I was talking to an employer the other day who was describing their current situation with their health plan. He explained how they had moved from a fully insured plan to a partial self-funded plan several years ago, and some of the historic changes they had made that led him to believe that they were “cutting edge” and were doing everything possible with their plan.

  • They had implemented what they thought was the best PPO network for themselves and their locations with the greatest discounts that their broker had evaluated.
  • They had made changes in their plan design and had included a plan for employees that was a high deductible plan with an HSA.
  • They had implemented a “wellness plan“ that rewarded employees for wellness activities and tobacco cessation.
  • Every year they shop for the most competitive stop lost coverage, but have had to raise their specific deductible occasionally to offset the rate increase.
  • They were charging a fairly high amount to employees out of their paycheck contribution to help contribute to the cost of the overall health plan.

Does this sound familiar? While I commended him for his progress, I thought to myself that there was so much more that they could also be doing. As I have said before, any given employer is only as good as their broker or consultant. They typically only know what the broker knows. And this employer was led to believe by their broker that they were cutting edge.

The bottom line is: they don’t know what they don’t know.

it was obvious by what they were doing with their plan that they knew nothing about these programs, just to name a few:

  • Metric Based Pricing
  • Oncology Management
  • Diabetes Management
  • Disease Management
  • Transparent Pharmacy Benefit Managers
  • Maximizing Prescription Rebates
  • Employee Concierge and Advocacy Services
  • Data Analytics
  • Specialty Drug Programs
  • Direct Contracting
  • Elimination of PPO Networks
  • Best In Class Vendors
  • Aggregating Specific Deductibles
  • Captives
  • Purchasing Cooperatives
  • And more…

I asked him when was the last time their broker brought an idea to them that could reduce their health insurance costs by 20% to 50%? He looked at me like I was from another planet! Was it because their broker was unaware that any programs existed? Or was it because the broker, for whatever reason, chose not to share these concepts and programs? If that’s the case, that begs the question “Why?”

Many employers I talk to are in the exact same situation.  They believe that they are doing everything possible to keep costs down – all at the recommendation of their broker.  While I have no reason to believe that their broker is not well intended, it still comes down to the 2 questions above. For whatever reason they really don’t know what else they could be doing – and there is a lot!

I believe that when an employer can dramatically lower their costs, and the cost to the employee through lower payroll contributions or lower the employee’s cost at the time of care, everyone wins. When healthcare and health insurance costs are lowered it obviously becomes more affordable. Affordability provides security to employees in the form of higher wages or bonuses, or more take-home pay for food, clothing, housing, education, etc. Affordability also provides the employer with the sustainability to continue to offer the meaningful benefits they provide for their employees.

If you’d like to learn more about how you can lower your healthcare and health insurance costs, or simply to lean more about other programs or concepts, please call me at 970.349.7707 or email me at frank.stichter@strategichpc.com