Evaluating health plans?

Ask yourself four questions.

Unemployment is at a historic low. There’s stiff competition for top talent. You need to attract and retain good employees, while also keeping costs in check. But how do you offer a competitive benefits package, when health care expenses continue to rise?

Self-insured health care plans can be an attractive solution. But before you decide how you’ll fund your plan, first take a few minutes to consider how the care is (or will be) delivered to members. Is it integrated, or fragmented? If it’s fragmented, making a switch to an integrated health care delivery system can help you save time and money, without taking on extra risks or responsibilities. How? Here are some things to think about…

Are you paying for unnecessary health care expenses?

It’s tough to be a health care consumer. Especially when navigating through the tangled web of a fragmented delivery system — getting referrals, scheduling lab work, filling out paperwork, and deciding where to go for treatment. Getting the care they need can cause headaches for your employees, and add up to excess costs for you.

But when providers are connected through an electronic medical record, they’ll know what your employees need, when they need it, which helps prevent duplicate or unnecessary tests, X-rays, and time out of the office.

Are your employees (and your bottom line) benefitting from industry-leading disease management programs?

Personal coaching and support for employees who need it can help them live life to the fullest. It can also help you reduce absenteeism and manage costs. Even when you have disease management programs in place, it’s hard to ensure everyone who needs them participates, and you can’t always measure their success.

When care and coverage are integrated, these types of programs are built-in, at no additional cost. Participants are automatically enrolled, and data is captured in their medical records. So, you can track the results (detailed reports are generally available for groups with 200 or more members).

Does the health care delivery system contribute to climbing costs of prescription drugs? Or does it help contain them?

It’s old news. The costs of prescription drugs (especially specialty drugs) are steadily climbing. But it’s hard to control costs when you have an open network, and little oversight. When the coverage and care delivery are integrated, there’s greater purchasing power (buying in bulk, negotiating prices, owning/operating pharmacies), which lowers costs. Plus, providers use a standard formulary, developed by doctors and pharmacists using evidence-based medicine (rather than one developed by financial analysts, or based on the marketing efforts of a pharmaceutical company).

Do you know what services your employees are using, and how they’re using them, so you can put cost-saving programs in place?

Understanding the behaviors and risk factors of your employees (such as how many have chronic conditions, or get necessary preventive care screenings) can help you put the right workforce health strategy in place — and make it more effective. In fact, less than half of all employers get comprehensive reporting.1 But when care is integrated, you can get reports based on clinical data from electronic medical records.

And knowing things like nurse advice line call volume, or how many employees are using email, or chat with a physician, as an alternative to office visits, can help you spot trends and address them to control costs. Getting the right care at the right time also leads to better outcomes and higher productivity.

Choose better. Choose the care delivery model that changed the health care industry.

1. Hewitt, 2009.

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