AH093 - Health Benefits that Work for Everyone: Aligning Incentives & Focusing on Members’ Needs, with Susana Villegas Spillman

Episode 93 of Astonishing Healthcare features Susana Villegas Spillman, who brings over 20 years of health benefits plan management experience to the studio for a discussion about what works, what’s broken, and what employer plan sponsors deal with day in and day out. This “unfiltered perspective” from the plan sponsor’s seat is welcome and timely. If you’re one of the increasingly large percentage of benefits directors, CHROs, CFOs, et al. out there looking to transition from a traditional benefits experience to a new, transparent, aligned, unified model, this episode is for you!Susana explains how a fragmented system fails members, and while we’ve evolved from the default “call the number on the back of the card” - which directs you to the emergency room - point solutions create more silos, and data is too scattered and stale to drive meaningful change. This forces employers to take control, which leads to her “most astonishing thing,” which is a critical reminder for every benefits leader: “Know what’s in your contracts.”Episode 93 covers:The importance of centering the strategy around long-term goals and member experience (with ruthless accountability).The upside of unbundling services from carriers and using independent navigation partners to guide members to high-quality care; why culture fit and flexibility matter when evaluating vendors.Why qualitative measures of success offer a better gauge of program effectiveness vs. empty promises of ROI.The evolving role of benefits consultants, and how to evaluate consultant relationships.The outdated RFP processes and how to run a better RFP.GLP-1 coverage for weight loss.Related ContentHealth Benefits 101: The Importance of a Transparent PBM ModelWhy this benefit leader switched to a more modern, transparent PBMReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessAH078 - More About Judi Health™ & the Unified Benefits Experience, with Dr. Sunil Budhrani and Mike TateCheck out our Health Benefits 101 ContentFor more information about Capital Rx and this episode, please visit Judi Health - Insights.