In this second discussion with Andreas Mang and Jon Camire of Blackstone, Stacey Richter has an advanced discussion on the intricacies of stop-loss reinsurance for high-cost claimants.
This show today, for sure, it’s for plan sponsors and anyone on or about plan sponsors; but also listen if you are serving high-cost claimants some other way. Because what you’ll learn here today is some insights relative to how plan sponsors go about making sure that they can pay you—like if you work for, for example, some clinical organization.
There’s a, I don’t know, 101 starting point of this conversation if you need it on stop-loss, which is episode 478 from a couple of weeks ago. This show is the, let’s say, 201-level conversation that I’m having with Andreas Mang and Jon Camire about, as I said, stop-loss insurance and stop-loss insurance considerations.
Emphasizing the importance of eligibility audits and aggregating buying power, the guests highlight best practices to avoid overpaying for coverage and ensuring comprehensive risk management.
This episode is sponsored by Havarti Risk, which I am so thankful for. The show, Relentless Health Value, actually does cost an unexpectedly large sum of money to create and produce; so I always appreciate when somebody offers to sponsor a show or help sponsor a show.
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07:47 What are the best practices for plan sponsors to use for stop-loss coverage?
10:11 What are the “unknown unknowns” within stop-loss coverage?
15:25 What are some policy provisions that plan sponsors should be aware of?
19:02 Why is it so important to do eligibility audits?
20:41 What are some common mistakes made with stop-loss coverage among the self-insured?
23:21 What’s a panel approach, and why is it important for negotiating stop-loss coverage?
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Episode 479.
"What Could Go Wrong CoveringHigh Cost Claimants With Stop-Loss
Reinsurance?" This is a slightlyadvanced conversation I'm having today
with Andreas Mang and Jon Camire,
(00:22):
American Healthcare Entrepreneurs AndExecutives You Want To Know, Talking.
Relentlessly Seeking Value.
This show today for sure, it'sfor plan sponsors and anyone on
or about plan sponsors, but alsolisten if you are serving high
cost claimants some other way.
Because what you'll learn heretoday is some insights relative
(00:46):
to how plan sponsors go aboutmaking sure they can pay you.
Like if you work for, for example,some clinical organization.
There's a, I don't know, 101 startingpoint of this conversation if you
need it on stop-loss, which is episode478 from a couple of weeks ago.
This show is the, let's say, 201 levelconversation that I'm having with
(01:09):
Andreas Mang and Jon Camire about,as I said, stop-loss insurance and
stop-loss insurance considerations.
And I'd like to start here.
If you're a very large employer, you'vegot 10,000 plus say, plan members.
The best stop-loss coverage termsare gonna be very, very different
than if it's a smaller employerwith 400 or 500 employees.
(01:32):
So this is not a one size fits all andthis is really relevant, especially
since stop-loss coverage is a big ticket.
And an extremely crucial decision.
Which is why the first piece of adviceoffered in this show, which is certainly
a carry on from that earlier episode Imentioned 478 from a couple of weeks ago.
(01:52):
The one piece of advice to rule themall get a very, very experienced
broker slash consultant who workswith self-insured plan sponsors of
your exact size and has for a while.
That is the one rule to rule them all.
Get this number one piece of advice rightand you'll do a whole lot better with
the rest of the todo's that Andreas andJon shared today, which are piece of
(02:14):
advice number two, get a whole bunch ofstop-loss coverage bids from different
vendors and get them every year.
Number three, piece ofadvice, pay attention to a
few key contract provisions.
There are four contract provisionsto be really watching out for.
One is the runout period, making surethere's no new lasers, that there's
renewal caps, and then mirroringprovisions and Andreas and Jon really
(02:39):
get into these in the show that follows.
And then last piece of advice,number four, piece of advice.
Watch out with the eligibility.
So after we run through the adviceportion of this podcast, I ask Andreas,
by the way, this whole intro is turninginto a giant spoiler alert, but after
the advice portion of our broadcast,I ask Andreas and Jon what the biggest
mistake they see plan sponsors make is.
(03:01):
And they both kind of agree,it's not balancing risk and
expense particularly well.
Andreas mentions how he was talkingto an executive at a stop-loss
carrier who in a moment of weakness,as Andreas tells it, this executive
revealed that he was shooting for a30 to 40% margin on the policies sold.
(03:24):
So yeah, buying too much stop-loss yearafter year means that the plan could
be spending millions of unnecessarydollars for too much insurance.
On the other hand, worrying too muchabout price and skimping and then
finding oneself un or underinsuredwhen that big high-cost claim
comes through is also not good.
(03:46):
I'm summarizing some big wisdomfrom Andreas and Jon, as I said,
so do listen to their thoughts.
After this in the show that follows,we get into the now what, knowing
all of this, what is actionable.
That we didn't cover already, and inshort, we circle the wagons around getting
into a collective and using a so-calledpanel approach, which gets explained.
(04:09):
Then last, but definitely not least,because you hear this on one after
another Relentless Health Value episode.
I mean, you ask anyone foradvice and this one comes up.
I was saying earlier the Get a GreatConsultant was the one rule to rule
them all, but this last one might bekind of like, hold my beer on that one.
Know how everyone is being paid fromyour consultant to the collective, to the
(04:33):
stop-loss carrier and or their brokers.
Get these disclosures.
Watch for things that don't haveto actually be on the disclosures.
And sometimes you can sort of figurethese out when somebody seems like
they're moving a little wonky.
Ask lots of questions.
So as I have said seven times already,today I am speaking with Andreas Mang.
Who is senior managing director atBlackstone and CEO Equity Healthcare.
(04:55):
I am also speaking with Jon Camire,who's also over at Blackstone.
Jon is managing directorand CFO Equity Healthcare.
Jon is an actuary and he runstheir stop-loss program over there.
So yeah, I'm very pleased withmyself for getting the likes of
these two to talk with you today.
Normally right now I say my name isStacey Richter, and then I say, this show
is sponsored by Aventria Health Group.
(05:17):
What I'm gonna say today instead though,is that this show is also sponsored by
Havarti Risk, which I am so thankful for.
The show Relentless Health Value actuallydoes cost an unexpectedly large sum of
money to create and produce, so I alwaysappreciate when somebody offers to
sponsor a show or help sponsor a show.
Havarti Risk empowers healthcareleaders like you to make smarter
(05:39):
decisions that increase qualityand lower the cost of care.
