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: How We Got to Where We Are
    1. Health care cost drivers and other factors affecting cost (examples)
      1. Fraud and abuse
      2. Pharmacy and special pharmacy
      3. Emerging technology
      4. Plan culture
      5. Population-based issues (e.g., COVID, opioid abuse)
  2. Fundamentals of Managing Providers and Patients
    1. Supply management—Managing providers
    2. Demand management—Managing patients
    3. The importance of data (measuring how the plan is doing and preparing for tomorrow)
  3. The Impact of Technology on Costs and Health
    1. New and emerging technology
    2. Challenges and cost considerations (examples)
      1. Pharmacotechnology
      2. Genomic medicine
  4. Prescription Drug Cost Management
    1. Prescription drug cost drivers
    2. Cost-control opportunities
  5. Basic Strategies for Cost Control
    1. Plan design, contributions, eligibility and coverage
    2. Nontraditional treatment settings
      1. Telemedicine
      2. Retail clinics
      3. Walk-in clinics
      4. Alternative medicine

Day 2

  1. Evolving Health Care Management
    1. Consumerism—Getting the workforce involved
    2. Health care literacy and its impact on behavior
    3. Evidence-based medicine
    4. Network design alternatives
    5. Approaches to reference-based pricing
    6. Worksite medical clinics
    7. Medical tourism—The evolution of centers of excellence
    8. Value-based health care (VBHC)
  2. Putting It All Together
    1. Short- and long-term strategies
    2. Decision points
  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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