Move over mainstream: Alternative health options a road to better value
A number of employers are seeking alternative ways to get better value for their healthcare spending. Read this blog post to learn more about alternative health options.
While employers may be the largest purchasers of healthcare outside of the federal government, rarely does one organization have enough influence when negotiating with the powerful health plans and provider systems. As a result, employers — and ultimately the consumers for whom they purchase healthcare services — pay the price.
Instead of taking these lumps of coal sitting down, there are a growing number of employers on the cutting edge of healthcare purchasing seeking alternative ways in 2019 to get better value for their healthcare spending. They are looking for the diamonds in the rough.
In more than half of the healthcare markets in the U.S., providers have merged reducing competition and leaving employers and consumers with little choice for their care. Employers must stop insisting that health insurance products provide access to the broadest network of healthcare providers — if providers know they’ll be kept “in network” no matter how they behave, employers and payers further reduce their negotiating position. Employers also should band together to be sizable enough to call the shots, but this rarely happens.
While this lack of market power and influence is a major frustration for employers, it’s far from the only one. Educated employers also know that the healthcare system produces uneven quality and high prices have nothing to do with excellent care. The amount an employer pays for a service merely represents the relative negotiating strength of the health insurance carriers and providers.
As prices continue to drive healthcare cost growth, Americans are finding their healthcare unaffordable and are willing to trade choice for affordability. Many Americans no longer view having the ability to pick any doctor they choose as essential if it means increased premiums and cost-sharing that comes at the expense of other basic needs. These shifting attitudes represent an opportunity for employers seeking diamonds to pursue the following new healthcare benefits options. Here are some.
Narrow networks: Health insurance plans built around a narrower network that cuts out care providers who are outlandishly expensive or have a particularly poor record on quality. Alternatively, center a smaller network around a direct contract with an accountable care organization selected for its potential to deliver higher quality and value. More commercial health insurance carriers and lesser known third-party administrators are offering and supporting these options. Premiums and cost-sharing are typically lower for the consumer than with broader network plans.
Centers of excellence (CoE): Steer patients to designated high-quality providers with expertise in a given medical area who are willing to enter into an alternative payment arrangement or offer a more reasonable price in return for more patients. Make CoEs attractive through more generous coverage or make them mandatory if employees want an elective or non-emergent procedure (e.g., bariatric or spine surgery). Either way, employers reduce the risk that employees will receive subpar or low value care.
Alternative sites of care: Increase access to and use of alternative sites of care including onsite or near-site clinics and telehealth services. These enhance the convenience of primary or behavioral healthcare for employees and can help the employer better control referrals to overpriced hospitals or specialists.
So, move over mainstream. When it comes to the tactics employers use to purchase healthcare, alternative is likely to become less fringe. Narrow networks, CoEs or alternative sites of care may not solve all of the frustrations. But employers’ pursuit of these new models sends a strong signal that lumps of coal aren’t going to cut it. Employers are on the hunt for a shinier, more attractive set of solutions.
SOURCE: "Move over mainstream: Alternative health options a road to better value" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/move-over-mainstream-alternative-health-options-a-road-to-better-value?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
Analytics are key to wellness success. Here’s why
How can benefits managers utilize analytics to maximize their companies’ investments? Continue reading to learn how analytics can help employers optimize their health, wellness and other benefits programs.
What do benefits managers have in common with Walmart? Both have the power to leverage data to create a sustainable competitive advantage.
Like other leading retailers, Walmart mines vast quantities of data and applies predictive analytics to fuel solutions that improve store checkout processes, maximize inventory turnover and optimize product placement. Data analytics also helps the company identify shoppers’ preferences and personalize their shopping experiences. New parents, as identified by prior purchases, might receive digital coupons for infant products, for instance.
Walmart’s data intelligence gives the international retailer the ability to act upon insights quickly. One Halloween, for example, a novelty cookie generated high sales across the United States, but no sales at all in two U.S. stores. The company’s data analytics swiftly ascertained that the cookies were never put on the shelves at those stores. The problem was resolved immediately through high-visibility product placement.
Employee benefits managers have similar opportunities to maximize their companies’ investments. The effective use of disparate data can help employers optimize their health, wellness and other benefits programs, and pinpoint the true value of their total rewards.
