May 29, 2019

Building smart self-funded health plans: What’s most important?

Use these insights to create a strategy that works for CFOs, HR and your employees.

Pattern Overlay

A change in health plans affects everyone: employees, human resources, consultants and executive teams. But with the right partners and strategy in place, everyone can benefit. Follow these best practices to build smarter self-funded health plans around what’s most important to your key stakeholders.


C-Suite executive teams

Elements of Smart Self-Funded Health Plans

Healthcare is typically the second largest expense for a business. Ensure your company can continue providing benefits that attract and retain talent by requiring:

  • An independent entity that can act as a steward of your plan free from conflicts of interest.
  • One integrated system with centralized experts for appeals, customer service, check-runs, COBRA and technology.
  • Auditing practices that ensure no savings opportunity goes undetected.
  • Line-item visibility into claims.
  • Proactive and results-driven strategies for engaging with highest-cost claimants
    • Look for: A breakdown of the facilities and diagnoses driving highest-dollar claims and how they are being managed.
  • Transparent Rx contracts, prior authorization and return of 100% of rebates.


Human Resources teams

Elements of Smart Self-Funded Health Plans for HR

When benefits are confusing or disruptive, employees look to HR for help. In our ongoing member survey, 52% of employees say that if they didn’t have access to Healthgram advisor, they would have involved HR. 39% would have avoided resolving their issue altogether. A better healthcare experience for HR should include:

  • Dependable client service that allows HR to focus on strategy
  • Fast issue resolution with one convenient point of contact
  • Proven strategies for engaging employees in existing offerings
  • Tangible examples of cost management to share with finance teams
  • Notification of large claims in the pipeline
  • Year-round transparency into plan performance
  • Minimal disruption that allows HR to successfully manage through change



Elements of Smart Self-Funded Health Plans for Employees

Smart benefits lead to savings and employer loyalty. Provide employees with a benefits experience that includes:

  • Concierge-level benefits guidance and issue resolution with one number to call
  • Proactive intervention that anticipates needs and helps them save on costs
  • Personalized care plans for new and ongoing issues
  • Omni-channel and customizable communication strategies



Elements of Smart Self-Funded Health Plans for Consultants

Companies rely closely on the expertise of their benefits adviser or broker. A successful health plan partner will provide them with:

  • Seamless access to on-demand plan performance data. You and your broker should have full visibility into the ins and outs of your plan so that together, you can make data-driven decisions.
  • Customized recommendations for improving health outcomes and savings.
  • Expertise in compliance support and accuracy of claims administration – plus a single point of contact when questions arise.
  • Trusted client retention rate, so that all parties can reap the benefits of ongoing savings.