Havarti s cutting edge approachcombines deep industry knowledge and
also actuarial expertise with advancedtechnology to transform how you
manage risk and optimize performance.
I mean, look, when you're putting patientsover profits and trying to manage that
quadruple play that we talk a lot about onRelentless Health Value, you need partners
(06:01):
who understand both the clinical andthe financial sides of healthcare risk.
To that end, I go a ways back withKeith Passwater, who's the CEO of
Havarti risk and moderated a panela couple of years ago that he was
on at the Society of Actuaries.
Right?
So I got myself invited to the Societyof Actuaries meeting, and that panel
was entitled can health actuariesmake the US healthcare system better?
(06:25):
And I have to say, I really appreciatedthe thoughtfulness that Keith
came into that conversation with.
And in short, yeah, there'sactually a lot actuaries can
do to make the system better.
If anyone can do it, let's gettheir big brains in on the mission.
So yeah, call KeithPasswater, call Havarti Risk.
There will be links in the show notes.
I really appreciate them steppingup with some dollars to support
(06:46):
this pod and keep it on the air.
And with that, here is myconversation about stop-loss
with Andreas Mang and Jon Camire.
Andreas Mang, welcome toRelentless Health Value.
Hey Stacey, thanks for having meand thanks for having me back.
Happy to, uh, chat aboutstop-loss with you today.
It is a pleasure to have you back.
Jon Camire, thank you somuch for being here today.
(07:07):
Thank you, Stacey.
It's a real pleasure.
There was a part one to this discussionand one of the things that came up
loud and clear in that first part is tomake absolutely sure if you're a plan
sponsor, you have a broker who at thatpoint is probably an employee benefit
consultant who is really experiencedin the plan, sponsors their exact
(07:28):
size plan, their exact type of plan.
There's just so many complicationsthat may be relevant to a
very specific size employer.
So that's the first thing.
But beyond that, I'm gonnaask Jon this question.
What are the pieces of advice that wereally, really need to take on board?
Like what are the best practices thatthe best employee benefit consultants and
(07:51):
plan sponsors are putting into practiceas it relates to stop-loss coverage?
So first of all, you know, they maygoing to three companies like they did
for medical, you know, makes sense.
But this is a broader market.
It's a unique market and there arecarriers getting in and out all the time.
And so you really need to market broadly.
And I, by that, I would sayseveral carriers at minimum.
(08:14):
So that's one thing we seecompanies not marketing stop-loss
even at all in a given year.
And that's just a mistake.
And so when you say marketingstop-loss, you mean getting bids from...
Yes.
Getting quotes each year.
Comparing contracts.
Different carriers may offerdifferent types of contracts.
I think that leads into the nextthing, which is really make sure
you know what you're buying.
(08:35):
Do not buy solely based on price.
For a company that's new toself-insurance, you know, you
may be eager to wrap up a lot ofdecisions earlier in the year.
A lot of companies, they'redoing their work July, August.
They're figuring out the planchoices, their carrier choices,
their contribution strategy.
(08:56):
They're getting their materials readyfor open enrollment and stop-loss
decisions tend to come later.
So you've already done your budget.
You've already locked in things youwant to do around contributions,
you're printing materials andstop-loss decisions don't really
even start to pick up until November.
At that point, you might have alreadyhad open enrollment, and let's say
(09:18):
the stop-loss market is tellingyou it's gonna be more expensive
than you thought it would be.
You might be inclined to picksomething that's cheaper than
the average plan being offered.
And in that way, you might bechoosing a contract type that's
gonna leave gaps in coverage.
And that's something a year anda half later when the claims
(09:38):
are starting to really rollin, you could really regret it.
And with stop-loss, it'sreally a risk management tool.
So it's those little gaps thatyou leave in the coverage that
you ultimately may come to regret.
The question that you answered, Jon,is what are the pieces of advice
that we need to really take on board?
And it sounds like an importantone is to make sure that you've
(10:01):
got a series of quotes thatyou're getting every single year.
It's not just go back to the same, right?
Like you have to kind of see what'sgoing on out there in the market and
then know exactly what you're buying.
You mentioned the gaps,these unknown unknowns.
Are there unknown unknowns thatyou kind of wanna point out here
because they're known unknowns?
If you've been doing this for a while.
Yeah, look, I think when you're makingthe decision, you know they're gonna
(10:23):
put some quotes in front of you and abig long spreadsheet, some small little
area that's gonna say, contract type.
Something like 12-15, 12-24or something like that.
You don't really know what it is.
You don't ask any questionsand you just keep going.
Well, I'm gonna give you an exampleof a company that we recently got
involved with that had a 12-15coverage and why that's a problem.
(10:46):
What that means is it's gonna cover claimsthat were incurred for the 12 months of
the policy period, and anything for threemonths after the policy period that gets
paid three months after the policy period.
So 12 months of the full calendar yearis the incurred period, and then 15
months, which is the 12 months of theincurred period, plus three months
of runout in the following period.
(11:07):
Well, what happens if you have, youknow, that premature baby born on
December 30th and they're in the NICU?
Well, it's very unlikely that that babyis going to be out of the NICU, have all
the claims submitted, have all the claimsprocessed, have all the claims paid in the
next three months and a couple of days.
(11:28):
And what happens, this company wasactually smaller than we typically
see that with about 200 employeesso not a large plan at all.
And the way the contract is built isanything that gets paid after March, they
would've been completely on the hook for.
So in this situation, this prematurebaby did not happen, but the risk is
that if it does, those premature tripletsare in the the NICU for nine months or
(11:52):
whatever, all those dollars are completelyuncovered by the stop-loss policy.
Now, if they had bought a differentpolicy, like I was saying, 12-24, now they
have a year of run out and you're closingthat gap to a much, much greater extent.
These terms, 12-15, 12-24, they,they sound very esoteric, but they're
really important because exactly likewith laser claims once a high cost
(12:17):
claim is identified, if you cross aplan year, now it's a known quantity
and nobody's gonna ensure that quantitybecause there's a hundred percent
risk and no one's gonna take that bet.
Yeah.
And what you want to do is youwanna weave policy periods together
with coverage that aligns exactly.
So that there are no gaps there,or there are absolutely minimized.
(12:40):
And you know, a good experiencedconsultant is going to do that.
