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Digital EditionHow All Star Mehb Khoja Put Health Care Cost Containment Front and Center
When employees need ongoing treatment for costly illnesses like hemophilia, employer groups understand that expenses can reach catastrophic levels. But as treatments advance, claim costs are skyrocketing.
Often self-funded, these groups look to stop-loss insurance for relief, expecting their plans to absorb costs that can easily exceed the $2 million mark.
Mehb Khoja, chief actuary at BCS Financial, and his team saw claims reach these levels six times in 2022.
Although insurers and reinsurers typically exclude high-cost claimants such as those living with hemophilia from coverage — placing the cost burden back on employers — Khoja’s team has been diligently working to educate BCS Financial’s customers about a different approach to handle these claims.
BCS, owned by all 34 primary Blue Cross Blue Shield licensees and the Blue Cross Blue Shield Association, developed BCS RiskNavigator using clinical expertise and insights from patient advocacy groups, with the intended goal of optimizing care for members and reducing overall claim costs.
However, Khoja acknowledged that this solution was overlooked before he joined the team in 2020.
“Our clients didn’t know how to utilize [it] until we went on a mission to inform [them] about better ways to engage our solutions that can help save them money — which ends up saving their customers money — and it’s a win-win for all of us.”
In concert with Melody Bautista, the director of clinical data analytics, and Jennifer Warren, the manager of claims, Khoja has amplified the benefits of employer groups tapping into the cost-saving resources available through BCS RiskNavigator.
The primary barrier that this tool removes is related to communication and data sharing, Khoja explained. For instance, when claim liability reaches the reinsurer level, “we may need some baseline information about the patient and where the claims were incurred,” he said.
Obtaining this information from employer groups, however, can be challenging due to privacy and other concerns.
“Because everybody needs to be careful in what they’re sharing,” Khoja acknowledged.
As Khoja’s team has highlighted, thanks to the quality-of-life and cost-saving resources available through the BCS RiskNavigator program, employer groups have become increasingly interested.
In collaboration with the program’s vendors and by finding ways to safely share patient data, all parties have started benefiting from the solution.
One case involved a hemophilia patient on three different medications with average claim costs exceeding $500,000 per month. The new approach maintained top-shelf medical attention for the patient and reduced claim costs by 85%.
“When our customers see [outcomes like] that, they want to engage those solutions,” Khoja said. &
Every year, Risk & Insurance selects deserving candidates to become Risk All Stars. These are risk managers who, through their perseverance, passion and creativity, make a big difference to the stability of their organizations.
See all the 2023 Risk All Star Winners here.
