If you’re like most employers, you are either in the middle of 2020 strategic planning or have recently given your broker-consultant directives to initiate conversations with your vendor partners. As a former benefits consultant, I know how busy renewal season is. And with the Affordable Care Act, it’s busier than ever.
For those of you keeping close tabs on your broker-consultant’s renewal process, you’ll see your adviser is requesting 2020 administrative fees or insured rates and confirming the length of time the fee or rate guarantee applies. Perhaps they also are asking the health plan to quote a new benefit design or specific co-pay changes, confirming mandated benefit changes and performance guarantees, and requesting timing of when the Summary of Benefits and Coverage and contractual documents will be available.
On the other hand, you may still be standing by while your broker-consultant compiles this information across all your vendor partners and your actuary develops your rates before delivering it to you in a package. After all, as a benefits manager, you have enough to do to keep your current benefits program running smoothly for your covered members.
If there’s one takeaway I could offer, it’s this: Employers, participate in the renewal process.
Renewal season affords employers the opportunity to re-evaluate their health plan relationship on an annual basis. Is your health plan’s strategy moving in a direction that aligns with your organization? While you don’t necessarily want to request proposals from others and have to evaluate them and secure leadership’s decision on a major vendor change, much less implement a new vendor annually, a once-a-year checkup can go a long way in evaluating your existing health plan to ensure its strategy is in alignment with yours.
Think of it as doing a 20-point checkup on your health plan for 2020.
Take a blank piece of paper, meet with your staff and discuss your priorities. After all, if employers ask for the same thing at the same time, it will send a stronger signal to the market. That means addressing the following in your 20-point checkup.
Payment and delivery reform strategies: Is your health plan negotiating more value-oriented contracts with providers from which your members seek care? Are your members seeking care from high-value providers as designated by the health plan?
Benefit and network design strategies: Which value-based insurance design strategies does your health plan recommend for your population? Is there a particular narrow or tiered network product that could be a good fit?
Price and quality transparency: Is your population using a price and quality transparency tool? Are key providers agreeing to publishing the information in it?
Special condition-related topics: What is the health plan doing to reduce the rate of cesarean deliveries? What about ensuring access to high-quality behavioral healthcare? What other conditions are important to your organization?
Aligned sourcing and standard plan accountable care organization reporting: Is your health plan agreeable to specific contract language across all these categories? Will your health plan provide transparency into its ACO’s performance through use of a standard, independent report template, such as SPARC?
Once you discuss with your staff and consider these areas, share a summary of your priorities with your health plan and request a meeting in conjunction with a presentation of its renewal quote.
Being a more active, engaged participant in the renewal process, you’ll have a better understanding of where your relationship with your health plan is headed over the next year. And hopefully, you’ll be more satisfied with not only the direction, but also the resulting impacts to your bottom line and employee health.