A data-driven approach to benefits analytics
Three out of five U.S. employers use health screenings and risk assessments to help employees detect conditions earlier, when treatment might be more effective and costs lower. However, the majority of employers do not measure the impact of these programs.
Those that do assess a program’s impact typically compare the dollars spent on it with the medical claims saved. Forward-thinking benefits managers, however, are examining the total value of investment (VOI) instead. This innovative approach analyzes not only the effect of a wellness initiative on medical costs but also its influence on productivity, absenteeism, disability costs and other factors.
By aggregating and analyzing different types of data — such as claims and non-claims data — benefits managers can determine crucial correlations between preventive screenings, health outcomes and healthcare costs. Thus, they can develop more targeted benefits packages that reduce costs while improving overall employee health and productivity.
Case Study: Implementation of predictive analytics in preventative screenings
One recent initiative undertaken by a state employee health plan demonstrates the power of data analytics to reveal the VOI of preventive cancer screenings.
The state provides medical benefits to around 205,000 employees and dependents. The agency that administers the benefits program wanted to know whether preventive cancer screenings improved health outcomes, and whether the program was cost effective. Analyzing screening and claims data showed that 6% to 8% of those who underwent screenings for breast, colorectal or cervical cancer received a diagnosis of cancer or a related condition. The follow-up and all-important question was: did those members experience different outcomes than members whose cancers were not detected through screenings?
The results indicated a high VOI for members’ preventive cancer screenings:
- The majority of new cases of breast, colorectal and cervical cancer were detected through preventive screenings.
- Among members who received preventive screenings, 5% to 11% underwent treatments because of screening results — and not just for cancer. Treatments included removal of benign tumors or polyps.
- Those diagnosed with breast, colorectal or cervical cancer through the screenings experienced less invasive treatments and had fewer complications than those diagnosed through other means.
- New cases of breast and cervical cancer diagnosed through the preventive screenings had lower costs, on average, than cases detected through other means.
Positive action through data
This cancer screening example illustrates how data analysis can empower benefits managers to improve employees’ health outcomes while reducing costs. Analytics can help employers invest in more effective care management resources, as well as design benefits packages that provide positive VOI in wellness, screening and preventive care.
With the cost of health benefits continuing to rise, it’s critical to leverage data to determine the total value of wellness investments. Just as retailers use data analytics to improve the retail experience and increase profits, benefits managers should use data analytics to guide the design and evaluation of benefits and other rewards.
SOURCE: Kramer, M. (21 January 2019) "Analytics are key to wellness success. Here’s why" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/analytics-are-key-to-wellness-success-heres-why
4 ways to help employees master their HDHPs in 2019
Do you offer High Deductible Health Plans (HDHPs) to your employees? Whether your employees are HDHP veterans or newbies, there are things companies can do to help improve employee understanding. Read this blog post to learn more.
With 2018 in the books, now is a great time to give HDHP veterans and newbies at your company some help understanding — and squeezing more value out of — their plans in 2019.
Here are four simple steps your HR team can take over the next few months to put employees on the right track.
1. Post a jargon-free FAQ page on your intranet
When: Two weeks before your new plan year begins
Keep your FAQ at ten questions (and answers!), maximum. Otherwise, your employees can get overwhelmed by their health plans and by the FAQ.
When writing up the answers, pretend you’re talking directly to an employee who doesn’t know any of the insurance jargon you do. Keep it simple and straightforward.
Make sure your questions reflect the concerns of different employee types: Millennials who haven’t had insurance before, older employees behind on retirement, employees about to have a new kid, etc. To get a clear sense of these concerns, invite a diverse group of 5-7 employees out for coffee and ask them.
Some sample questions for your FAQ might be:
• Is an HSA different from an FSA?
• Do I have to open an HSA?
• How much money should I put in my HSA?
• This plan looks way more expensive than my PPO. What gives?
2. Send a reminder email about setting up an HSA and/or choosing a monthly contribution amount
When: The first week of the new plan year
When your employees don’t take advantage of their HSA not only do they miss out on low-hanging tax savings, your company misses out on payroll tax savings, too.
So right at the start of the new year, send an email that explains why it’s important to set up a contribution amount right away.
