EP471: High-Cost Claimants in 2025 and Beyond—What Is Really Expensive Not to Know? With Christine Hale, MD, MBA

Recently on Relentless Health Value, we’ve been tinkering around with a few recurring themes—recurring through lines—that are just true about American healthcare these days.

In this episode of Relentless Health Value, host Stacey Richter speaks with Dr. Christine Hale about high cost claimants and the implications for healthcare plans in 2025 and beyond. They discuss the importance of trust in patient care, the financial incentives behind patient steering, and the critical role of timely and comprehensive data analysis.

Dr. Hale emphasizes the need for an integrated approach to medical and pharmacy claims data to avoid expensive consequences and improve patient outcomes. She also shares strategies for plan sponsors to effectively manage high cost claimants through evidence-based care, appropriate treatment settings, and creative problem-solving, while underlining the importance of patient engagement and satisfaction.

Don't miss next week's episode with Dr. Eric Bricker for a deeper dive into these topics.

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05:22 What is a high-cost claimant, and how is the definition changing?

07:42 Why buy-and-bill pharmaceuticals can be so costly for plan sponsors.

10:19 What are plan sponsors getting wrong about this situation?

11:28 What do you need as an employer to understand your plan data fully?

13:41 EP462 with Scott Conard, MD.

17:35 What are plan sponsors currently doing that they should not being doing?

19:54 Why starting small is important.

23:02 EP468 with Matt McQuide.

25:37 What are the steps employers should take to improve their high-cost claimant spend?

31:02 EP371 with Erik Davis and Autumn Yongchu.

33:46 EP467 with Stacey.

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard