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For self-insured employers, selecting a broker is without a doubt one of the most important parts of designing a health benefits plan. In a sense, the selection itself marks the beginning of the plan design process. Bad health plan design will almost certainly overlook health savings opportunities and miss costs that could have been avoided. It’s important to select a broker who understands the nuances of plan design and who can quickly adapt to the rapidly shifting health coverage and policy landscape. Health policy architects designed the Affordable Care Act and quality-based reimbursement initiatives to stem rising healthcare costs through population health management. These initiatives may indeed prove effective over the long term, but in the short-term costs continue to rise. Employers need an ombudsman, a consultant with the know-how, resources and technological tools, including predictive analytics, to expertly navigate and take advantage of the current healthcare system; someone who can provide answers and action steps necessary to improve outcomes from the outset.

Since 2005, employee health insurance costs have risen a whopping 135%, while the employer cost burden has risen by 62% – yet there are many hidden opportunities to begin better managing and allocating healthcare costs through data analysis. So, where are your hidden health-related cost centers? Without data transparency and integration tools and services, they’ll remain elusive to spot.

Finding these hidden costs is where a savvy broker can really add value. They can not only uncover cost centers, but access data sets from everywhere patients receive healthcare to create nuanced action steps that will save you money and improve health. Below is a handy checklist of questions you may want to ask a benefits brokers you are considering for population health management and plan design.

  • How can you ensure medications and Rx do not cost us more than they should?

  • Can you monitor and preempt our employees from seeing too many specialists and PCPs? If so, how?

  • Can you identify preventable and/or non-emergent inpatient and emergency department use?

  • Can you provide a care management team with drilldown ability to help them follow-up with all members that are biometric outliers, starting with those who are at the highest risk?

  • Do you provide added services beyond your firm’s internal expertise?

  • Do you customize your strategic planning services?

  • What technological resources do you provide for managing benefits and influencing employee compliance? Can you predict plan costs? What is your accuracy score?

  • Do you provide continuous employee outreach and support?

  • Can you utilize data to create a healthy work environment, targeting the costliest plan members to galvanize wellness participation and improve population health management outcomes?

Because of skyrocketing costs and an increasingly complex healthcare landscape, the role of the broker and health benefits consultant has become paramount. Employers are demanding more strategic guidance and rigorous data analysis to help them better manage their health plan design and costs. Health reform changes also makes it necessary for brokers and consultants to provide self-funded employer clients with a clear view of their plan and actionable steps for improving its performance. Predictive analytics was once a “sexy” addition to a broker’s arsenal but has now become a competitive requirement. This is because so much of a health plan’s performance and optimization is dependent on the broker’s ability to provide precise, clear-cut action steps (derived from data) to modify behavior and avoid costly pitfalls within the plan. Above all, self-insured employers must ensure that their broker of choice has the wherewithal, expertise and resources to manage a population in today’s technologically driven healthcare landscape.


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