A few reasons why it’s really important to do this:
- You can’t use any HSA funds until your account is fully set up and you’ve chosen how much you’re going to contribute.
- If you pay for any healthcare at all next year, and don’t contribute to your HSA, you’re doing it wrong. Why? You don’t pay taxes on any of the money you put into your HSA and then spend on eligible health care…which puts real money back in your pocket. (Last year, the average HSA user contributed about $70 every two weeks and saved $267 in taxes as a result!)
- There’s no “use it or lose it” rule! Any money you put into your HSA this year is yours to use for medical expenses the rest of your life. And once you turn 65, you can use it for anything at all. A Mediterranean cruise. A life-size Build-a-Bear. You name it.
3. Give your HDHP newbies tips on navigating their first visit to the doctor and pharmacy
When: The week insurance cards are mailed out
When employees who are used to PPO-style co-pays realize they have to pay more upfront with their HDHP, they can get…cranky. And start to doubt their plan choice — or worse, you as their employer choice.
So set expectations ahead of time to avoid employee sticker shock and to prevent you from getting an earful. Specifically, remind employees which types of visits are considered preventative care (and likely free) and which aren’t. Then explain their options when it comes to paying for — and getting reimbursed for — the visit.
4. Share tips on saving money on care with all your HDHP users
When: Any time before the end of the first quarter of the year
Specifically, you might recommend that your employees:
- Check prescription prices on a site like Goodrx.com before they buy their meds
- Visit an urgent care center instead of the ER, if they’re sick or hurt but it’s not life-threatening
- Use a telemedicine tool (if your company offers one) to get free online medical advice without having to leave their Kleenex-riddled beds
Sure, following this communication schedule requires extra elbow grease. But if you defuse your employees’ stress and confusion early, they’ll feel more prepared to take control of their healthcare and get the most out of their plans. And as a bonus, you and your team get to spend less time answering panicked questions the rest of the year.
SOURCE: Calvin, H. (2 January 2019) "4 ways to help employees master their HDHPs in 2019" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/4-ways-to-help-employees-master-their-hdhps-in-2019
The benefits issue that costs employers big: Ineligible dependents on company plans
Frequently, roughly 10 percent of enrolled dependents are ineligible for the healthcare programs. Continue reading this blog post to learn more.
Are you paying insurance premiums for people who aren’t qualified to be on your company plan?
For some employers, too often the answer is “yes.”
In our experience, we find that nearly 10% of dependents enrolled in employee health and welfare plans are not eligible to be in the program. And for a company with a couple of hundred employees that spends around $2 million a year on benefits, ineligible dependents can become a significant financial issue.
When employers pay for ineligible dependents, costs increase for them and employees. Unfortunately, it’s an all-too-common issue that employers need a solid strategy to combat.
So how do ineligible dependents get enrolled in the first place? There are a couple of common ways that employers end up paying health insurance premiums for ineligible dependents. The most basic factor is a change in a person’s situation — children pass the age of 26, spouses get jobs, people get divorced, etc. — and the employee is unaware of the need to notify the plan sponsor. Most often, these situations arise because the employer doesn’t have a process in place.
But some situations are more nefarious: An employee mischaracterizes someone as a dependent. They may claim that a nephew is a son, or that they’re still married to an ex-spouse. In either of these situations, the employer loses.
Prevent ineligible dependents with best practices
Prevent paying for ineligible dependents by putting into place best practices that begin when a new employee joins the company.
During onboarding, investigate each potential plan member when the employee applies for insurance coverage. That means seeking documentation — such as marriage certificates and birth certificates — to verify that a person is, in fact, married, or that their kids are their kids and not someone else’s. Following these processes at the outset prevents the awkwardness of having to question employees about their various family relationships. Nobody wants to ask a colleague if the divorce is final yet.
To make it easy for employees to verify everyone’s eligibility, provide access to a portal where they can upload scans or images of relevant documents. This will also make it easier to track—and keep track of—onboarding documents and dependent audits when the time comes.
Once this best practice is established, it’s important to conduct periodic dependent eligibility audits, as required by ERISA. The employer can conduct an audit or hire an external auditor. This decision is usually driven by the size of the workforce.