I think the comment that I wannamake, why you chose that shorter
contract, that 12-15, a 12-15 contractis cheaper than a 12-24 contract.
So, as I said, you've alreadylocked in your budget, you're making
the decision late in the year.
You may impudently choose the 12-15because it's saving you a hundred
(13:04):
thousand dollars on the premium.
So you have to make sure that you havesome kind of coverage to cover those
known claims if they cross a planyear, which yeah, sure, I can certainly
see how that's gonna be an unknownunknown until it happens to someone.
I wanna reinforce, this goes back towhat we've now said a hundred times.
The importance of your consultant,your broker, in this one case,
(13:26):
when we shared with the CEO, Doyou know that you potentially have
unlimited upside, unlimited exposure?
He said, Well, my broker told mewe were totally buttoned up, right?
This goes back to this does get weed deep.
This does get complicated.
And you know, we don't expect the peoplein HR and even sometimes in finance to
fully understand the intricacies of this.
(13:47):
And so the importance of having someonethere who knows how to do this, who
has the experience and structuresyou in a way to protect you from that
catastrophic loss is super important.
In this case, their broker, told themthat they were structured properly and you
know, to our horror, they were not right.
And so we had to do some tap dancing thereand some fingers crossed at the end of
(14:07):
the year that there wasn't something likea preemie baby at the end of the year.
And thankfully there wasn't.
But for a while there, who knows.
So basically what you're saying is12-15 is a little, maybe precarious?
Is that what I'm understanding?
Well, there's some situation whereit could make sense though, Jon,
like why is that even offered?
I think it's largely offered becausethere are companies that are selecting
it, but I'm not sure that the companies,the companies that are selecting
(14:29):
it, are doing it based on price.
Not doing it based on risk.
And I think in, situations of stop-loss,I think a lot of times you wanna
think risk first and cost second.
What I'm really, understanding here isthat there's always gonna be uncertainty.
I mean, that's what insurance is.
It's figuring out how to balance, howto navigate uncertain terrain, which
(14:52):
is not gonna be eliminated, and kind ofbuy down the uncertainty to a palatable
level, such that, everyone feels confidenthere and that does take experience.
Which kind of again, goes backin points to the making sure that
the consultant is really good.
(15:12):
It does.
So we, we talked a little bit aboutthe 12- 15 might be a little bit
light, think about 12- 24, and wetalked a little bit about the, kind
of the structure of the contract.
What else do we have?
Yeah, so let, let me hitthree, three quick ones here.
So common provisions in purchasingstop-loss contracts where you know it's
being done by people who kind of knowwhat to look for or have the volume
to extract better terms (15:34):
first is no new lasers, so that can be a provision
that once the policy is written thatyou can't introduce new lasers despite
what's happening in the risk pool.
Second would be renewal caps.
So caps on what the subsequent yearsincrease could be, so it's not limitless
and unending in terms of upside.
(15:54):
Third, really important is somethingcalled a mirroring provision, meaning
that the stop-loss contract has to mirrorthe medical plan's coverage provisions.
So where you may say, look, we'regonna cover whatever infertility.
They can't say, well, we'renot gonna cover infertility.
So those are three really keycontract provisions I just wanted
(16:16):
to make sure we had in there.
Yeah, I can definitely see how you don'tinclude any of those that you could wind
up with a bit of a mess on your hands.
So for our contracting provisions to makesure that we include here is to really
watch the 12-15, maybe consider 12-24.
But you know, obviously price is an issue.
So again, you really need to have abroker who knows what they're doing,
(16:38):
how you're structuring this whole thing.
And then the last three that youjust mentioned, Andreas, no new
lasers, making sure that there arerenewal caps there, and then also
the, the mirroring provisions.
Is there anything else that wewanna put in our advice list?
We haven't touched on this oneyet, but I do wanna, something I'm
eager to talk about, and I touchedon it last time, is eligibility.
(17:02):
So companies, when you'reself-insured, you have to be really.
On top of your eligibility in termsof who's eligible for your plan,
and are you covering people whoare supposed to be on your plan?
So the 27-year-old kid who's still sittingon their parents' plan, Hey, guess what?
They're no longer eligible.
That 27-year-old kid has acatastrophic claim and it comes in.
Who do you think's really,really good at eligibility?
(17:24):
I'll tell you what.
The stop-loss carriers are really,really good at eligibility.
Right?
A million dollar claim comes in,they're gonna wanna make sure that
that person who they're about topay a huge amount for is eligible.
And if they're not, guesswho gets to pay for it?
You the employer.
And so whenever we talk about things likeeligibility audits, that can make some
employers uncomfortable, they worry aboutcreating friction in their workforce?
(17:49):
Well, I'd be careful, right, becauseMurphy's Law is that when one of those
catastrophic claims comes in, if youhaven't been really fastidious about
eligibility, that person's not eligible,you're gonna be on the hook for it.
And that is a very bad outcome.
Yeah.
I will say I probably spend a littlebit too long on the insurance subreddits
(18:09):
on Reddit, and probably every day thereis this question somebody writes, Hi,
I am 32 years old and I'm still on myparents' plan, and no one has noticed.
My claims are being paid.
So, dot, dot, dot, right?
(18:29):
Like there's a there.
There's a lot.
Dangerous game.
It's a dangerous game.
It's risky.
Yeah.
Well, I mean, from the plan memberperspective, or their kid, they're
thinking they just won the lotterybecause they have their coverage
and you should see the replies.
Well just keep, why wouldn'tyou just keep doing it?
You, you know, like, if you're thinkingabout it from just a rational, I'm trying
(18:51):
to save money and I'm 32 years old, Ican barely afford my rent perspective.
Like why wouldn't you?
It's just they almost look at it like I'm,I'm also on my mom and dad's cell plan.
Right.
And I look, I would say that whenwe have had companies do it, and
we certainly have had dozens.
It averages, I'd say 2-3% ofthe dependents that are on
(19:12):
the plan are not eligible.
And it varies by company.
Some do a better job of staying on top ofit than others, but it's a real amount.
It's not, you know, one, two people.
It's in many cases, hundreds of people.
Yeah.
And it's one thing if, I guessyou're paying kind of like for
some 27 year olds or 32 year olds,physical every year, whatever.
(19:32):
But to your point, if somethingterrible would happen, now it's
really bad for everybody becausesuddenly that individual is not
gonna have their catastrophic claim.
