Five Questions to Ask when Analyzing Your Group Health Plan
- 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.
- 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.
- 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-media 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?
- 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 with the best outcomes from the best providers.
- 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.