The most logical time to conduct an audit is during benefit enrollment. Employees are already considering options for the next plan year, and they likely won’t be confused by the need to submit verifying documents. (During this exercise, it’s also a good idea to ask plan participants to verify beneficiaries on employer-provided life insurance.)
Some employers — again, depending on the size of the workforce — will conduct random sample audits of 20-25% of their employee population. Obviously, the larger the sample size, the better. Benefits administration platforms typically streamline this process.
What happens when employers identify an ineligible dependent?
Many employers offer workers an amnesty period during which an employee can come forward to say they have someone that should be taken off the plan. If the plan sponsor identifies an ineligible dependent, employees are typically offered a one-time pass. Then, they must sign an affidavit attesting that they can be terminated if it happens again.
If the employer has processed insurance claims for an ineligible dependent, they can declare fraud and seek back payment of claims payouts. Again, most in this situation prefer a more benevolent approach and will ask the employee to make monthly differential payments until the account is even. Conducting regular dependent eligibility audits as part of the benefits administration process needs to be handled with finesse for the good of organizational culture.
Some employers may shy away from conducting audits out of concern for creating awkward situations. But frankly, it’s the plan sponsor’s job to help them navigate the waters, educate them and keep them engaged in the process by becoming their best advocates. This will not only help enhance the efficiency and accuracy of employee benefit offerings, but it will result in a smoother ride for everyone involved.
Ensuring that a health and welfare benefits program follows eligibility best practices is the responsibility of the plan sponsor. But employees have a share in that responsibility, too.
SOURCE: O'Connor, P.(28 November 2018) "The benefits issue that costs employers big: Ineligible dependents on company plans" (Web Blog Post). Retrieved from:
Healthcare waste is costing billions — and employers aren’t doing anything about it
Providing your employees with healthcare insurance is expensive. A large chunk of healthcare costs is being wasted by the healthcare industry, according to a new survey. Read on to learn more.
Providing the workforce with healthcare coverage is expensive, but a new survey of 126 employers suggests a large chunk of that cost is being wasted by the healthcare industry on treatments patients don’t need.
The healthcare industry wastes $750 billion per year on unnecessary tests and treatments, according to a survey from the National Alliance of Healthcare Purchaser Coalitions and Benfield, a market research, strategy and communications consulting firm. Some 60% of employers don’t take steps to manage their healthcare plan’s wasteful spending, despite the fact that the same percentage of employers view it as a problem, the survey says.
“While waste has long been identified as a key concern and cost contributor, employers are operating blind and need to look at a more disciplined approach to address top drivers that influence waste,” says Michael Thompson, National Alliance president and CEO.
Employers are under the impression that prescription drugs are the culprit behind the spending waste, and they are, just not as much as other services. Around 54% of health spending waste is caused by unnecessary medical imaging tests, such as MRIs and X-rays, the survey says. Specialty drugs, unnecessary lab tests and specialists referrals are also major money pits.
However, the survey data isn’t suggesting these procedures and treatments shouldn’t be covered by employer health plans. The tests and treatments are potentially life-saving, they’re just used more than they should be. Sometimes previous test results can help with a current diagnosis, but medical staff don’t always check patient files before ordering new tests.
Most employers don’t monitor unnecessary healthcare spending. The 34% of employers who do rely entirely on their healthcare vendors to do it for them, trusting that it’s being taken care of.
“The idea of reducing waste in the healthcare system can be overwhelming,” says Laura Rudder Huff, senior consultant for Benfield. “While employers ask themselves: ‘Where to start?’ this is an issue where even small steps matter. Employers can begin by collecting data to identify where the inefficiencies are in their workforce and community and use assets such as vendors and organizations like coalitions to realize market improvements.”
The survey also recommends employers enlist the services of Choosing Wisely, an organization that counsels patients and employers on healthcare plans and medical treatments.
SOURCE: Webster, K. (7 November 2018) "Healthcare waste is costing billions — and employers aren’t doing anything about it" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/healthcare-waste-is-costing-billions-and-employers-arent-doing-anything-about-it
Why Employers Should Boost Dental Benefits Enrollment
Original post benefitsnews.com
You might eat a balanced diet and squeeze in a mix of cardio and weight-lifting workouts every week to stay healthy. But to be truly healthy, you’ve got to focus on more than just working out and eating well. Believe it or not, you’ve also got to focus on oral health.
