High-cost claims are on the rise, and with them, plan sponsors are seeing annual stop-loss premium increases in the double digits. For self-funded employers, it may seem like there’s not much that can be done to mitigate these costs, but many purchasers don’t fully understand the many complex factors that go into a stop-loss quote and how to determine the appropriate level of coverage for their organization. Are the specific and aggregate attachment points optimized for the plan? Are there instances where lasers are actually cost effective for a plan? Is additional run-out worth the added cost? Should you be considering additional stop-loss policies for areas like gene and cell therapy?

For this member meeting we’ll be joined by one of the leading stop-loss experts in the country, Jon Camire, Managing Director at Blackstone and Chief Financial and Analytics Officer at Equity Healthcare, to talk about all the nuances and best practices that go into stop loss coverage. Jon will lay out the host of considerations that plan sponsors should be taking into account as they evaluate their coverage options, and he will help equip attendees with the knowledge they need to manage their spend effectively. This presentation will help any employer who is currently self-funding or that thinks they may want to self-fund in the future.

About Jon Camire, FSA, MAAA

As the Managing Director at Blackstone and Chief Financial and Analytics Officer at Equity Healthcare, Jon Camire is responsible for financial evaluation, benchmarking, and modeling of health plan performance optimization for existing and potential Blackstone Equity Healthcare Member Companies, including benefit design alternatives, clinical programming, and innovation partner opportunities.

Prior to joining Blackstone Equity Healthcare, Jon served as Vice President of Financial Modeling with Unum, spearheading the modernization of the actuarial and financial management capabilities across the enterprise.  Prior to Unum, Jon operated his own health actuarial and healthcare reform consulting practice supporting payer, provider, employer, and government clients in navigating the risks and opportunities of rapidly evolving health system dynamics.  Earlier in his career, he held actuarial leadership roles with Blue Cross Blue Shield of Massachusetts, driving employer informatics, Commercial product development, Medicare Advantage and Stop Loss.  Jon holds a B.S. in Mathematics from the University of Massachusetts.  He is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries.

SHRM professional development credits available.

Thank you Clark Insurance and Meritain Health for sponsoring this event!

During Maine’s 132nd Legislature Long Session, LD 1906 (An Act to Improve Accountability and Understanding of Data in Insurance Transactions) was enacted, granting healthcare plan sponsors the right to conduct claims audits. Previously, restrictive contract terms made these audits impossible, limiting both their potential cost savings and transparency. Beginning in January 2026, all third-party administrator (TPA) and pharmacy benefit manager (PBM) contracts for Maine based employers must permit claims auditing.

Join us for a webinar that will provide an overview of claims auditing and hear from a vendor for Maine plan sponsors to consider.

Join HPA on September 24th for a conversation with Michael Bailit, President of Bailit Health, on how states are tackling high hospital prices and healthcare cost growth. Drawing on examples from states like Oregon and Rhode Island, Michael will explore the landscape of state legislatures’ affordability efforts, pros and cons of each approach, and what early outcomes they’ve achieved.

Michael brings decades of experience advising government agencies and employer coalitions in over 30 states. Since founding Bailit Health in 1997, he has helped shape payment and delivery system reforms, including ACOs, Medical Homes, and episode-based payment models. His work also focuses on performance measurement, value-based purchasing, and leading collaborative, multi-stakeholder initiatives to improve system accountability and affordability.

This session will offer valuable insights for policymakers, providers, and purchasers focused on making healthcare more affordable and sustainable in Maine.

Thank you Johnson & Johnson for sponsoring this meeting!

Join us for a virtual event where Lisa Nolan, the HPA’s Director of Strategy and Advocacy, will discuss what happened during the Legislature's long session. We will review the outcomes and implications for the healthcare sector and look ahead to what we might see during the short session. Don't miss this opportunity to stay informed and engaged in shaping the future of healthcare policy.

