Episode-Based Benefit Plans: The Right Way to Do Reference-Based Pricing for Employees

U.S. employers have implemented reference-based pricing programs since 2009. As healthcare prices continue to grow at a rate that outpaces inflation, and high-deductible health plans are causing employees to reduce the use of high- and low-value services, many employers are looking to alternative benefit plans to keep costs down and employee engagement up.

In this webinar, we will explore:

  • The potential for episode-based benefit plans to be an effective alternative to high-deductible health plans
  • Using episode-based benefit plans to help employees find high-value providers and become more engaged in managing their own health
  • The advantages of adding episode-based benefit plans to a referenced-price product to reduce or eliminate hidden pitfalls of these reemerging products

This is the third of our Executive Webinar Series: Transforming Healthcare with Value-Based Payment & Benefit Strategies.

Register to View Recording 

Original Air Date: August 2, 2018

Roger Francoline
Executive Vice President, Remedy Partners, Commercial Business Lines

James Robinson, PhD, MPH 
Berkeley Center for Health Technology, University of California - Berkeley

Mike Thompson
President and CEO, 
National Alliance of Healthcare Purchaser Coalitions
More on the speakers:
Roger Francoline

Roger Francoline serves as Executive Vice President of Remedy Partners’ Commercial Business Lines and oversees all its day-to-day responsibilities. Since 2016, Roger has led the development of all business and operational requirements to convert and update existing company technology and operational assets to support episode-of-care initiatives in the commercial space. His deep expertise in risk and insurance has allowed Remedy Partners to deploy products for payers, self-funded employers and provider organizations.

Prior to joining Remedy Partners, Roger served as Chief Operating Officer and Chief Administrative Officer at Maas Global Solutions, a global transaction-processing technology company, which served the high-volume/ availability needs of independent sales organizations (ISOs) and merchants in all industries. From 2006 to 2014, Roger served as the Co-Founder and Chief Administrative Officer of TransEngen, a company which facilitated healthcare and financial transaction processing, growing revenue to more than $5 million per year.

Before TransEngen, Roger served as Senior Vice President for Aon Healthcare, where he developed risk products and technology solutions that included working to place a billion-dollar reinsurance program for the newly established Medicare Part D product. From 2000 to 2005, Roger was the Senior Vice President of HealthMarkets, an episodes of care consumer driven health plan. He oversaw product development, compliance, underwriting and the actuarial function for a consumer driven health plan (CDHP) operating in nine states. He was part of the team that developed the methodology and business rules for the first-ever designed “episode of care” benefit. From 1994 to 2000, Roger held senior regulatory and underwriting roles at Coventry Health Plans and MAMSI, which is now a subsidiary of United HealthCare Services, Inc. Roger holds a bachelor’s degree in Economics and Finance from Vanderbilt University and a J.D. from the Columbus School of Law at The Catholic University of America.

James Robinson, PhD, MPH

James Robinson is the Leonard D. Schaeffer Professor of Health Economics, director of the Berkley Center for Health Technology and head of the Division of Health Policy and Management at the University of California, Berkeley. Previously, he was editor-in-chief of Health Affairs, the policy journal of the health sphere. His research focuses on medical groups, hospital systems, health insurance, health care consumerism and capital finance. Dr. Robinson has published over 75 papers in peer-reviewed journals and two books through the University of California Press. Professor Robinson is a member of the board of directors of the Integrated HealthCare Association.

Mike Thompson

Michael Thompson is the President and CEO of the National Alliance of Healthcare Purchaser Coalitions (National Alliance), an association of approximately 50 regional coalitions collectively supporting over 12,000 healthcare purchasers and providing health coverage to more than 45 million Americans. The National Alliance helps to lead improvements in health, wellbeing and value for companies and communities across the country. Prior to joining the National Alliance, he was a principal at PricewaterhouseCoopers (PwC) for 20 years.

Thompson is a nationally recognized thought leader for business health strategies and health system reform. He has worked with major employers and other stakeholders on sustainable cost reduction, integrated health, wellness and consumerism, retiree health, private health exchanges and health reform. Known for developing and promoting collaborative cross-sector health industry initiatives, Mike participated on the steering board of the World Economic Forum’s “Working towards Wellness” initiative and co-founded the Private Exchange Evaluation Collaborative (PEEC).

Prior to joining PwC, Thompson served as an executive with diverse roles with Prudential Healthcare for over 17 years. He is a fellow of the Society of Actuaries, serves on the Health Practice Council, and chairs the Medicare Sub-Committee of the American Academy of Actuaries (AAA). He is also widely recognized as a leading national advocate for mental health and wellbeing and was Past President of the New York City chapter of the National Alliance for Mental Illness (NAMI). Thompson previously was an active member of the board of the Northeast Business Group on Health for 11 years.