Benefits Pro cited 5 levers to control healthcare costs. Jake Doman, Consulting Director at Axion, breaks down what those levers could mean for you. The full article from Benefits Pro is cited below.
- A self-funded plan allows an employer to create a customized plan that serves its employees and company well as they take control of quality and cost.
- They have less administration cost than equivalent fully insured plans.
- The savings realized in administration can be used to fund stop-loss insurance, which offers less risk and higher reward.
- They have stop-loss that activates if claims exceed projections, but if claims are lower than projected the company saves money that wouldn’t be saved on a fully insured arrangement.
- Access to data allows for better informed decisions for the employer and consumers.
- Employers of any size can use a self-funded plan and reap the benefits.
2. Pharmacy and specialty drug strategies
Independent prescription risk management companies can:
- Assess and manage employees’ pharmacy and specialty drug needs.
- Provide specialized expertise and solutions that increase value versus expense.
- Make sure costs are in line with benchmarks.
- Improve user experience and health outcomes.
Specialty drug programs can seek alternative funding and sourcing for these expensive drugs to improve savings.
3. Virtual health/telemedicine strategies
- Companies can save time and money using a telehealth service for a wide range of needs including on-demand behavioral health programs.
- Telemedicine strategies serve the needs of a growing online population and improve health care access for employees at a lesser cost.
4. Population health
- It uses predictive modeling to identify at-risk individuals and intervene or coach them to better outcomes.
- It helps at-risk employees work with professionals to help navigate care.
- The goal of population health is to lower catastrophic hospital and emergency room visits, and lower costs for employees and employers.
5. Direct contracting/direct primary care
- Direct contracts offer another avenue to keep health care costs in check by eliminating middlemen.
- Direct contracts can be direct to provider or based on a reference-based pricing (RBP) reimbursement method.
- Health care through these plans is data-based, with negotiated contracts for service and pharmacy charges that are closer to actual Medicare costs.
- Direct contracts can provide more resources to help employees navigate their health care and minimize billing.
- Direct contracting often results in improved experiences, improved health and reduced cost.