They're not gonna have coverage, or theemployer's gonna wind up paying for it.
Either one is, yeah, probablysuboptimal for somebody.
Right, it's the worst possible time forsomething like this to happen, whether it
(19:53):
be to the company or to the individual.
Okay, so back to our main list here.
Pieces of advice when it comes to stopless coverage if you are a self-insured,
pretty much anybody, here we go.
We started out talking about theimportance of the consultant or broker.
And then we talked secondly get bidsevery single year, multiple bids,
and then after that, contractingprovisions, including the runout period.
(20:17):
No new lasers, making sure thereare renewal caps in there, and
then also the mirroring provisions.
And then the last piece of advice isnumber four, watch eligibility and really
make sure you're doing eligibility audits.
That's really, really a big deal.
Okay, so now do we have anyexamples of where things went wrong?
And I really, actually, I would prefernot getting an outlier here, just what
(20:42):
do you see when you onboard a new planfrequently enough relative to their
stop-loss coverage or lack thereof?
Well, you know, I think there arethe risk terms, like the contract
terms, but honestly, the thing I seemost often is an overly conservative
point of view in terms of stop-loss.
Stop-loss is a high margin product.
(21:03):
If your deductible is too low and you'renot increasing it on a regular basis,
if you just haven't marketed it andthey're just taking premium increases
year after year after year, we seecompanies that are just paying hundreds
of thousands, if not millions of dollarsmore than what a, you know, probably
(21:24):
market rate policy should be paid.
And as much as you know, the contracttype might create risk and there you have
unbound liability potential, if you'repaying a million dollars more than you
should be paying year after year afteryear, in many cases, that's even worse.
Jon just touched on something importantand I got to know the CEO of one of
(21:46):
the large stop-loss carriers prettywell, and in a, maybe in a moment
of weakness, he revealed to me whatthe margins are, what they shot for.
And this particular company shotfor 30 to 40% margins on stop-loss.
And so Jon just said, it'sa high margin coverage.
Now I get it.
They're taking out a lot of risk.
I get all that, but as the employer,you need to play the game, right?
(22:07):
Your job is to extract as much ofthat back as you can and try to get
the best coverage at the lowest rate.
And too many companies fail to beactive purchasers in this field.
So, is there a way that you recommendfor purchasing stop-loss insurance?
So we talked about definitely the thingsthat you wanna make sure of when you
(22:28):
are buying stop-loss, but relative tolike purchasing it from the process by
which one procures the stop-loss to beginwith, do you have any suggestions there?
Well, in our case, we actuallytake advantage of a panel approach.
So we have a multi insure panel whoannually is competing for a very large
block of overall stop-loss premium everyyear, and that has helped us in terms
(22:52):
of getting the best rates possible, thatensures that every year our companies are
actually going to the market, as Jon said.
And allowing competitiveforces to play in your favor.
And so I think that's one way to goabout this as opposed to just kind of
going out to the market on your own everyyear and hoping you do the right thing.
Take advantage of volume.
(23:13):
I think we're gonna talk aboutthis, maybe take advantage of a
collective as we do to try to allowmarket forces to work in your favor.
So this might be our lastreally big piece of advice.
Try to aggregate as many, as muchvolume as one can, such that when
you go to a stop-loss carrier, youcan leverage that volume of business
(23:35):
and try to get a better rate.
And you're calling that a panel approach?
Yeah.
So, well, the panel approach, it'simportant that each, each individual
company is individually underwritten.
But when you have 50, 60, 70, 80companies all competing under similar
terms, all competing in a dynamicwhere every bidding carrier knows
(23:56):
that they're up against a lot ofcompetition, the pencil stays sharp.
The contract terms that they'rebidding on are consistent.
The process is consistent.
The results end up being just a, an addedefficiency, and then ultimately there's
a lot more strong choices to be made.
As I said earlier, carriersare getting into the market.
(24:17):
Carriers are getting out of the market.
Some years carriers areexcited about stop-loss.
Some years they're not.
And so by looking at a panel and getting,you know, 7, 8, 9, 10 different carriers
bidding for your business, you know thatwhat you're getting is relatively the best
in the market that they have to offer.
So does the panel refer to the number ofemployers that are ganging up together,
(24:38):
or does the panel refer to, you'reasking a lot of different stop-loss
carriers, like who's the panel here?
In this case, it's a panelof stop-loss carriers.
So in our case, we use nine or 10 carriersthat all understand, hey, there's a lot
of different companies here to be bid on.
If you can stick to this process, ifyou can bid on this contract type.
(25:00):
If you can, you know, manageclaims effectively throughout the
year and work with us on that.
That's our panel approach.
All right, so in part one of this episode,we have talked about what stop-loss is.
We've talked about these termsthat wind up getting bandied
about relative to stop-loss.
A lot of times we've talked about today,the advice that you have , and we just
(25:22):
finished up here with the buying processitself, which sounds like, again, there's
probably better or worse ways to do this.
And I just keep thinking about whatyou said at the very beginning,
Andreas, about making sure that theconsultant knows what they're doing.
Is there anything that we neglected totalk about that we wanna bring up today?
The one thing I wanted to add is make sureyou know what your consultant is getting
(25:46):
paid, and if you're using some type ofcollective or captive or whatever, make
sure you know what they're getting paid.
Over the years, we've seen some, youknow, questionable behavior when it
comes to commissions on stop-lossbecause it's not an employee benefit.
It's not reported on 5500s.
If you have that reputable broker,you're doing disclosures and things
(26:08):
like that, you're probably okay.
Same thing with a strong collective.
Definitely know what these peopleare being paid on this coverage.
Andreas, anything that youwanna add as a wrap up here?
No, I think, I think we coveredthe waterfront pretty well.
This stuff is complicated.
I hope it doesn't scare anyone away.
I hope this helps clarify some ofthe important points that you need to
look at, and it's just, it's a reallyintegral, important part of the overall
(26:31):
self-insurance equation that is too easyto sort of, view as that last buying
decision that we talked about and sortof you wanna sweep it under the rug.
It's probably one of the mostimportant buying decisions.
Unfortunately, it happens at the way endof the process when everybody's really
tired and beat up and you know, you gottahang in there and get through this one
and put as much into it as every otherpart of what, you've done to sort of
(26:53):
structure your plan for your employees.
