EP276: Advice for Self-insured Employers and That Prediction of a 4% to 40% Premium Increase in the Fully Insured Market, With Brian Scott From Point6 Healthcare

In this Episode 276, Part 2 of a two-part conversation, Stacey Richter talks with Brian Scott of Point6 Healthcare about advice for self-insured employers and that prediction of a 4% to 40% premium increase in the fully insured market.

WHAT YOU'LL LEARN

✅ Why provider billing behavior shifts triggered by COVID are likely to outlast the pandemic itself

✅ How the fully insured market differs from the self-insured market in its incentive to control costs

✅ What could happen to fully insured carriers who can no longer raise premiums to cover COVID costs

✅ What self-insured employers should avoid doing right now

✅ How to think about cost vs value of care when trying to avoid outlier claims

WHY THIS MATTERS

Brian Scott brings a background spanning underwriting, complex claims management, and stop-loss consulting to the question of where employer health costs are headed post-pandemic. His take: COVID-driven changes in provider billing behavior are likely to stick around well beyond the pandemic itself, and self-insured employers face very different incentives and exposure than the fully insured market, which some predict could see premium increases anywhere from 4% to 40%. For employers trying to avoid big outlier claims, Scott's advice centers on understanding the real cost-vs-value tradeoffs in their plan design rather than reacting to headline premium numbers alone.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

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.