SIIA 2025: The High-Cost Claims Alarm Is Ringing

October 28, 2025 SIIA 2025 in Phoenix wasn't just about what's coming next, it was about what's already here. Catastrophic claims are no longer rare outliers. They're multiplying, intensifying and threatening the sustainability of self-insured health plans across the country.

Bruce D. Roffé, President & CEO of H.H.C. Group, put it bluntly during the panel on "New and Innovative Solutions to High-Cost Medical Claims":

"High-cost claims today aren't just expensive, they're strategic threats. If you're not acting early, fast and smart, you're going to lose control."

During the session, Bruce offered practical, proven strategies for tackling catastrophic claims, emphasizing solutions that plans can act on immediately:

• Directing patients to alternative, lower-cost infusion therapy sites of care, reducing expenses by avoiding inflated charges at high-cost facilities.


• Using AI and predictive analytics to identify plan members at risk of generating high-cost claims and engaging them proactively with personalized interventions.


• Implementing step-therapy treatment programs to guide care efficiently and avoid unnecessary, high-dollar procedures.
  Negotiating high-dollar in-network claims when provider contracts allow, leveraging existing terms to unlock additional savings.

Unique Perspective Based Upon Experience

Bruce brought a unique perspective to the discussion, shaped by decades of leadership and innovation in healthcare. He previously headed a major hospital's pharmacy department, worked with a pioneering company in home-based intravenous therapy and built H.H.C. Group from the ground up into a trusted, nationally recognized cost-containment partner.

Bruce took part in the discussion of innovative strategies for controlling maternity and neonatal event costs. Among his recommendations for managed maternity to improve the care and outcomes for newborns, especially those with critical health conditions was newborn gene sequencing to detect treatable diseases.

"Innovation in neonatology is driven by the need to forecast and identify problems in infants, leading to more accurate and individualized treatment plans," he said. "AI and Machine Learning technologies are being used to enhance the diagnosis and treatment of neonatal conditions by analyzing vast amounts of medical data."

What the Industry's Talking About and Why It Matters

The conversations at SIIA were focused, urgent and direct because the numbers don't lie:

• Gene therapies and specialty drugs are breaking six-figure thresholds in a single fill: In 2024 alone, the FDA approved 50 novel therapies, most of them specialty medications, further accelerating cost growth and shifting expectations for care delivery. Although they are used by less than 2% of the population, specialty drugs now account for around 54% of all drug benefit costs.


• Cancer, neonatal and cardiovascular events are driving runaway expenses.


• Negotiation timelines are shrinking and some providers aren't budging without a fight.

What's clear: reactive claims handling is no longer an option. Plans need proactive cost-containment partners who know how to act decisively the moment a claim hits the desk.

How H.H.C. Group Is Already Delivering What the Industry Needs
While others are planning next steps, H.H.C. Group is already in action – working daily to contain the most complex, high-dollar claims.

Here's what we're bringing to the table:

• Attorney-Led Negotiators & Licensed Health Insurance Adjusters
  All of our highly skilled negotiators are licensed health insurance adjusters, professionals who have passed rigorous state exams and specialized training. H.H.C. Group itself is a fully licensed and accredited organization, ensuring both company-wide compliance and individual accountability. This dual certification gives clients the confidence that every negotiation is conducted with legal precision, regulatory awareness and full transparency, protecting your plan from compliance risk and unnecessary spend.


• Certified Coders & Licensed Pharmacists
  Our experts combine coding precision, pharmacy expertise, and ISO-certified quality controls to scrutinize each line item for accuracy and compliance — ensuring you pay only what's reasonable and medically justified.


• 30 Years of Relationships for Results
  With three decades of experience, we've built professional relationships with provider decision makers nationwide. They take our calls because they know we're fair, fact-based, and credible — and that helps us achieve faster, deeper discounts.


• Independent Clinical Reviews & Reference-Based Pricing
  We don't just confirm fairness — we enforce it. Our URAC-accredited medical reviewers and Medicare-indexed pricing expose inflated charges and protect payors from overpayment. Every dollar paid is clinically necessary, contractually defensible, and financially fair.

A Wake-Up Call and a Call to Action

SIIA 2025 was a reminder that this is no longer business as usual. If your current vendors are slow, soft or silent, you're exposed. Every day you wait to act is another dollar lost, another plan at risk.

Whether we met at the conference or not, now is the time to connect.

Contact HHC Group today and bring us your toughest claims. Let us show you the savings you're missing. Let us prove it with real repricing results, real clinical reviews and real people who fight on your behalf.