Andreas Mang and Jon Camire,thank you so much for being on
Relentless Health Value today.
Happy to be here.
Thanks so much for having us.
Thank you, Stacey.
Hi, I am Keith Passwater,CEO of Havarti Risk.
Relentless Health Value hasconsistently challenged the way I
think about the business of healthcare.
The conversations are smart,relevant, and grounded in the
realities we face every day.
(27:14):
If you're as passionate aboutdriving healthcare change as I
am, I really encourage you tofollow Relentless Health Value on
LinkedIn and join the conversation.
Thanks for listening.
Episode 479.
"What Could Go Wrong CoveringHigh Cost Claimants With Stop-Loss
Reinsurance?" This is a slightlyadvanced conversation I'm having today
with Andreas Mang and Jon Camire,
(00:22):
American Healthcare Entrepreneurs AndExecutives You Want To Know, Talking.
Relentlessly Seeking Value.
This show today for sure, it'sfor plan sponsors and anyone on
or about plan sponsors, but alsolisten if you are serving high
cost claimants some other way.
Because what you'll learn heretoday is some insights relative
(00:46):
to how plan sponsors go aboutmaking sure they can pay you.
Like if you work for, for example,some clinical organization.
There's a, I don't know, 101 startingpoint of this conversation if you
need it on stop-loss, which is episode478 from a couple of weeks ago.
This show is the, let's say, 201 levelconversation that I'm having with
(01:09):
Andreas Mang and Jon Camire about,as I said, stop-loss insurance and
stop-loss insurance considerations.
And I'd like to start here.
If you're a very large employer, you'vegot 10,000 plus say, plan members.
The best stop-loss coverage termsare gonna be very, very different
than if it's a smaller employerwith 400 or 500 employees.
(01:32):
So this is not a one size fits all andthis is really relevant, especially
since stop-loss coverage is a big ticket.
And an extremely crucial decision.
Which is why the first piece of adviceoffered in this show, which is certainly
a carry on from that earlier episode Imentioned 478 from a couple of weeks ago.
(01:52):
The one piece of advice to rule themall get a very, very experienced
broker slash consultant who workswith self-insured plan sponsors of
your exact size and has for a while.
That is the one rule to rule them all.
Get this number one piece of advice rightand you'll do a whole lot better with
the rest of the todo's that Andreas andJon shared today, which are piece of
(02:14):
advice number two, get a whole bunch ofstop-loss coverage bids from different
vendors and get them every year.
Number three, piece ofadvice, pay attention to a
few key contract provisions.
There are four contract provisionsto be really watching out for.
One is the runout period, making surethere's no new lasers, that there's
renewal caps, and then mirroringprovisions and Andreas and Jon really
(02:39):
get into these in the show that follows.
And then last piece of advice,number four, piece of advice.
Watch out with the eligibility.
So after we run through the adviceportion of this podcast, I ask Andreas,
by the way, this whole intro is turninginto a giant spoiler alert, but after
the advice portion of our broadcast,I ask Andreas and Jon what the biggest
mistake they see plan sponsors make is.
(03:01):
And they both kind of agree,it's not balancing risk and
expense particularly well.
Andreas mentions how he was talkingto an executive at a stop-loss
carrier who in a moment of weakness,as Andreas tells it, this executive
revealed that he was shooting for a30 to 40% margin on the policies sold.
(03:24):
So yeah, buying too much stop-loss yearafter year means that the plan could
be spending millions of unnecessarydollars for too much insurance.
On the other hand, worrying too muchabout price and skimping and then
finding oneself un or underinsuredwhen that big high-cost claim
comes through is also not good.
(03:46):
I'm summarizing some big wisdomfrom Andreas and Jon, as I said,
so do listen to their thoughts.
After this in the show that follows,we get into the now what, knowing
all of this, what is actionable.
That we didn't cover already, and inshort, we circle the wagons around getting
into a collective and using a so-calledpanel approach, which gets explained.
(04:09):
Then last, but definitely not least,because you hear this on one after
another Relentless Health Value episode.
I mean, you ask anyone foradvice and this one comes up.
I was saying earlier the Get a GreatConsultant was the one rule to rule
them all, but this last one might bekind of like, hold my beer on that one.
Know how everyone is being paid fromyour consultant to the collective, to the
(04:33):
stop-loss carrier and or their brokers.
Get these disclosures.
Watch for things that don't haveto actually be on the disclosures.
And sometimes you can sort of figurethese out when somebody seems like
they're moving a little wonky.
Ask lots of questions.
So as I have said seven times already,today I am speaking with Andreas Mang.
Who is senior managing director atBlackstone and CEO Equity Healthcare.
(04:55):
I am also speaking with Jon Camire,who's also over at Blackstone.
Jon is managing directorand CFO Equity Healthcare.
Jon is an actuary and he runstheir stop-loss program over there.
So yeah, I'm very pleased withmyself for getting the likes of
these two to talk with you today.
Normally right now I say my name isStacey Richter, and then I say, this show
is sponsored by Aventria Health Group.
(05:17):
What I'm gonna say today instead though,is that this show is also sponsored by
Havarti Risk, which I am so thankful for.
The show Relentless Health Value actuallydoes cost an unexpectedly large sum of
money to create and produce, so I alwaysappreciate when somebody offers to
sponsor a show or help sponsor a show.
Havarti Risk empowers healthcareleaders like you to make smarter
(05:39):
decisions that increase qualityand lower the cost of care.
Havarti s cutting edge approachcombines deep industry knowledge and
also actuarial expertise with advancedtechnology to transform how you
manage risk and optimize performance.
I mean, look, when you're putting patientsover profits and trying to manage that
quadruple play that we talk a lot about onRelentless Health Value, you need partners
(06:01):
who understand both the clinical andthe financial sides of healthcare risk.
To that end, I go a ways back withKeith Passwater, who's the CEO of
Havarti risk and moderated a panela couple of years ago that he was
on at the Society of Actuaries.
Right?
So I got myself invited to the Societyof Actuaries meeting, and that panel
was entitled can health actuariesmake the US healthcare system better?
(06:25):
And I have to say, I really appreciatedthe thoughtfulness that Keith
came into that conversation with.
And in short, yeah, there'sactually a lot actuaries can
do to make the system better.
If anyone can do it, let's gettheir big brains in on the mission.
So yeah, call KeithPasswater, call Havarti Risk.
