Health Care Cost Management Course Outline

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Rising health care costs, new technology, new drugs and changes in the health status of participants have led to coverage challenges never faced before. Any of these can result in individual claims exceeding $1 million. 
 
It is critical to understand these challenges and how to address them in plan documents. To be most effective, cost-management actions should be taken within the broader framework of other steps the plan has already taken or should be taking. 
 
There is no single strategy for reducing cost trend or avoiding unnecessary expenses. An organization’s approach to managing health care costs will depend on many factors, including the specifics of the organization, the employee population, the organization’s location and the available options.  
 
This session explores the entire landscape of health care cost trends and cost-containment strategies, with special emphasis on today’s emerging land mines. 

Day 1

  1. Health Care Influences and Trends: Where We've Been and What Is Changing
    1. Cost Influencers and Trends
    2. The Impact of Medical Technology
      1. New and emerging technology
      2. Challenges and cost considerations (examples)
        1. Pharmacotechnology
        2. Genomic medicine
    3. The Cost Impact of Prescription Drugs
      1. Prescription drug cost drivers
      2. Cost-control opportunities
    4. Beyond the Pandemic
    5. Predicting Your Health Care Trend
  2. The Importance of Your Data
    1. Data Analysis
    2. Sources of Health Care Data
      1. Medical claims
      2. Pharmacy and Specialty Pharmacy Claims
      3. Enrollment/eligibility statistics
      4. Health Risk Assessments
    3. Prescription Data
  3. Basic Strategies for Cost Control
    1. Basic Plan Elements
      1. Coverage
      2. Eligibility
      3. Contribution Strategies
      4. Plan Design
    2. Price and Utilization Management
      1. Basics of Utilization Management
      2. Price Management
      3. Reference-Based Pricing
      4. Controlling Drug Costs
      5. Managing Fraud and Abuse
    3. Network Designs
      1. PPO Network Design
      2. Direct Contracting
      3. Work Site Clinics
      4. Non-Traditional Treatment Settings
    4. The Patient Side of Cost Control
      1. Promoting Health and Reducing Health Risk
      2. Consumerism
      3. Health Literacy

 

Day 2

  1. Evolving Issues in Health Care Cost Management
    1. Evidence-based medicine
    2. Value-Based Health Care
    3. Accountable Care Organizations
    4. Patient Centered Medical Homes
    5. Precision/Personalized Medicine
  2. Putting It All Together
    1. Opportunities for Reducing Costs or Lowering Trend
    2. What You Decide to Do Will Depend on Who You Are
    3. What You Decide to Do Will Also Depend on Where You Are
    4. The Levers to Consider
    5. Longer Term Strategies to Improve Workforce Health
  3. Case Studies
    Attendees will be divided into several groups to explore alternatives for controlling the costs of a hypothetical plan sponsor. In each of two breakout sessions, they will create a business plan that proposes both short- and longer term, broad-based solutions to the problem of rising costs through changes to the health care plan.

    The hypothetical plan sponsors may be multiemployer, public sector or commercial, depending on the cross section of the attendees.

    The case studies allow attendees to explore various topics from within the session and are wonderful opportunities to exchange real-time ideas.

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