentary webinar and take the first step toward protecting your health plan from high-cost claims.
Date: October 3, 2024
Time: 2 PM EST | 11 AM PST
Can’t attend? Register here for an on-demand recording after the webcast.
WellRithms would like to thank BenefitsPRO for providing logistical support for this important event.
For more information visit https://www.wellrithms.com
