Suggestions
Nikhil Krishnan
Founder of Out-Of-Pocket
Nikhil Krishnan is the founder and "Thinkboi" at Out-Of-Pocket, a platform aimed at making healthcare more accessible through humor and relatable content. He has a background in sustainable development and business management, having graduated from Columbia University in 2014. His professional experience includes roles such as the Strategic Partnerships Manager at TrialSpark and Senior Industry Analyst at CB Insights, where he focused on digital health and biotechnology trends.
At Out-Of-Pocket, which he founded in February 2020, Krishnan uses memes and humor to educate people about the complexities of healthcare operations. His approach aims to demystify the healthcare system and engage a broader audience.14 He is also active on Substack, where he publishes a newsletter that has gained significant traction, reaching tens of thousands of subscribers.23
In addition to his current venture, Krishnan previously founded Get Real, a platform designed to facilitate structured online-offline friendships, and has held various internships in organizations like Uber and the Earth Institute.14 His work emphasizes a blend of humor and critical analysis of healthcare, making complex topics more digestible for the general public.
Highlights
my lightly disagreeable take is that company holiday parties should not allow +1s
It's not even a cost thing, though that helps. Holiday parties are meant for people at a company to vent, learn what else is happening at the company, and build rapport with people you're currently on projects with
When everyone brings their +1 you can't do that, it just becomes small talk and people leave early (most of the hashing out happens at 10pm and later)
finally read this lawsuit between a self-insured employer and anthem health plans of virginia.
It’s an interesting suit* because it shows some of the weird things coming to light in these “administrative only” arrangements that health plans have with insurers.
As a refresher, this is when the health plan only does administrative stuff like process bills, negotiate rates, etc. but doesn’t take on the financial risk.
As you can imagine, that basically means the health plan is essentially price insensitive since the employer is footing the bill. There’s a lot of interesting things here, but a few specifics
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the self insured company basically had to sue to get claims that showed the billed amount, allowed amount, and excluded amount. This would essentially show what kind of rates the plan was negotiating for the employer. The health plan said that rates they negotiate are considered confidential, which is interesting because isn't that a big reason you become self-insured? Access to the claims data?
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The suit claims that the health plan purposefully getting better rates for it’s fully insured plan where they’re financial at-risk in exchange for paying providers more from their administrative only arrangements where they aren’t on the financial hook.
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There’s a super interesting section about the BlueCard program. Basically all the blues have agreed to not go into each other’s territories. One thing that blues plans sell to employers is the BlueCard program, essentially “if your employee ends up somewhere else, we’ll use the rates of the blues plan in that area”. But apparently they also pass all the fees for being a part of the BlueCard program to the employer. One example they give is the Blues plan in a different state would charge a “network access fee” every time it’s used, which is $2000 per claim. Their point is basically that each individual Blues plan is loyal to the Blues coalition more than the employer itself, which is a violation of fiduciary duty.
