Nothing worth having comes easy. Six-pack abs, meaningful relationships and a thriving, impactful business all require hard work. The same applies to providing truly affordable healthcare for employers and plan members — which will reap huge rewards.
It's time to ditch the status quo on employer-sponsored healthcare. You know the drill: The plan renewal arrives with a double-digit increase, so you shop for a cheaper plan among the typical list of insurers, none of which have a vested interest in actually saving anyone money. Along the way, quality and value are left in the dust. The only explanation for the increase is that "claims were up." There's no strategic plan for preventing future increases because, let's face it, there's no incentive for the insurer to implement lower cost solutions.
Herein lies the gridlock: To avoid putting the company budget in a chokehold, you jack up the employee's out-of-pocket expenses. Then you get the miserable job of "selling" a lemon of an insurance plan to a roomful of employees whose only choice is to put their lives in idle and take the hit until they figure out an exit strategy. What's so beneficial about a major medical plan that feels more like catastrophic coverage when the rubber meets the road?
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The easy button has consequences.
This low-friction lather, rinse and repeat cycle plagues every CEO, CFO, HR director and benefits adviser nationwide every year. Is it actually low-friction? Maybe for the adviser and employer because, let's be honest, the member is absorbing all the friction. The fact that healthcare debt is responsible for
Now, when you negotiate the premium increase into the single digits, you feel rather proud of yourself. But the truth is this: After the increased premiums, deductibles and copays are presented to the staff at the annual meeting, you head out to the local Panera for a coffee and salad. Meanwhile, an employee calls his wife while he's eating his bagged lunch to tell her to cancel their vacation plans because their paycheck is taking another hit this year, and they don't want to tell Junior he can't play Little League.
If this sounds extreme, just do the math. Even if a worker gets a raise this year, it's likely in the single digits. Deduct the inflationary climb in prices for consumer goods, utilities, housing and gas, and you'll see what I mean. Nearly everything is more expensive than it was even a year or two ago. Then deduct the freshly increased insurance premium from a biweekly paycheck, and the next thing you see is the employee's income trajectory in a tailspin.
Nearly half of Americans worry about affording their health expenses. Many health problems are unexpected, but 40% of Americans don't have $400 on hand for
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We all know that employees are an employer's greatest asset. Their health plan should treat them as such. And if an employer is not on board with that, the Consolidated Appropriations Act of 2021 (CAA) makes
It starts with the plan data, which acts as a compass pointing to savings opportunities and transformational health benefits. The data tells you which members are spending the most healthcare dollars, which services are accruing the most spend and where services are commonly provided.
Data shines a spotlight on the best next step toward the highest quality care at a dramatically lower cost. Of course, all worthwhile endeavors demand motivation, so it's critical to incentivize member engagement with cost-saving programs to improve everyone's bottom line. This process of being informed by the data, implementing positive change and incentivizing the beneficiaries requires work that reaps huge rewards.
The practice of negotiating down annual renewal increases doesn't have a positive impact on any of the stakeholders, nor is it sustainable if you want to ensure that healthcare benefits are genuinely beneficial and CAA compliant. Your leadership has the power to make a dramatic difference in the lives of employers and members.
The status quo is unacceptable. It's time to do the work to promote and execute strategic solutions to utilization management, alternative reimbursement models, pharmacy optimization and enhanced access care. It's worth it every time.
