SmartDecision Webinar - August 2021

Creating Value Beyond Reference Based Pricing

Recorded August 4, 2021


Program Length: 50 minutes

HealthSmart’s Approach to Reference Based Pricing 

As the cost of health benefits continues to rise faster than the rate of inflation, many plan sponsors are looking for alternatives to traditional PPO networks. Plan sponsors want benefits administration partners that can deliver creative and comprehensive solutions that control costs while delivering high quality clinical outcomes and member satisfaction. SmartDecision, HealthSmart’s approach to Reference Based Pricing (RBP), offers a unique alternative.
 
Reference based pricing refers to a reimbursement system for hospitals and other facilities that provides reimbursement based on a multiple of Medicare, rather than a discount from billed charges, as most PPO networks function. HealthSmart offers a comprehensive alternative to traditional RBP programs. Our concierge hosts help members navigate the health system, which contributes to a less stressful member experience and to higher compliance with treatment recommendations. We also offer a bundled approach to non-emergency procedures that includes both facility and professional fees to provide high quality care with no deductibles for members and no balance billing in several markets.
 
In this webinar, Craig Julien, EVP, TPA Operations for HealthSmart and Kevin Glass, VP of Business Development for HST,  will discuss how providing a superior member experience combined with industry-best benefits administration can change the frame of reference from pricing to value. 

Attendees will learn:
  • How a Reference Based Pricing program compares to traditional PPO networks;
  • How SmartDecision protects members from balance billing, collections and credit across their RBP program;
  • How a comprehensive concierge approach to managing the member experience improves satisfaction while reducing benefit costs;
  • How bundled pricing for non-urgent episodes of care, inclusive of facility, professional and ancillary fees creates higher value for self-funded plans in select coverage areas; and
  • How pricing and quality transparency matched with technology and clinical judgement deliver overall average savings of 70 percent or more from billed charges; and
  • How industry-leader HST’s services combine with HealthSmart’s SmartDecision program to create greater value than conventional approaches to RBP

Speakers: 

Craig Julien
Executive Vice President, HealthSmart

Craig Julien joined HealthSmart in 2016 as Senior Vice President of Operations for the Company’s eastern region. In 2018, he was promoted to Executive Vice President, TPA Operations, overseeing HealthSmart's core operational and service functions for medical, dental, vision, COBRA, FSA and STD claims administration.

Prior to joining HealthSmart, Craig served as Vice President of Global Operations for TriZetto, a Cognizant Company, where he was responsible for all aspects of claims operations, including receipt and entry of membership data, plan building, account management, inventory management, claims processing and customer service. He has 20 years’ experience in BPO operations, 10 years’ experience in the healthcare payer vertical and eight years' experience with the QNXT and QicLink platforms. Prior to his experience at TriZetto, Craig held senior level roles with Kenexa Technologies (an IBM Company), Ceridian, and CNA Insurance Companies. Craig holds an MBA from University of California – Irvine, a BS in Business Administration from University of Phoenix, and a number of certifications, including a Six Sigma Green Belt.

 

 

Kevin Glass
Vice President, HST

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For over 22 years Kevin has been highly successful at driving business growth and transformational success within the healthcare industry.  Kevin has worked with managed care, diabetes and medical management companies holding senior leadership roles in each.  He was recognized as “Leader of the Year” & “Representative of the Year” multiple times throughout his career.  He continues to make invaluable contributions in the areas of leadership, sales, product development, reference based pricing, and account management.  Kevin created proprietary programs that increased profits exponentially and attributed to him closing some of the most prestigious clients in the industry.  Prior to HST, Kevin lived in London, England consulting for healthcare IOT and connected care-based technology organizations. 

Kevin completed his B.S. Degree in Healthcare Administration with honors from Southern Illinois University.

 

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