The link between oral health and cardiovascular health isn’t new; however, there is new evidence that more closely ties periodontitis, better known as gum disease, to heart attacks and stroke. One study showed that treating oral inflammation caused by gum disease with a topical remedy reduced vascular inflammation, which is a leading risk of hypertension, heart attack and stroke.
Heart disease is a serious problem in the United States — one in four people will die of the malady if it goes untreated. It’s also a major expense for Americans, including employees and employers who sponsor their health plans; heart disease costs nearly $1 billion a day in medical care and lost productivity.
Gum disease can affect more than just the heart. For pregnant women, it can also affect unborn babies. The bacteria caused by periodontitis can get into the blood stream and target the fetus, contributing to premature birth or low birth weight. Not only does prematurity and low birth weight put newborns at risk for issues in the beginning of life and learning, as well as developmental issues later on, it’s also costly for a family. In its first year, a preemie can cost around $49,000 in expenses, compared to just $4,551 for an infant who doesn’t experience complications. The March of Dimes reports that pre-term birth costs more than $12 billion in excess healthcare costs.
Diabetics also need to pay special attention to their oral health. In addition to monitoring their feet, eyes, kidneys and heart for complications, they are more prone to periodontitis. A higher risk of gum disease can make it more difficult to control blood glucose, and can also cause disease and infections in the bones that hold teeth in place, making it more difficult to chew. Gum disease may also lead to tooth loss. Diabetes costs the United States $322 billion in a combination of healthcare fees and lost productivity.
It’s important for employers and employees to understand how oral health plays a part in overall health, and that simple, inexpensive treatment can save businesses and plan participants thousands of dollars and countless hours of pain and suffering.
Analyzing claims data is one way to see how oral health might affect employees. The highest number of claims typically comes from cardiovascular, maternity, diabetes and musculoskeletal claims — all of which are exacerbated by periodontitis.
For years, dental health was given a back seat in health plans, wellness initiatives and employee education. Most initiatives focused on preventing heart disease through diet and exercise, and focused little, if at all, on dental care. Many health plans did not — and still do not — include dental coverage, which is a minimal expense compared to other program costs overall. Consequently, employees may simply write off dental care because they may not have a history of cavities. But dental coverage and consistent employee education and communication can help them understand the risks, develop good habits and begin to take their dental health into their own hands.
Employers can work closely with insurance brokers to understand medical and dental coverage, and what their costs and claims are for both. They’ll likely see that medical claims are far higher than dental claims. They can then work together with benefit consultants to create an affordable dental plan, or bridge the gap between dental and medical for those at higher risk for periodontitis issues so that employees can get the treatment they need.
Finally, employers need a long-term communication strategy to educate employees on the value of benefit offerings and the importance of good oral hygiene. They’ll be happy and healthier, and the employer’s medical costs will decrease.
Everybody wins.
5 Strategies to Cut Healthcare Costs without Cutting Benefits
Original post benefitsnews.com
For employers, it’s been an ongoing battle to keep health insurance costs down without cutting employee health benefits. According to a PwC report, healthcare costs will remain a challenge in 2016 as costs are expected to outpace general economic inflation with a 4.5% growth rate.
There is no single culprit in the battle against rising healthcare costs; rather, there are many drivers contributing to the increase. Soaring prices for medical services, new costly prescription drugs and medical technologies, paying for volume over value, unhealthy lifestyles and a lack of transparency concerning prices and quality are all factors contributing to the spike in premiums.
So what can you do?
It can be a difficult juggling act to keep your health insurance premiums from financially squeezing your business, while also providing a robust benefits package for your employees. However, you may have more options for controlling your company’s healthcare costs than you realize. With the right knowledge and planning, there are ways to keep health insurance costs from derailing your company’s profits while also providing your workforce with the benefits they need.
Here are five strategies to cut costs without minimizing the benefits offered to employees:
1. Level-funding company healthcare costs.
In between a traditional fully insured plan and a traditional self-funded plan lies an innovative solution known as level-funding.
