Caroline Loy is Principal Product Strategist at Turquoise Health.

In this episode, she explains what health plan design is, the decisions employers make when designing or buying plans, and how plan design affects care.

• (00:00) - Intro
• (00:15) - What is health plan design?
• (01:35) - Who decides plan design?
• (02:32) - What are self-funded vs fully insured plans?
• (04:32) - How do employers choose between self-funded and fully insured plans?
• (06:44) - What are the levers employers can pull during plan design?
• (09:43) - How many employer plans are self-funded vs. fully insured?
• (10:27) - Employer access to claims data with self-funded plans
• (12:36) - How would an employer build a self-funded plan?
• (13:52) - Broker, TPA, and carrier: What does each do?
• (16:57) - The questions employers ask during plan design
• (19:33) - What does the plan design process look like?
• (21:02) - Can employers incentivize behavior through plan design?
• (23:50) - How does plan design impact providers?
• (25:12) - How does plan design affect collections?
• (27:35) - What are accumulators? How do they affect predicting patient responsibility?
• (31:53) - Revenue cycle management (RCM) for providers
• (35:01) - What does Stedi do?
• (36:25) - How does Turquoise Health help providers predict patient responsibility?
• (38:38) - What is the difference between CPT codes and Service Type Codes?
• (43:20) - What are contracted rates?
• (45:42) - Who are Turquoise Health's customers?
• (46:36) - How would Caroline change revenue cycle management?
• (48:31) - Outro