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Tiered Provider Networks: BCBS-SC Explores Learnings and Future Potential

  • November 06, 2019
  • 12:00 PM – 1:00 PM ET
  • online
about

Health plans have a unique opportunity to guide members to the right provider and care setting by improving their network optimization strategies (e.g. elite, narrow, tiered, etc.). Obviously, steering members to a network of providers who excel in quality of care, ease of access at the lowest cost would be the objective for optimizing a provider network, but what does it really take to get there?

During the webinar, the speakers will explain how they used data analytics reporting to track and manage their tiered networks by focusing on steerage, utilization and other specific metrics – and how it has changed over time. Attendees will get insight into BCBS of South Carolina’s experiences with their tiered network, some valuable lessons learned along the way and what the future holds.

 


Speakers


Mike Harris
Vice President of Sales
BlueCross BlueShield of South Carolina

Mike is a graduate from the University of North Carolina-Greensboro with a bachelor’s degree in Management and Marketing from the Bryan School of Business and Economics. Mike has 34 years’ experience in the insurance industry and is responsible for sales and marketing for Large Groups, National Accounts, Association Group plans, Chamber Association Sales and Student Health Plans in South Carolina through three Regional Offices located in Greenville, Columbia and Charleston. Mike has earned his Health Insurance Associate (HIA) designation, NAHU PPACA Certification designation and is active member and past president of the local National Health Underwriters Chapter, active member in the State Chamber of Commerce and Vice President Executive Board member for the Indian Waters Chapter of the Boy Scouts of America.


Brent Raymond
Senior Director, Health Plan Services
Health Data & Management Services, Inc. (HDMS)

Brent Raymond is a senior director of health plan client services for HDMS, a health care analytics company. He is responsible for customer experience supporting health plan clients using analytic services and products. Brent works with customers to help support and build strategies that advance analytic agendas to ultimately deliver maximum value to their health plan sponsors and employees. His background previously working for a large health plan allows valuable insight into what is necessary to insure successful outcomes.

He received his bachelor’s degree in Business Administration with a major in Management Information Systems from Central Michigan University.