The webinar will include:

• Overview of Key Bills

• Impact on Employers

• Healthcare System Implications

• Interactive Q&A Session

Who Should Attend:

• Employers in Maine seeking to understand legislative impacts on benefits

• Healthcare professionals interested in healthcare system reforms

• Policy analysts and advocates focused on the legislative landscape in Maine

Don’t miss this opportunity to stay informed about the significant legislative outcomes that will impact employee benefits and healthcare in Maine.

Are you a local Maine business? Contact us to get the registration fee waived.

Access to primary care in Maine is a growing concern, with some patients facing wait times of months—or up to a year—to see a provider. To tackle this challenge, Firefly Health has developed a clinically-integrated health plan that provides employees and their families with dedicated care teams for timely, convenient care within a value-based, affordable health plan.

But can this model work in Maine?

IDEXX has already adopted Firefly Health for its employees and has seen remarkable improvements in access to care, company and employee expenses , as well as preventative care outcomes. Their experience offers a valuable case study in how employers can play a key role in solving healthcare access issues.

Join us on July 24th for a conversation with Firefly Health and IDEXX. You’ll learn how this innovative model works, hear firsthand results from IDEXX’s implementation, and explore whether a clinically-integrated health plan could be the solution for your organization.

This event is approved for 3 SHRM Professional Development Credits. All our events are free to HPA members!

Are you looking for strategies to control costs and better engage employees and dependents? Look no further! The Healthcare Purchaser Alliance of Maine is offering a 3 hour mini-conference where we will share insights into a host of tactics Maine employers are using to deliver higher quality, more affordable healthcare to their employees.

The conference will begin with a networking breakfast, followed by a series of short presentations where we will:

• Explore trends in the healthcare market and examine how they're impacting your employees and business;

• Understand the pros and cons of being fully-insured, level-funding, joining a captive, and self-funding;

• Learn what to watch out for when evaluating TPAs, pharmacy benefit managers (PBMs), and point solutions;

• Better understand how to leverage data to define and track your healthcare strategy;

• Identify a host of cost saving resources and strategies that business of all sizes can employ today!

This event will be a great learning opportunity for any employer who is struggling with high healthcare costs and feels powerless to control year after year of premium increases. We hope you can join us!

Who Should Attend?

The ideal attendee is an HR professional who works for an organization with 50 or more employees on their health plan and wants to be proactive about controlling their organization's healthcare costs.

At our upcoming June 11th event, Thom Walsh, member of Vermont's Green Mountain Care Board (GMCB), will share how his state is leveraging transparency and oversight to address rising healthcare costs. The GMCB is a nonpartisan organization created by the Vermont legislature to provide unbiased information and analysis regarding the performance of Vermont's healthcare system. Its primary responsibilities include offering impartial evaluations of hospitals and insurers and regulating hospital budgets, commercial insurance rates, and statewide reform initiatives. In addition to his role on the GMCB, Thom is an adjunct faculty member at Dartmouth College, where he teaches courses on Health Systems & Policy at the Geisel Medical and Tuck Business schools. He has authored two books and numerous articles on features of U.S. healthcare systems.

Before his appointment to the GMCB, Thom was the co-founder and Chief Strategy Officer of Cardinal Point Health Solutions, a consulting company whose clients included The Joint Commission, Veterans Affairs, Navy Medicine, Boise State University, OneHealth Nebraska, and the University of Tulsa. His background includes direct patient care as a board-certified Physical Therapist specializing in Orthopedics. Throughout his clinical career, he pursued further education, earning a Master of Science in Clinical Evaluative Science and a Doctorate in Health Policy, both from the Dartmouth Institute for Health Policy and Clinical Practice.

In addition to a presentation from Thom, HPA will be presenting the results of our financial analysis of Maine’s top four health systems: MaineHealth, Northern Light, Central Maine Healthcare, and MaineGeneral.

The HPA analytics program leverages claims from nearly 150,000 commercially insured lives in Maine to uncover trends, analyze spend, evaluate vendors, and inform value-based benefit design. Our large employer members receive regular reports and presentations throughout the year, and our data team shares key insights across members through book of business analyses.

