HOW HEALTHY IS YOUR HEALTH PLAN?

 

 

THE OPPORTUNITY

Over 155 million Americans receive medical coverage through their employer, and most consider it a driving factor in accepting or remaining in a position. At the same time, employers’ investments are threatened by a lack of transparency into the performance of their Plan, missed savings opportunities and double-digit increases with no known cause. 


Could you be doing more to impact the root cause of healthcare spending instead of just dealing with the symptoms? This checklist provides benefits teams, executives and HR teams with a way to evaluate the health of their current health benefits strategy.

HEALTH PLAN AUDIT


VENDOR ALIGNMENT


Administrators are often owned by insurance carriers or other entities, which can make transparency difficult, and even create a conflict of interest for employees. Ensure your vendors are independent stewards of your healthcare investment acting with you interests in mind.
Employers must be confident in each renewal that they are getting the best possible rate and seeing all possible solutions. The cause of any increases must be clear and a direct result of our health plan performance, not external factors.



DATA-DRIVEN DECISIONS


Recommendations should be made based on available and actionable. Employers should own their own data and receive customized recommendations based on their population's data trends.
Health plan administrators are well-positioned to identify high risk employees and direct them towards meaningful outreach. The impact of that outreach should be clear and accessible to you.



SAVINGS BEYOND A NETWORK DISCOUNT


Network discounts should never be the only means to cost control. Employers must be confident that additional savings strategies are being used beyond a network discount.
Administrators should alert your team before large claims so that your team can plan ahead.
Employers cannot rely on auto-adjudication of claims, and instead should expect the detailed expertise required to identify and act upon savings opportunities.
Employers should be confident that an administrator can help them prepare for a new wave of healthcare that emphasizes price transparency and smart consumerism.

 



INTEGRATION OF WIN-WIN BENEFITS


Employers are rapidly adopting more employee-centric models. Employees should know exactly who to call when they need help navigating the healthcare system.
Employers can't fall victim to the cost/benefit dilemma. Outreach programs must accomplish the goals of lowering costs and improving employee experience.

 

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IN GOOD COMPANY

 

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