Most employers are either totally frustrated at their employee benefits program or are frozen in place waiting to hear about the next round of Congressional votes.
This is actually a good time to back up and take a look at your group health plan to identify what’s most important (and affordable) and what you can do to achieve that sort of plan.
The following five questions are a good guide through the process. We’ve included suggestions and options to assist you when you speak with your benefits advisor about next steps.
1. How do you select your carrier or administrator?
Most mid-sized advisers focus on the lowest rate for each 12-month period. Compare that method with establishing a strategic platform that addresses your challenges over multiple years. Challenges and options include integrated administration, care coordination, networks and reinsurance. The goal should be negotiation of multi-year total rate guarantees and caps. In addition, consider advisers who will work with best in class partners to identify customized initiatives like high performance networks for savings opportunities.
2. What is the cost structure and how are rates determined?
Approximately 80 percent of midsized employers are fully insured and paying between 7 and 9 percent in fees, taxes and profits. An option to consider is “level funding,” which avoids fees and taxes, authenticates claims and uses data strategically. It also eliminates subsidies of other, less innovative employers stuck in deteriorating insured pools.
3. Who assists you and your employees with questions?
Many carrier call centers and websites are either not helpful or not responsive. A better option is to identify carriers or administrators who offer dedicated teams, by name, to conduct multi-medium open enrollments, and provide for telemedicine, prescription assistance, claims, care coordination and wellness. What if they contacted doctors and pharmacies on behalf of employees to assure accurate insurance information for that first visit?
4. How engaged are your employees in evaluating cost and quality of healthcare services and how compliant are they with treatment recommendations?
A continuing challenge for cost control and improved employee health is to involve employees in shopping for cost and/or quality. Many either don’t understand or can’t afford to comply with their course of treatment. By contrast, look for benefits advisers who identify carriers or administrators who will actually research cost and quality and intervene to incent patients to get the best care in the most cost-effective ways from the best providers.
5. What type of communications tools are available?
Too often, communications are “one size fits all,” whether in content or method of presentation. Increasingly, benefits advisers are suggesting more creative ways to identify when and how employees want to be communicated with, including ways to involve spouses and partners.
As you can see, putting in place even a simple planning process can provide you with an effective roadmap to lead to fewer hassles, better care and more cost-effective services. I think you’ll agree it’s well worth your time.