Five Healthcare Cost Levers

Posted On: May 12, 2021 | By: Abigail Cutler

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.

1. Self-funding

  • 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.

Source: BenefitsPro