Rethink your health plan for better benefits and managed costs

August 27, 2012
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Today’s competitive business environment demands that employers balance the need for a healthy and productive work force with the costs associated with high-quality health plans and wellness programs. This balance is forcing employers to assess their long-term benefit strategies and how they deliver health coverage to their employees.

The temptation is to focus on the Patient Protection and Affordable Care Act, or PPACA, as the trigger for change in the delivery of health care. But the reality is that economic conditions in the marketplace have already been driving much of this change and will continue to do so regardless of the final impact of PPACA.

In response, employers, insurers and health care providers must find ways to better control rising costs while continuing to improve outcomes. It’s time for a paradigm shift in the dynamics of the employer-employee relationship and the delivery of employer-sponsored health plans. Here are some suggestions:

**Find the right insurance agent or consultant. You need someone who understands the market and has experience with your industry. A good agent or consultant will work to understand your business goals, both short-term (managing expenses, encouraging employees to make healthier choices) and long-term (using health care benefits to recruit new employees, maintaining employees’ newly adopted good health habits). The right agent will be able to identify the best health plan and help you navigate the difficult balance between cost, benefits and employee health. He or she will also partner with you and your health plan to help you achieve long-term, sustainable wellness goals.

  • Develop a long-term plan. These goals usually focus on improving the health and wellness of your employees while at the same time managing your costs. By defining long-term goals, you will be better equipped to review the plans offered by health insurance companies and determine which options best fit your business needs. An amazing spectrum of options is available, from consumer-driven plans to defined contributions, HSAs and high-deductible plans.

  • Choose a health plan that’s focused on controlling costs. Ask what types of programs are offered to track long-term cost trends and help your business manage costs. Look for a health plan that offers pharmacy management, case management and disease management programs — and then ask about their results. For example, a Priority Health client recently noticed a spike in the number of back surgeries being reported by its employees. In reviewing the cases, we discovered that workers who complained about back pain were sent directly to a surgeon. We encouraged employees to work with their primary care physician instead, as well as visit a physiatrist — a doctor who specializes in rehabilitation — before going to a surgeon. The result? A 27 percent reduction in the number of back surgeries and a corresponding increase in member satisfaction.

  • Add the right wellness plan. Wellness plans are an increasingly integral part of most health plans. Don’t worry: There’s no need to go full-tilt right away. Many businesses begin with an incentive-based program, offering rewards to employees who agree to make key lifestyle changes, such as exercising more or quitting smoking. These types of programs often evolve into an outcomes-based plan, when employees who achieve certain results receive a richer benefits package. Regardless of the wellness program you choose, remember that it takes three to five years to start seeing a return on your investment.

  • Evaluate your plan annually. Start by asking your employees about their health care experience. Do they have access to quality doctors through a strong network of providers? Do their families have the coverage they need for their specific health issues? Do they receive good customer service from your health plan? Asking these types of questions will help ensure your business is spending its health dollars most effectively. Continue to evaluate your long-term strategy on an annual basis with your agent or consultant to ensure that you are still on track in achieving your goals.

Follow these tips as you review your current plan, and you’ll be able to balance comprehensive health care benefits with the need to manage your business costs. One additional benefit is guaranteed: a more productive, healthy work force — and a healthier bottom line for your business.

Scott Norman is vice president of sales and client services at Priority Health. He can be reached at

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