After 15 years with Health Data Management Solutions as our data warehousing partner, the HPA is moving to a new, innovative vendor that will allow us to expand and enhance the reporting we provide.

Join us online on May 14th as we discuss these enhancements with Certilytics, a leading healthcare analytics company, and learn about the powerful tools they’re bringing to HPA members. We’ll provide a brief overview of the transition, and then we will turn it over to the Certilytics team to walk through all the exciting new resources that will be available later this year. The session will include a live demo of their dynamic online platform that will power the next chapter of our data program.

This session will focus on the program's impact on employers and working families in Maine. Shawn Gremminger, CEO of the National Alliance of Healthcare Purchaser Coalitions, will offer valuable insights on the current landscape of the 340B program, highlighting the key challenges and potential areas for reform .

What You’ll Learn:

• A comprehensive overview of the 340B program

• Specific insights into 340B’s impact on Maine employers and their workforce

• Guidance on next steps in Maine to navigate and address 340B-related challenges

Want to learn more about 340B before the webinar? Check out this resource page from the National Alliance and recent New York Times article about this program.

Over the last twenty years, nearly half of all Maine hospitals have consolidated into just two dominant health systems. Hospitals have touted these mergers as opportunities to streamline efficiencies and improve quality and affordability, but new research from Yale health economist, Zack Cooper, calls this assertion into question.

In two studies from earlier this year, Dr. Cooper and his fellow authors from the University of Chicago and Harvard found that mergers the FTC could have challenged as predictably anti-competitive led to price increases of 5% or more. Follow-up research in the National Bureau of Economic Research found that non-health care employers have responded to price increases by reducing their payroll and cutting jobs for middle-class workers. For the average county, a 1% increase in health care prices resulted in an aggregate income reduction in the area of approximately $8M annually.

This critical research lends credence to the increasingly accepted view that rising health care costs are dragging down the wider economy, and it raises important policy questions about how we address health care affordability. In this presentation, Dr. Cooper will discuss his findings and outline strategies to tackle this pressing challenge.

ABOUT ZACK COOPER

Zack Cooper is an Associate Professor of Public Health and Associate Professor of Economics at Yale University. He also serves as Director of Health Policy at Yale's Tobin Center for Economic Policy. Professor Cooper is a health economist whose work is focused on producing data-driven scholarship that can inform public policy. In his academic work, he has analyzed the impact of competition in hospital and insurance markets, studied the influence of price transparency on consumer behavior, investigated the causes of surprise out-of-network bills, and examined the influence of electoral politics on health care spending growth. Cooper has published his research in leading economics and medical journals including the Quarterly Journal of Economics and the New England Journal of Medicine. He has also presented his research at the White House, the Department of Justice, the Federal Trade Commission, and the Department of Health and Human Services.

In January 2021, Zack Cooper and Fiona Scott Morton launched the 1% Steps for Health Care Reformproject. The aim of the project is to harness the power of rigorous economic scholarship to identify tangible steps that can be taken to reduce health care spending in the US without harming quality. The project includes 16 briefs written by leading economists that describe 16 specific interventions, which would collectively lower health care costs in the US by approximately $400 billion annually. You can hear a description of the project on the Freakonomics Podcast (Part 1and Part 2).

Cooper received his undergraduate degree from the University of Chicago and his PhD from the London School of Economics, where he received the Richard Titmuss prize for Best PhD thesis. He was an Economic and Social Science Research Council Postdoctoral Fellow in economics at the LSE’s Centre for Economic Performance where he remains a Faculty Associate. Cooper is a Faculty Research Fellow at the National Bureau of Economic Research and a 2019 winner of and Andrew Carnegie Fellowship from the Carnegie Corporation of New York.

His research on health care spending on the privately insured can be found at: healthcarepricingproject.org.