There will be links in the show notes.
I really appreciate them steppingup with some dollars to support
(06:46):
this pod and keep it on the air.
And with that, here is myconversation about stop-loss
with Andreas Mang and Jon Camire.
Andreas Mang, welcome toRelentless Health Value.
Hey Stacey, thanks for having meand thanks for having me back.
Happy to, uh, chat aboutstop-loss with you today.
It is a pleasure to have you back.
Jon Camire, thank you somuch for being here today.
(07:07):
Thank you, Stacey.
It's a real pleasure.
There was a part one to this discussionand one of the things that came up
loud and clear in that first part is tomake absolutely sure if you're a plan
sponsor, you have a broker who at thatpoint is probably an employee benefit
consultant who is really experiencedin the plan, sponsors their exact
(07:28):
size plan, their exact type of plan.
There's just so many complicationsthat may be relevant to a
very specific size employer.
So that's the first thing.
But beyond that, I'm gonnaask Jon this question.
What are the pieces of advice that wereally, really need to take on board?
Like what are the best practices thatthe best employee benefit consultants and
(07:51):
plan sponsors are putting into practiceas it relates to stop-loss coverage?
So first of all, you know, they maygoing to three companies like they did
for medical, you know, makes sense.
But this is a broader market.
It's a unique market and there arecarriers getting in and out all the time.
And so you really need to market broadly.
And I, by that, I would sayseveral carriers at minimum.
(08:14):
So that's one thing we seecompanies not marketing stop-loss
even at all in a given year.
And that's just a mistake.
And so when you say marketingstop-loss, you mean getting bids from...
Yes.
Getting quotes each year.
Comparing contracts.
Different carriers may offerdifferent types of contracts.
I think that leads into the nextthing, which is really make sure
you know what you're buying.
(08:35):
Do not buy solely based on price.
For a company that's new toself-insurance, you know, you
may be eager to wrap up a lot ofdecisions earlier in the year.
A lot of companies, they'redoing their work July, August.
They're figuring out the planchoices, their carrier choices,
their contribution strategy.
(08:56):
They're getting their materials readyfor open enrollment and stop-loss
decisions tend to come later.
So you've already done your budget.
You've already locked in things youwant to do around contributions,
you're printing materials andstop-loss decisions don't really
even start to pick up until November.
At that point, you might have alreadyhad open enrollment, and let's say
(09:18):
the stop-loss market is tellingyou it's gonna be more expensive
than you thought it would be.
You might be inclined to picksomething that's cheaper than
the average plan being offered.
And in that way, you might bechoosing a contract type that's
gonna leave gaps in coverage.
And that's something a year anda half later when the claims
(09:38):
are starting to really rollin, you could really regret it.
And with stop-loss, it'sreally a risk management tool.
So it's those little gaps thatyou leave in the coverage that
you ultimately may come to regret.
The question that you answered, Jon,is what are the pieces of advice
that we need to really take on board?
And it sounds like an importantone is to make sure that you've
(10:01):
got a series of quotes thatyou're getting every single year.
It's not just go back to the same, right?
Like you have to kind of see what'sgoing on out there in the market and
then know exactly what you're buying.
You mentioned the gaps,these unknown unknowns.
Are there unknown unknowns thatyou kind of wanna point out here
because they're known unknowns?
If you've been doing this for a while.
Yeah, look, I think when you're makingthe decision, you know they're gonna
(10:23):
put some quotes in front of you and abig long spreadsheet, some small little
area that's gonna say, contract type.
Something like 12-15, 12-24or something like that.
You don't really know what it is.
You don't ask any questionsand you just keep going.
Well, I'm gonna give you an exampleof a company that we recently got
involved with that had a 12-15coverage and why that's a problem.
(10:46):
What that means is it's gonna cover claimsthat were incurred for the 12 months of
the policy period, and anything for threemonths after the policy period that gets
paid three months after the policy period.
So 12 months of the full calendar yearis the incurred period, and then 15
months, which is the 12 months of theincurred period, plus three months
of runout in the following period.
(11:07):
Well, what happens if you have, youknow, that premature baby born on
December 30th and they're in the NICU?
Well, it's very unlikely that that babyis going to be out of the NICU, have all
the claims submitted, have all the claimsprocessed, have all the claims paid in the
next three months and a couple of days.
(11:28):
And what happens, this company wasactually smaller than we typically
see that with about 200 employeesso not a large plan at all.
And the way the contract is built isanything that gets paid after March, they
would've been completely on the hook for.
So in this situation, this prematurebaby did not happen, but the risk is
that if it does, those premature tripletsare in the the NICU for nine months or
(11:52):
whatever, all those dollars are completelyuncovered by the stop-loss policy.
Now, if they had bought a differentpolicy, like I was saying, 12-24, now they
have a year of run out and you're closingthat gap to a much, much greater extent.
These terms, 12-15, 12-24, they,they sound very esoteric, but they're
really important because exactly likewith laser claims once a high cost
(12:17):
claim is identified, if you cross aplan year, now it's a known quantity
and nobody's gonna ensure that quantitybecause there's a hundred percent
risk and no one's gonna take that bet.
Yeah.
And what you want to do is youwanna weave policy periods together
with coverage that aligns exactly.
So that there are no gaps there,or there are absolutely minimized.
(12:40):
And you know, a good experiencedconsultant is going to do that.
I think the comment that I wannamake, why you chose that shorter
contract, that 12-15, a 12-15 contractis cheaper than a 12-24 contract.
So, as I said, you've alreadylocked in your budget, you're making
the decision late in the year.
You may impudently choose the 12-15because it's saving you a hundred
(13:04):
thousand dollars on the premium.
So you have to make sure that you havesome kind of coverage to cover those
known claims if they cross a planyear, which yeah, sure, I can certainly
see how that's gonna be an unknownunknown until it happens to someone.
I wanna reinforce, this goes back towhat we've now said a hundred times.
The importance of your consultant,your broker, in this one case,
(13:26):
when we shared with the CEO, Doyou know that you potentially have
unlimited upside, unlimited exposure?
He said, Well, my broker told mewe were totally buttoned up, right?
This goes back to this does get weed deep.
This does get complicated.
And you know, we don't expect the peoplein HR and even sometimes in finance to
fully understand the intricacies of this.
