There are probably as many specific reasons for offering an employer- sponsored health plan as there are employers offering them. Common general themes among these reasons include recruitment, retention, general concern for employees' & their families' health & welfare, and employee productivity. As employers continue to struggle with unsustainable health plan cost baselines and annual increases, they should ask themselves what exactly is the value of what we are getting for the dollars we spend on our health plan?
To answer this question you may need to look beyond the medical & prescription drug claims, plan administration, and other typical product or service costs of an employer-sponsored health plan. In the context of health care we often lose sight of a simple truth. That is, the product of health care is good health. It is not the pharmaceutical, the week in ICU, the Cesarean-Section deliver, or the mundane annual physical from your family doctor. All of these things are a means to an end. That important end is good or improved health.
Employers, when was the last time you evaluated your health plan on that basis? Ask yourself this simple question, did the dollars we spent on our health plan over the prior quarter, six months, or year deliver tangible improvements to the health status of our employees and their families? This is important because good or improved health is less expensive than poor or declining health. It stands to reason that if your population's health is getting worse that you will be spending more money on your health plan in the future. On the other hand, improving population health will result directly in lower health plan expenditures, and indirectly in lowering other health-related costs.
Developing a reliable mechanism for gauging your group's health status is the genesis of this journey. Then systematically comparing your evolving baseline to periodic assessments will determine if you are heading for higher future health plan costs or the Promised Land - cost reductions. If you do not already assess this measure, imagine what it might do to help you in your annual health plan negotiations. In particular if your group gets limited claims data, loss ratios, or other plan performance metrics from your insurance carrier.
Whether you are fully-insured or partially self-funded, using this data can help you negotiate proper insured or reinsurance rates. In fact, when this knowledge is used to focus your attention on cost-drivers in your plan design, plan members' behaviors, health plan partners' behaviors, or other variables affecting your annual plan costs, it gives you powerful results and enviable leverage with fully-insured or self-funded markets.
It also allows you to assess the quality of the health care delivered by the physicians and hospitals that your plan members are utilizing. Not all providers are equally capable of delivering the highest risk-adjusted outcomes at the lowest cost. If doing something about this matters to you, you can use your health status data along with data from other sources to gently or more aggressively steer plan members to providers with better track records of delivering good or improved health.
In the end assessing and tracking population and individual health status can determine whether or not your plan meets your primary criteria for sponsoring one in the first place. Here are a few examples how value-based health strategies can match up to your initial reasons for having a plan. Lower total health plan costs means you can offer a richer health plan and pay more of the premium than industry or geographical competitors. A healthy positive thriving work environment lowers employee turnover and increases productivity. Employees and their families get the unambiguous message that their most valuable asset, their health, is also yours.
Regardless of your reasons for offering an employer-sponsored health plan, assessing your group's health status can help you gauge the precise value your plan provides in promoting and restoring good health. I personally cannot think of a better health plan standard of performance.
Additional Articles From -
Home |
Insurance |
Health
