Tom's Take Blog

January 10, 2018

Where could we be missing some savings opportunities in our company’s health plan?

Tom’s Take: When employers take a closer look at their health plans and break down the various elements, the savings opportunities start to become more obvious. In doing a broader analysis, here are three areas I’d like to point out.

 

  • Health Claims – With a self-funded plan, employers pay only for the health care services used. That’s a plus. But even in this structure (vs. fully insured), you could be paying too much. You need to be sure health claims are properly scrutinized, as this is a big area where savings are frequently missed. Here are some things to be looking for: miscoded items, duplicate entries, bundled services , upcoded services, medical necessity and charges for services that were never received.
  • Benefits Data – This is one area where many employers don’t realize the potential for savings. With self-funding, you receive all types of reports on things like care utilization, emerging trends, benchmark comparisons and more. This data is meant to help employers identify any high-cost and recurrent conditions that can be addressed through wellness programs and other pro-active, health-focused tactics.
  • Plan Customization – Customizing your health plan goes right along with using your data. Are you implementing benefit solutions that can bring costs down based on the stats received? Think about it in terms of a prescription management example. Does your plan include a service that shows which prescriptions are most utilized? One that educates employees about medications and helps them understand the most cost-effective options as far as generics vs. brand names? A plan that isn’t customized with appropriate services like this will often fail to maximize savings.

 

Many savings opportunities, especially in self-funding, come down to being educated. That means knowing your health claims should be (and are!) thoroughly reviewed, taking the time to assess plan data and understanding your options for tailoring benefits. There are plenty of ways to save with health plans … you just need to be proactive about finding them!

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