The news, research and trends impacting your workforce.  

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement

Healthgram VP of Pharmacy Benefits exposes the opportunities for employers to save on pharmacy benefits management by understanding pricing, recognizing shortcomings in contracts and identifying PBM p...

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement
Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency

Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency

To manage rising pharmacy benefit costs, employers are challenging the status quo. Consider these six ways for employers to break an outdated cycle and shift to a transparent pharmacy benefit manageme...

Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency
How To Set Actionable Goals for your Onsite Clinic

How To Set Actionable Goals for your Onsite Clinic

Before launching your onsite health clinic, use these tips to define your company’s health and financial goals and use them to drive vendor evaluation and design custom clinic initiatives.

How To Set Actionable Goals for your Onsite Clinic
What Employers Should Know About Direct Primary Care

What Employers Should Know About Direct Primary Care

The health and financial risks of traditional healthcare are leading employers to embrace a new approach: direct primary care. In this article, Thold Gill, Principal of Wellness Coalition America, an...

What Employers Should Know About Direct Primary Care
Why the future of healthcare starts with better data

Why the future of healthcare starts with better data

The future of healthcare begins with employers leveraging their workforce data to improve benefits offerings, reduce costs and help employees achieve better health outcomes.

Why the future of healthcare starts with better data
How employers are closing the gaps in healthcare

How employers are closing the gaps in healthcare

Employer-sponsored healthcare is full of contradictions. Employers pay more and get less. Employees value their benefits, but aren't satisfied. How are employers working to close the gaps?

How employers are closing the gaps in healthcare
Room for improvement? How to evaluate this year's open enrollment

Room for improvement? How to evaluate this year's open enrollment

Another year, another benefits open enrollment in the books. So, how did you do? Before you turn to other business, it’s time to breathe, take stock of the process and evaluate what went well and whe...

Room for improvement? How to evaluate this year's open enrollment
Looking to improve the impact of your corporate wellness program? Prepare to get personal

Looking to improve the impact of your corporate wellness program? Prepare to get personal

Our experience and recent research on the subject finds that wellness program success relies on two important factors: health coaching and personalization. With these findings in mind, we’ve crafted ...

Looking to improve the impact of your corporate wellness program? Prepare to get personal
Real stories of health coaching and when wellness works

Real stories of health coaching and when wellness works

Research points to two major trends for healthy corporate wellness programs: customization and the power of coaching. While apps and trackers can help employees plan for healthy habits, when it comes ...

Real stories of health coaching and when wellness works
Providing benefits for an evolving workforce: what attracts and retains top talent?

Providing benefits for an evolving workforce: what attracts and retains top talent?

In addition to changes in education level, technical skills and culture expectations, a younger generation of workers brings a new perspective to the advantages of employer sponsored health insurance....

Providing benefits for an evolving workforce: what attracts and retains top talent?


Hearing these questions from employees? It may be a sign to evaluate your health plan administrator

Hearing these questions from employees? It may be a sign to evaluate your health plan administrator

 

Your employees depend on their healthcare coverage for themselves and for their families. At the same time, employers trust that their health plan administrator takes care of their employees while managing spend. But recently, you’ve heard more complaints from employees about gaps in service and concerns about coverage. Suddenly, what was intended to be a competitive benefit to keep your workforce strong is presenting symptoms of a broken system.

 

You’re not alone. A spate of recent insurance carrier mergers has resulted in fewer entities providing care and larger numbers that these mega-companies are responsible for covering.  With larger numbers of employees relying on the limited resources of large insurance carriers, it might come as no surprise that basic service issues are becoming the norm and individual answers from knowledgeable benefits professionals are the rare exception.

 

If your HR department is hearing the following questions from employees, a lack of service from your health plan administrator may be to blame.

 

Question: Am I covered for this?

 

For most employees, their involvement in healthcare benefits stops after selecting a plan during open enrollment. Research backs up this claim, with a recent Harris poll finding that although they may have been involved in electing their plan, two in five insured Americans did not have a good understanding of the services actually covered under those healthcare plans. 

 

When employees need care, avoiding the ins and outs of their health plan benefits are no longer an option. Your health plan administrator should be your partner in clearing the lines of communication and helping educate employees about their benefits.

 

It's a process that starts with a comprehensive overview of the benefits your company offers, often given to employees as part of a handbook or online document. A successful program includes an engaging Open Enrollment process that carefully walks employees through choices and continues with hands-on customer services and online tools.

 


Need a place to start? Share our guide to employee benefits with your team.


 

Question: Why is healthcare so expensive?

 

Employees are becoming increasingly engaged in cost of care discussions, with 17% of Americans reporting that healthcare is their family's top financial concern. What many employers and employees don't know is that in the face of rising premiums and network discounts there are significant opportunities for cost savings within their network.

 

For example, prices for common imaging and surgeries can vary by thousands of dollars between facilities within the same ZIP code. That means an employee in need of a knee surgery can pay as little as $2,000 or over $18,000 for the same procedure. With the employer footing the bulk of the bill, both parties stand to overpay by up to 500% if options aren't carefully explored. 

 

On the other hand, proactive utilization management can save employees and employers money. In some cases, employers are even incentivizing employees with monetary rewards to explore their options.

 


Related: Six ways to help employees manage rising healthcare costs.


 

Question: Where should I go for treatment?

 

Employees should never question that they are getting the right care, at the right place, for the right price. 

 

Unfortunately, it's much easier said than done. Shareholder obligations, mergers and a lack of independence can obstruct an insurance carrier's ability to act on behalf of your financial investment and your employees' health.  An independent administrator with the ability to contract directly with facilities who provide the best care at a fair price presents a win-win for employers.

 

 

Question: Who should I call for help?

 

Members, providers, employers and payers should all be communicating about patients and treatments to deliver a seamless and cost-effective experience. In afact, a recent study conducted by J.D. Power & Associates found that health plans that utilize an integrated delivery system outperform traditional health plans in every one of the following factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service.

 

Unfortunately, this doesn’t always happen, costing HR precious time and leaving members to navigate the healthcare system on their own. 

 

Employers are increasingly turning to concierge member service models that provide one-on-one customer service from a live medical expert. Typically, these services provide employees with guidance on finding fair-price treatment options and resolving billing issues. It's this level of personalized service that reduces burden on HR and truly engages employees in their health benefits.

 


See it in action: Hear from one member who saved herself and her plan over $20,000


 

All of these questions beg another: is your administrator taking care of your employees and your bottom line? Discover more common symptoms of an outdated strategy with our 5-minute self-audit.

 

START THE AUDIT

 

Related

Share

 


SUBSCRIBE

   
Get our monthly executive outlook covering the news, research and trends affecting your workforce:

 


SPEAK WITH AN EXPERT

Healthgram partners with self-funded employers and benefits advisers to deliver a better healthcare experience.

To learn how we can help you accomplish your goals, contact a member of our team.

CONTACT US
 


CURRENT CONVERSATIONS

 

 

Let's design cost-saving health benefits your employees will love.
Start a conversation with our team to learn more. 

GET IN TOUCH