Pharmacy costs now account for 25% of the Healthcare Purchaser Alliance's book of business spend, and the upward cost trend shows no sign of abating. If anything, experts expect cost increases to pick up steam in the coming years as more expensive specialty drugs like gene and cell therapies come to market. So what can employers and public purchasers do to mitigate this trend?

The answer... a lot! Join us on September 18th at The Woodlands Club in Falmouth for a discussion on pharmacy trends, strategies, and contracting with ERISA attorney Paul Holmes and industry experts from Capital Rx. We'll discuss what terms plan sponsors need to eliminate from their contracts NOW, and how innovative employers are cutting pharmacy spend by double digits through the adoption of more transparent, pass through PBM models. We’ll also cover some of the key Rx trends coming down the pike and discuss how purchasers should be preparing for a wave of high-cost drugs.

Wondering if this is the right event for you? Give this recent NYTimes article a read about the egregious practices of PBMs. You aren't going to want to miss this opportunity to become even more informed about PBMs to make decisions for your organization and bottom line.

Register now to secure your spot!

SHRM and Broker PD credits available.

Thank you, New England Cancer Specialists, for sponsoring this event!

Join us for an informative webinar exploring the landscape of health insurance captives. This session will kick off with an in-depth overview from Jack Longstreth from ParetoHealth of what captives are and how they function. Following this, Palmer Higgins of Chenmark will share his firsthand experience transitioning to a captive, detailing the strategic decisions involved, including the selection of vendors and employee communication initiatives required. He will also discuss the significant outcomes achieved in the first year and any adjustments or considerations for the future.

Don’t miss this opportunity to gain valuable insights into alternative funding strategies that could transform your approach to health insurance.

Come join us for an enlightening event with Dr. Peter Pronovost at The Woodlands Club.

The program for this event will include:

• Overview from the Healthcare Purchaser Alliance on its work with health system CFOs to better understand delivery system finances

• Presentation on the financial challenges facing Maine hospitals from Steve Littleson, CEO of Central Maine Healthcare

• Keynote presentation from Dr. Peter Pronovost, Chief Quality & Clinical Transformation Officer at University Hospitals. Dr. Pronovost will share a framework for hospital efficiency that he developed which led to a 33% decrease in the cost to treat Medicare enrollees, which ultimately allowed the UH system to be profitable on Medicare reimbursement.

Peter Pronovost, MD, PhD, FCCM, is a globally recognized patient safety champion and critical care physician, celebrated for his pioneering work in health care innovation and policy. With over 1000 peer-reviewed publications, he has made significant contributions as a physician executive, researcher, and technology entrepreneur. Dr. Pronovost's notable achievements include the development of safety checklists that have drastically reduced central line-associated bloodstream infections in the U.S., slashing mortality rates akin to those of major cancers by 80%. His efforts have earned him prestigious accolades such as inclusion in Time Magazine's 100 most influential people and a MacArthur Foundation “genius grant.”

To accommodate our speakers and audience, we have decided to move this event to hybrid. A portion of the event will be in person and the keynote will be done virtually. For those who wish to attend virtually, please contact us to get the Zoom webinar link.

Wrapping up the 131st Legislature: Outcomes and Looking Ahead

Join us for a virtual event where Lisa Nolan, the HPA’s Director of Value-based Purchasing and Legislative Affairs, will discuss what happened during the Legislature's short session. We will review the outcomes and implications for the healthcare sector and look ahead to what we might see during the 132nd Legislature. Don't miss this opportunity to stay informed and engaged in shaping the future of healthcare policy.

The webinar will include:

• Overview of Key Bills

• Impact on Employers

• Healthcare System Implications

• Interactive Q&A Session

Who Should Attend:

• Employers in Maine seeking to understand legislative impacts on benefits

• Healthcare professionals interested in healthcare system reforms

• Policy analysts and advocates focused on the legislative landscape in Maine

Don’t miss this opportunity to stay informed about the significant legislative outcomes that will impact employee benefits and healthcare in Maine.