BROADCASTS.com

This episode\u2019s conversation is about the new Consolidated Appropriations Act (CAA), the fee disclosure part of it, as well as ERISA and the fiduciary responsibility that self-insured employers are responsible to comply with under the law. Don\u2019t worry, the first thing my guest in this healthcare podcast, Christin Deacon, does is explain these terms, what they actually mean, and how they can be a tool actually in CEOs\u2019 or CFOs\u2019 toolboxes to get access to the employer\u2019s own claims data, which is a linchpin here that we\u2019ll talk about in a sec.

But suffice to say here that the ERISA fiduciary responsibility has a few provisions and, in general, self-insured employer health plan administrators kind of tend to off-load worrying about these provisions to their brokers and consultants. The problem with this is that brokers and consultants do not bear the ERISA fiduciary responsibility. They do not bear the responsibility of complying with the CAA either. The employer does.

You\u2019d think that, given this, more self-insured employers would dig in hard to do their own due diligence to check whether or not their plan is compliant. But they don\u2019t. I asked Parker Edman from Leavitt Partners why, and he said he thought that it\u2019s likely a combination of the \u201cold boy\u2019s network\u201d and a fear of the massive lift that switching up plan designs or even looking at this might entail.

But here\u2019s another facet: There\u2019s a contingent of plan advisors and carriers who have a very vested interest in self-insured employers not knowing what\u2019s going on with their spend. And they actually even have a magic trick that they have developed to beat back inquiries.

In this magic trick, HIPAA is the abracadabra. Let me give you an example role-play.

Self-insured employer: I need my claims data.

Carrier: HIPAA.

Self-insured employer: Nooo, not the HIPAA. I stand down. Forget I mentioned it.

Here\u2019s a pro tip: Actually read HIPAA. Pull it up on your computer. It\u2019s easy to find. Spoiler alert: You know what you\u2019ll discover? Ninety percent of it is a love note to the carriers themselves that govern the data they must possess and the structure of that data.

Ten percent of it is about the privacy of that data, and in that 10%, it specifies clearly that a self-insured employer is a covered entity and, therefore, falls under the umbrella of who can have access to claims data, especially if it is deidentified.

Of course, said employer has obligations as to how to treat that data, but yeah, just don\u2019t be fooled by the HIPAA when it\u2019s wielded like sorcery. The only reason that word has any power is because so many C-suites let it have power.

Also now, there\u2019s some provisions in the Consolidated Appropriations Act, the CAA (which was passed in 2020), which really ups the ante here. My guest, Christin Deacon, explains all of this and more, including what\u2019s up with the CAA, which is good because I could barely remember the name of it throughout the course of this interview.

Christin Deacon is a healthcare leader and public-sector entrepreneur. She is a former deputy attorney general, a \u201crecovering attorney\u201d as she calls herself. Earlier this year, 2021, she left her role running the state health and school health benefits plan for about 800,000 New Jersey public employees. Now, she\u2019s just transitioned to the private sector where she serves as an executive VP at 4C Health Solutions.

Christin Deacon is a healthcare thought leader who brings with her a wealth of experience in both public and private sector. Driven by her passion to change the healthcare system to truly benefit patients and payers, she focuses on bringing solutions and agency to self-funded and government-sponsored health plans.

\xa0

\xa0

04:10 What is ERISA, and what does it stand for?
05:40 What is a fiduciary obligation for an employer?
08:18 \u201cWe\u2019re now at a point of spending 17.7% of our GDP on healthcare costs.\u201d
09:39 \u201cYou absolutely have the keys to \u2026 controlling that spend.\u201d
13:35 \u201cYou have to own your data.\u201d
15:04 \u201cIf you don\u2019t have your claims data, how do you know you\u2019re paying reasonable fees?\u201d
15:31 \u201cIf your carrier is telling you, \u2018Oh, HIPAA \u2026 you can\u2019t look at your data,\u2019 you need to pull out that red BS card.\u201d
16:25 How do employers navigate carriers refusing to share claims data?
21:36 \u201cIt has only as much teeth as the self-funded employer is \u2026 willing to learn about it and \u2026 willing to push back.\u201d
22:22 \u201cThis is not aspirational; this is an absolute floor.\u201d
24:11 \u201cWhat does value mean?\u201d
27:41 \u201cBecome familiar with HIPAA beyond just the privacy piece.\u201d
29:30 \u201cAt the end of the day, it\u2019s about people.\u201d
29:38 \u201cIf you\u2019re not paying reasonable fees, you\u2019re using plan assets to enrich others.\u201d
32:21 \u201cThe self-insured market \u2026 they hold the keys to unlocking value. And they\u2019re holding them; they just have to use them.\u201d
34:10 Marshall Allen\u2019s new book.

@deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is ERISA, and what does it stand for? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What is a fiduciary obligation for an employer? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cWe\u2019re now at a point of spending 17.7% of our GDP on healthcare costs.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cYou absolutely have the keys to \u2026 controlling that spend.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cYou have to own your data.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cIf you don\u2019t have your claims data, how do you know you\u2019re paying reasonable fees?\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cIf your carrier is telling you, \u2018Oh, HIPAA \u2026 you can\u2019t look at your data,\u2019 you need to pull out that red BS card.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How do employers navigate carriers refusing to share claims data? @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cIt has only as much teeth as the self-funded employer is \u2026 willing to learn about it and \u2026 willing to push back.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cThis is not aspirational; this is an absolute floor.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cWhat does value mean?\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cBecome familiar with HIPAA beyond just the privacy piece.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cAt the end of the day, it\u2019s about people.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cIf you\u2019re not paying reasonable fees, you\u2019re using plan assets to enrich others.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

\u201cThe self-insured market \u2026 they hold the keys to unlocking value. And they\u2019re holding them; they just have to use them.\u201d @deacon_christin of @4CHealth discusses the #CAA and #ERISA for #selfinsured #employers on our #healthcarepodcast. #healthcare #podcast #digitalhealth

Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster