This week’s episode features a conversation with Craig Clemente, President & Chief Operating Officer at Specialty Care Management. Specialty care is both a claims exposure and a clinical component and Craig details how plans need to focus on both. He also explains the nuances of the plan document language and the need to have member champions to spread awareness. Finally, Craig discusses the steps plans can take to bring down the extreme costs of specialty drugs and air ambulances.
What You’ll Learn From This Episode:
Quotes:
06:54 “It is really important that we look at this not as a diagnosis in that you cannot be discriminatory in any way in your plan document, whether that’s for again dialysis or anything else.”
13:28 “Ultimately, I think one other key component is you always try to find that individual within the member population that’s going to be your kind of vocal champion, your internal supporter.”
16:48 “Average cost of an air ambulance ride is about $49,000 and many times, it’s much much higher than that. And there’s no real regulation in this space.”
18:24 “We’re seeing that we’re upwards of 70 to 80 percent off total bill charges in those scenarios even with companies that have never traditionally given anything over and above 30 percent historically.”
19:12 “The overarching theme here is risk management and understanding that risk management works well beyond a single BUCA entity, for example, where you’re just putting one solution in place to manage everything.”
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
