Employees have been moving from fully insured products into employer-sponsored, self-funded benefit plans across the country for over 10 years. Employers typically retain a third party that will provide access to its provider networks and administrative services in exchange for an access fee. At the same time, some employers recognize that they have significant leverage in their healthcare markets, and that they can achieve lower costs in some geographies by negotiating agreements directly with provider systems and certain key providers. This webinar will explore some of the benefits and pitfalls of this emerging “direct-to-employer” trend, including the following:
- Best practices for direct provider-employer negotiations
- Terms in contracts with major plans and leased network arrangements that must be considered
- The role of ERISA
- Key cost reduction drivers:
- Employer-created narrow networks, tiered networks and branded networks
- Reference-based benefit structures
- Advanced payment methodologies
- Direct contracting with digital health
- Data acquisition, retention and use
King & Spalding is an accredited provider of CLE credit in California, Georgia, Illinois, New York and Texas. We can issue reciprocal credit for attorneys licensed in Connecticut, Florida, and New Jersey. We will apply for credit in Colorado, North Carolina and Virginia (subject to MCLE Board approval). For jurisdictions not listed, attendees are provided with a Universal Certificate of Attendance. New York licensed attorneys: Transitional/Appropriate for newly-admitted and experienced attorneys. Financial aid is available for qualifying lawyers. For CLE-related questions, please contact Gisel Arias, firstname.lastname@example.org. King & Spalding, 1180 Peachtree Street NE, Atlanta, GA 30309. CA Provider #10947.
General information on our practice is available in our electronic publications Serving the Life Sciences Industry and Serving the Healthcare Industry. If you would like to be included on our regular pharmaceutical manufacturers, medical device manufacturers or healthcare provider mailing lists to receive notices of other events and written updates, you can be added by submitting your full contact information to email@example.com and specifying the list you wish to join.