(13:47):
And so the importance of having someonethere who knows how to do this, who
has the experience and structuresyou in a way to protect you from that
catastrophic loss is super important.
In this case, their broker, told themthat they were structured properly and you
know, to our horror, they were not right.
And so we had to do some tap dancing thereand some fingers crossed at the end of
(14:07):
the year that there wasn't something likea preemie baby at the end of the year.
And thankfully there wasn't.
But for a while there, who knows.
So basically what you're saying is12-15 is a little, maybe precarious?
Is that what I'm understanding?
Well, there's some situation whereit could make sense though, Jon,
like why is that even offered?
I think it's largely offered becausethere are companies that are selecting
it, but I'm not sure that the companies,the companies that are selecting
(14:29):
it, are doing it based on price.
Not doing it based on risk.
And I think in, situations of stop-loss,I think a lot of times you wanna
think risk first and cost second.
What I'm really, understanding here isthat there's always gonna be uncertainty.
I mean, that's what insurance is.
It's figuring out how to balance, howto navigate uncertain terrain, which
(14:52):
is not gonna be eliminated, and kind ofbuy down the uncertainty to a palatable
level, such that, everyone feels confidenthere and that does take experience.
Which kind of again, goes backin points to the making sure that
the consultant is really good.
(15:12):
It does.
So we, we talked a little bit aboutthe 12- 15 might be a little bit
light, think about 12- 24, and wetalked a little bit about the, kind
of the structure of the contract.
What else do we have?
Yeah, so let, let me hitthree, three quick ones here.
So common provisions in purchasingstop-loss contracts where you know it's
being done by people who kind of knowwhat to look for or have the volume
to extract better terms (15:34):
first is no new lasers, so that can be a provision
that once the policy is written thatyou can't introduce new lasers despite
what's happening in the risk pool.
Second would be renewal caps.
So caps on what the subsequent yearsincrease could be, so it's not limitless
and unending in terms of upside.
(15:54):
Third, really important is somethingcalled a mirroring provision, meaning
that the stop-loss contract has to mirrorthe medical plan's coverage provisions.
So where you may say, look, we'regonna cover whatever infertility.
They can't say, well, we'renot gonna cover infertility.
So those are three really keycontract provisions I just wanted
(16:16):
to make sure we had in there.
Yeah, I can definitely see how you don'tinclude any of those that you could wind
up with a bit of a mess on your hands.
So for our contracting provisions to makesure that we include here is to really
watch the 12-15, maybe consider 12-24.
But you know, obviously price is an issue.
So again, you really need to have abroker who knows what they're doing,
(16:38):
how you're structuring this whole thing.
And then the last three that youjust mentioned, Andreas, no new
lasers, making sure that there arerenewal caps there, and then also
the, the mirroring provisions.
Is there anything else that wewanna put in our advice list?
We haven't touched on this oneyet, but I do wanna, something I'm
eager to talk about, and I touchedon it last time, is eligibility.
(17:02):
So companies, when you'reself-insured, you have to be really.
On top of your eligibility in termsof who's eligible for your plan,
and are you covering people whoare supposed to be on your plan?
So the 27-year-old kid who's still sittingon their parents' plan, Hey, guess what?
They're no longer eligible.
That 27-year-old kid has acatastrophic claim and it comes in.
Who do you think's really,really good at eligibility?
(17:24):
I'll tell you what.
The stop-loss carriers are really,really good at eligibility.
Right?
A million dollar claim comes in,they're gonna wanna make sure that
that person who they're about topay a huge amount for is eligible.
And if they're not, guesswho gets to pay for it?
You the employer.
And so whenever we talk about things likeeligibility audits, that can make some
employers uncomfortable, they worry aboutcreating friction in their workforce?
(17:49):
Well, I'd be careful, right, becauseMurphy's Law is that when one of those
catastrophic claims comes in, if youhaven't been really fastidious about
eligibility, that person's not eligible,you're gonna be on the hook for it.
And that is a very bad outcome.
Yeah.
I will say I probably spend a littlebit too long on the insurance subreddits
(18:09):
on Reddit, and probably every day thereis this question somebody writes, Hi,
I am 32 years old and I'm still on myparents' plan, and no one has noticed.
My claims are being paid.
So, dot, dot, dot, right?
(18:29):
Like there's a there.
There's a lot.
Dangerous game.
It's a dangerous game.
It's risky.
Yeah.
Well, I mean, from the plan memberperspective, or their kid, they're
thinking they just won the lotterybecause they have their coverage
and you should see the replies.
Well just keep, why wouldn'tyou just keep doing it?
You, you know, like, if you're thinkingabout it from just a rational, I'm trying
(18:51):
to save money and I'm 32 years old, Ican barely afford my rent perspective.
Like why wouldn't you?
It's just they almost look at it like I'm,I'm also on my mom and dad's cell plan.
Right.
And I look, I would say that whenwe have had companies do it, and
we certainly have had dozens.
It averages, I'd say 2-3% ofthe dependents that are on
(19:12):
the plan are not eligible.
And it varies by company.
Some do a better job of staying on top ofit than others, but it's a real amount.
It's not, you know, one, two people.
It's in many cases, hundreds of people.
Yeah.
And it's one thing if, I guessyou're paying kind of like for
some 27 year olds or 32 year olds,physical every year, whatever.
(19:32):
But to your point, if somethingterrible would happen, now it's
really bad for everybody becausesuddenly that individual is not
gonna have their catastrophic claim.
They're not gonna have coverage, or theemployer's gonna wind up paying for it.
Either one is, yeah, probablysuboptimal for somebody.
Right, it's the worst possible time forsomething like this to happen, whether it
(19:53):
be to the company or to the individual.
Okay, so back to our main list here.
Pieces of advice when it comes to stopless coverage if you are a self-insured,
pretty much anybody, here we go.
We started out talking about theimportance of the consultant or broker.
And then we talked secondly get bidsevery single year, multiple bids,
and then after that, contractingprovisions, including the runout period.
(20:17):
No new lasers, making sure thereare renewal caps in there, and
then also the mirroring provisions.
And then the last piece of advice isnumber four, watch eligibility and really
make sure you're doing eligibility audits.
That's really, really a big deal.
Okay, so now do we have anyexamples of where things went wrong?
And I really, actually, I would prefernot getting an outlier here, just what
(20:42):
do you see when you onboard a new planfrequently enough relative to their
stop-loss coverage or lack thereof?
