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5 WAYS TO REDUCE CLAIMS FOR SELF-FUNDED PLANS

Dec, 06 2016

There’s not an employer in the country that’s not looking for ways to reduce their benefits costs. I hear from more and more employers who are frustrated with the skyrocketing cost of providing fully-insured plans. If you’re like most brokers, you’re looking for new ideas and solutions more than ever before. And, maybe like me, you’re finding many employers are now considering self-funded plans to get control over price increases.

But this only works by engaging the employees to become better consumers and live healthier lifestyles. Implementing the necessary tools for them to make this happen is the first step toward managing and reducing cost through a self-funded program. While there’s no magic bullet, it’s absolutely possible to lower health care costs with a strong, well-constructed self-funded plan.

I’m sharing five cost-reducing ideas you can implement to achieve this…

1. Choose the right Third Party Administrator (TPA) for claims adjudication

There are so many reasons why this is the way to go when you’re looking to reduce costs and even increase the efficiency of a plan. An expert claims payer will…

  1. Quickly and correctly pay claims per the established benefit contract
  2. Minimize mistakes, fraud, waste or abuse by members and providers
  3. Provide reporting that will allow brokers and employers to analyze and determine trends in activity

2. Implement a Surgery Benefit Management Program

This will be a quality-assured and separate bundled provider network for high cost surgeries. Whether or not a provider is included in the network is based on the quality of the provider, not the location. Case rates are transparent to employers and members, and are pre-negotiated by the companies providing the network. As a result, the incentive for the member becomes finding the best provider, not necessarily the closest.

Here’s one employer’s story: an employee needs a common knee surgery, so the plan would offer two options:

  1. stay in town and use a provider who is in-network with the plan. The employee will pay for their deductible and all out-of-pocket costs, as usual.
  2. choose a surgery center from the Surgery Benefit Management provider list which happens to be in a city six hours away. The employer pays flight costs for the family, accommodations at the local four-star hotel for the recovery time, and all costs associated with the actual surgery. The employer also gives the employee a $5,000 bonus. This option is SO much more cost-effective that the employer still saves thousands to their bottom line.

Which do you think most employees choose? Note that this can be a complicated process, so look for networks that have an additional concierge service to help employees navigate the choices.

3. Provide high quality telehealth and ehealth services 

Telehealth and ehealth are making their way to becoming the leading options for inexpensive and convenient health care. Start by choosing a vendor that will support the plan with an employee engagement and awareness campaign. This increases utilization and delivers ROI. When used to its full potential, these services:

  • Redirect general practitioner, specialist, urgent care and emergency room visits away from the health plan
  • Saves the employees money, time, and anxiety, helping them be more productive
  • Help employees get customized care and information from general practitioners and specialists. The ehealth service is particularly helpful in getting second opinions from specialists, saving money on what could have been a costly visit. telehealth_email_banner_788x274_0

 

4. Include an Advocacy service

An unbiased advocate “shops around” for employees getting cost estimates for procedures, while staying in-networkand maintaining quality. With this service, employees don’t have to do the legwork when investigating issues or questions about their bills, benefits or diagnoses. An advocate can perform a full medical bill reconciliation and then negotiate on behalf of your employees, as needed. As with anything, another set of eyes minimizes mistakes and overbilling. Employees feel more comfortable with plan changes, become better consumers, and are more productive at work, all while accessing help to get the most out of their insurance plan. This service can also be a huge help to the HR team and your office.

5. Add health coaching access to the plan

This type of service provides employees with diet, lifestyle and fitness sessions on a consistent timeline while incentivizing them to follow the advice and guidelines. This will increase awareness enabling employees to make better choices in these areas.

An innovative self-funded plan can be an excellent way to get control of one of the biggest expenses employers face. It makes sense for employers to consider this option. The trick is to implement complementary win-win tools that help the employer and employees!

Now it’s your turn! Are you working with clients to mitigate costs through self-funded programs? What strategies do you find effective? Comment below or email me at dan@freshbenies.com.

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Tanya Boyd
Tanya Boyd
President of Tanya Boyd & Associates

I didn’t want to go to urgent care or the ER. Using Doctors Online in my freshbenies membership, I went online to ask a doctor. The doctor responded and said to check my blood pressure. He followed up with the next day to make sure my numbers were OK. By then, the feeling was starting to go away. He told me if it persists to contact my doctor. It was great that I didn’t have to go somewhere and wait forever, and it was free.” - Kelli from Texas

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Shannon
Shannon from TX
beniebeliever

It was Sunday night at 10pm and my husband was feeling very sick. He was considering going to an emergency room since he had a very busy work week ahead.

Using the freshbenies Telehealth service, we registered him online for a visit and within 15 minutes he received a call from a doctor. The doctor informed him he had the flu and called in a prescription to a local 24 hour pharmacy.

We avoided paying for an emergency room visit and my husband was back at work by Wednesday!