Oct 6, 2026 · 54 min · 13 segments
In this week’s podcast, Host Dorothy Cociu discusses medical plan cost containment and pharmacy benefit cost containment with Kyle Gerdts, VP of Sales & Account Management for Pinnacle Health…
Dorothy CociuHostKyle GerdtsGuestDon AndersonGuest
What are some other things? And I want to talk about plan design because to me, plan design has always been key in cost containment.
And so I literally grew up in the TPA business and literally grew up in self-funding.
And I didn't know that I could, at that time, I didn't know that I could hire planned document writers because I was young and naive and I had no idea.
So I started writing to myself just, and they weren't very good at the beginning.
And then after a while I got a good prototype, but it took me a couple of years to get there.
And then I start, you know, getting smarter about this and finding out, you know, I guess I could have contracted that out.
But at that point, my plan docs and summary plan descriptions were pretty good.
So let's talk about plan design because you can make it or break it in a plan, in a self-funded health plan by how you design the plan.
I think plan design is absolutely one of the biggest cost containment tools available for a self-funded employer.
There's a lot of things you can do to it to cut costs, right? So at Pinnacle, we don't believe our role is to dictate the plan design.
We work collaboratively with our broker partners, our consultants, the plan sponsor during implementation, upon renewal, looking at the data to really identify areas within the plan design that we administer.
to support them and their population and their company to cut costs, right? Others want us much more involved, looking at the data, some less involved because the consultant's kind of doing all that, right? So we are there to help identify opportunities and helping the model differentiate the strategies and so forth, right, based on that population.
The employer has, you know, much more flexibility to design a plan around, you know, its particular population.
What are some other things? And I want to talk about plan design because to me, plan design has always been key in cost containment.
And so I literally grew up in the TPA business and literally grew up in self-funding.
And I didn't know that I could, at that time, I didn't know that I could hire planned document writers because I was young and naive and I had no idea.
So I started writing to myself just, and they weren't very good at the beginning.
And then after a while I got a good prototype, but it took me a couple of years to get there.
And then I start, you know, getting smarter about this and finding out, you know, I guess I could have contracted that out.
But at that point, my plan docs and summary plan descriptions were pretty good.
So let's talk about plan design because you can make it or break it in a plan, in a self-funded health plan by how you design the plan.
I think plan design is absolutely one of the biggest cost containment tools available for a self-funded employer.
There's a lot of things you can do to it to cut costs, right? So at Pinnacle, we don't believe our role is to dictate the plan design.
We work collaboratively with our broker partners, our consultants, the plan sponsor during implementation, upon renewal, looking at the data to really identify areas within the plan design that we administer.
to support them and their population and their company to cut costs, right? Others want us much more involved, looking at the data, some less involved because the consultant's kind of doing all that, right? So we are there to help identify opportunities and helping the model differentiate the strategies and so forth, right, based on that population.
The employer has, you know, much more flexibility to design a plan around, you know, its particular population.
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