In this health care podcast, I talk with Brian Scott. Brian has a background which is perfect for the question of “Will employer health care costs go up or will they go down as a result of this pandemic?” First, Brian was an underwriter at United. Then he was in a dedicated complex claims group for Lockton that managed self-funded plans. And now he’s at Point6 Healthcare, where he works to put together the best-value plan for employers, including getting stop-loss. Brian works with TPAs (third-party administrators) across the country to this end.
So, this conversation that I had with Brian is a two-part affair: The first episode (episode 275) was mostly about the specific additions as a result of this pandemic used in cost models and also what some self-insured employers are doing or considering doing to address the underlying risk factors that might help drive up costs in a plan. This, however, is episode 276; and it includes Brian’s advice for self-insured employers, as well as a look into the fully insured market. Why there have been those estimates that costs will go up 4% to 40% when premiums are re-upped, Brian has some thoughts.
You should definitely listen to both episodes (275 and 276), although you probably don’t need to listen to them in order if you just happened to hit on this show first.
You can learn more at point6healthcare.com and brian.scott@point6healthcare.com. You can also connect with Brian on LinkedIn.
Brian Scott is an assistant vice president at Point6 Healthcare. He joined the team in 2019 to implement and lead a new type of ICU related to self-funded employers focused on implementation, consulting, and underwriting strategies on behalf of self-funded benefits plan sponsors. Point6 is an authority on employer-sponsored self-funded health care financing and risk transfer strategies in the United States and maximizes the value of interactions between those providing, receiving, and financing health care.
Brian has also worked as the strategic consultant for a major consulting firm specializing in employer stop-loss and cost-containment strategies, where he managed administrator and carrier relationships and opportunities, risk transfer strategies, and self-funding overall, while growing a team to ultimately handle stop-loss placements nationwide. Prior to that, Brian worked as a senior underwriting consultant for a BUCA managing stop-loss negotiation and placement, administration, and pharmacy pricing for large and complex self-funded, fully insured, and HMO cases.
Brian works to maximize employer strategies for managing high-cost claimant risk, focusing on opportunities to enhance plan designs, administrator-specific gap avoidance, and cost-containment processes. Brian has assisted with the formation of medical stop-loss captives, merger and acquisition risk coverage strategies, fully insured to self-funded conversion strategies, and reference-based pricing and alternative funding concerns as well.
02:48 What health care costs and revenue look like further out—2021.
06:13 Can and will employers meaningfully impact the price of care?
07:59 “A lot of it has to do with, ‘Who do I receive direction from?’”
10:54 The fully insured market vs the self-insured market.
14:15 The cost of care for COVID-19 cases and the cost of care for cases that turn out not to be COVID-19.
14:41 “Provider billing behavior is going to be impacted well beyond COVID.”
16:02 Covered California in the time of COVID-19.
17:15 Does a fully insured carrier have the incentive to cut costs?
17:40 What will happen to fully insured carriers who can no longer raise premium costs to cover COVID-19 costs.
19:13 What self-insured employers shouldn’t be doing right now.
20:07 Examining cost vs value of care.
23:42 “How can you create the best chance that you’re not going to have really big outlier costs on your plan?”
24:35 Where the name Point6 Healthcare came from.