Well, you know, I think there arethe risk terms, like the contract
terms, but honestly, the thing I seemost often is an overly conservative
point of view in terms of stop-loss.
Stop-loss is a high margin product.
(21:03):
If your deductible is too low and you'renot increasing it on a regular basis,
if you just haven't marketed it andthey're just taking premium increases
year after year after year, we seecompanies that are just paying hundreds
of thousands, if not millions of dollarsmore than what a, you know, probably
(21:24):
market rate policy should be paid.
And as much as you know, the contracttype might create risk and there you have
unbound liability potential, if you'repaying a million dollars more than you
should be paying year after year afteryear, in many cases, that's even worse.
Jon just touched on something importantand I got to know the CEO of one of
(21:46):
the large stop-loss carriers prettywell, and in a, maybe in a moment
of weakness, he revealed to me whatthe margins are, what they shot for.
And this particular company shotfor 30 to 40% margins on stop-loss.
And so Jon just said, it'sa high margin coverage.
Now I get it.
They're taking out a lot of risk.
I get all that, but as the employer,you need to play the game, right?
(22:07):
Your job is to extract as much ofthat back as you can and try to get
the best coverage at the lowest rate.
And too many companies fail to beactive purchasers in this field.
So, is there a way that you recommendfor purchasing stop-loss insurance?
So we talked about definitely the thingsthat you wanna make sure of when you
(22:28):
are buying stop-loss, but relative tolike purchasing it from the process by
which one procures the stop-loss to beginwith, do you have any suggestions there?
Well, in our case, we actuallytake advantage of a panel approach.
So we have a multi insure panel whoannually is competing for a very large
block of overall stop-loss premium everyyear, and that has helped us in terms
(22:52):
of getting the best rates possible, thatensures that every year our companies are
actually going to the market, as Jon said.
And allowing competitiveforces to play in your favor.
And so I think that's one way to goabout this as opposed to just kind of
going out to the market on your own everyyear and hoping you do the right thing.
Take advantage of volume.
(23:13):
I think we're gonna talk aboutthis, maybe take advantage of a
collective as we do to try to allowmarket forces to work in your favor.
So this might be our lastreally big piece of advice.
Try to aggregate as many, as muchvolume as one can, such that when
you go to a stop-loss carrier, youcan leverage that volume of business
(23:35):
and try to get a better rate.
And you're calling that a panel approach?
Yeah.
So, well, the panel approach, it'simportant that each, each individual
company is individually underwritten.
But when you have 50, 60, 70, 80companies all competing under similar
terms, all competing in a dynamicwhere every bidding carrier knows
(23:56):
that they're up against a lot ofcompetition, the pencil stays sharp.
The contract terms that they'rebidding on are consistent.
The process is consistent.
The results end up being just a, an addedefficiency, and then ultimately there's
a lot more strong choices to be made.
As I said earlier, carriersare getting into the market.
(24:17):
Carriers are getting out of the market.
Some years carriers areexcited about stop-loss.
Some years they're not.
And so by looking at a panel and getting,you know, 7, 8, 9, 10 different carriers
bidding for your business, you know thatwhat you're getting is relatively the best
in the market that they have to offer.
So does the panel refer to the number ofemployers that are ganging up together,
(24:38):
or does the panel refer to, you'reasking a lot of different stop-loss
carriers, like who's the panel here?
In this case, it's a panelof stop-loss carriers.
So in our case, we use nine or 10 carriersthat all understand, hey, there's a lot
of different companies here to be bid on.
If you can stick to this process, ifyou can bid on this contract type.
(25:00):
If you can, you know, manageclaims effectively throughout the
year and work with us on that.
That's our panel approach.
All right, so in part one of this episode,we have talked about what stop-loss is.
We've talked about these termsthat wind up getting bandied
about relative to stop-loss.
A lot of times we've talked about today,the advice that you have , and we just
(25:22):
finished up here with the buying processitself, which sounds like, again, there's
probably better or worse ways to do this.
And I just keep thinking about whatyou said at the very beginning,
Andreas, about making sure that theconsultant knows what they're doing.
Is there anything that we neglected totalk about that we wanna bring up today?
The one thing I wanted to add is make sureyou know what your consultant is getting
(25:46):
paid, and if you're using some type ofcollective or captive or whatever, make
sure you know what they're getting paid.
Over the years, we've seen some, youknow, questionable behavior when it
comes to commissions on stop-lossbecause it's not an employee benefit.
It's not reported on 5500s.
If you have that reputable broker,you're doing disclosures and things
(26:08):
like that, you're probably okay.
Same thing with a strong collective.
Definitely know what these peopleare being paid on this coverage.
Andreas, anything that youwanna add as a wrap up here?
No, I think, I think we coveredthe waterfront pretty well.
This stuff is complicated.
I hope it doesn't scare anyone away.
I hope this helps clarify some ofthe important points that you need to
look at, and it's just, it's a reallyintegral, important part of the overall
(26:31):
self-insurance equation that is too easyto sort of, view as that last buying
decision that we talked about and sortof you wanna sweep it under the rug.
It's probably one of the mostimportant buying decisions.
Unfortunately, it happens at the way endof the process when everybody's really
tired and beat up and you know, you gottahang in there and get through this one
and put as much into it as every otherpart of what, you've done to sort of
(26:53):
structure your plan for your employees.
Andreas Mang and Jon Camire,thank you so much for being on
Relentless Health Value today.
Happy to be here.
Thanks so much for having us.
Thank you, Stacey.
Hi, I am Keith Passwater,CEO of Havarti Risk.
Relentless Health Value hasconsistently challenged the way I
think about the business of healthcare.
The conversations are smart,relevant, and grounded in the
realities we face every day.
(27:14):
If you're as passionate aboutdriving healthcare change as I
am, I really encourage you tofollow Relentless Health Value on
LinkedIn and join the conversation.
Thanks for listening.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Cold Case Files: Miami
Joyce Sapp, 76; Bryan Herrera, 16; and Laurance Webb, 32—three Miami residents whose lives were stolen in brutal, unsolved homicides. Cold Case Files: Miami follows award‑winning radio host and City of Miami Police reserve officer Enrique Santos as he partners with the department’s Cold Case Homicide Unit, determined family members, and the advocates who spend their lives fighting for justice for the victims who can no longer fight for themselves.