Traditional fully insured plans are contracts between the employer and the insurer where the employer pays a predetermined and fixed amount per employee per month (PEPM) and the insurer assumes the financial (claims) risk, net of employee co-pays and deductibles.
Traditional self-funded plans are one in which the employer assumes the financial (claims) risk for providing healthcare benefits to its employees. In practical terms, self-insured employers pay for each out-of-pocket claim as they are incurred, and the model is almost always is packaged with stop-loss insurance in case of large claims.
Level-funding is a hybrid of the two aforementioned plans, whereby the plan is filed as a self-funded plan, but the employer is billed each month a fixed and unchanging premium per employee per month, and after a year or two may qualify for a refund of premium if claims were lower than expected, or receive a proposed increase to premiums at renewal if claims were higher than expected. Since these plans are filed as self-funded, they are typically exempt from state taxes and many of the federal healthcare law’s health insurance taxes, but subject to a modest annual transitional reinsurance fee.
Additionally, according to data from the U.S. Department of Health and Human Services, nearly 30% of employers with between 100 and 499 employees self-insures their benefits, and over 80% of employers with 500 or more employees self-insure their benefits.
2. Provide a proactive wellness initiative.
Health and wellness programs have become popular ways for employers to manage healthcare costs — and some companies are finding that employees are more engaged in these programs when they’re offered incentives, rewards or even disincentives for participating or attaining certain health-related goals. Some companies are also seeing an impact of incentives on their program ROI.
For wellness programs to be effective, they need to be robust and allow for individual needs and interests. Wellness programs need to be comprehensive and tailored to individuals; meeting them where they are and helping them keep their healthy goals and ambitions in check with robust resources.
One other important aspect of having an effective wellness program is measuring employee engagement. By determining their level of inclusion, employers can understand how to implement incentive-based initiatives for the future. And remember, leading by example is important to make your employees feel comfortable.
3. Implement tax-advantaged programs.
Tax-Advantage benefits programs allow for a reduced cost of living for employees by handling expenses using pre-tax dollars. This method ensures the use of money that is valued at 100% of a wage or salary, instead of paying with funds that are devalued due to taxation.
There are four major types of programs that utilize this method: flexible spending accounts (FSAs), health savings accounts (HSAs), health reimbursement arrangements (HRAs) and premium offset lans (POPs). Each program offers a different process for healthcare payments that involves both employers and employees, and can lighten the burden of rising medical expenses.
4. Use a flexible contribution arrangement (FSA).
Elaborating further on the aforementioned benefit programs, FSAs enable employees to collect and store money that can be used for medical expenses tax-free. FSAs may be funded by voluntary salary reductions with an employer, and there is no employment or income tax enforced.
Another benefit of FSAs stems from the ability of employers to make contributions towards an account that can be excluded from an employee’s gross income. From an employee’s mindset, an FSA allows for flexibility and a metaphorical safety net in case of a medical emergency.
5. Use deductible exposure mitigation vehicles (HRAs).
A health reimbursement arrangement is another tax-advantaged employer health benefit plan that can trim your tax bill and reduce the cost of medical services.
HRAs are an employer funded medical expensed reimbursement plan for qualifying medical expenses. These plans reimburse employees for individual health insurance premiums and out-of-pocket medical expenses. They allow the employer to make contributions to an employee's account and provide reimbursement for eligible expenses. All employer contributions are 100% tax deductible when paid to the participant to reimburse an expense. They are also tax-free to the employee.
Based on the plan design, HRAs can be an excellent way to supplement health insurance benefits and allow employees to pay for a wide range of medical expenses not covered by insurance.
What works, what doesn’t
It’s crucial to educate employees on available tools and programs — by doing so you can control costs, while simultaneously providing appropriate benefits and employee engagement. To make the most out of a conscientious business decision, take the time to understand what is and isn’t working for you on your current plan, and what your other options are.
By adopting these new healthcare benefit strategies, you are engaging your workforce and enabling them to have an active role in determining an appropriate course of action.
A proper benefits partner maintains track of legislation and regulatory changes, advocates for small to mid-sized businesses and has the expertise to prevent violations from unforeseen rules and laws. By enabling these programs and using the right benefits partner, you can see your company’s healthcare costs lower substantially.