5 Ways To Reduce Claims For Self-funded Plans

Guest blog content provided to Q4iNetwork Consultants by freshbenies freshbenies-Logo-1

 

There’s not an employer in the country that’s not looking for ways to reduce benefits costs. And more and more employers are frustrated with the skyrocketing cost of providing fully-insured plans.

If you’re like most businesses, you’re demanding new ideas and solutions more than ever. Maybe you’re even considering self-funded plans to get control over price increases. 

But this only works by enabling employees to become better consumers and live healthier lifestyles. Implementing the necessary tools for them to make this happen is the first step toward managing and reducing cost through a self-funded program.

While there’s no magic bullet, it’s absolutely possible to lower health care costs with a strong, well-constructed self-funded plan.

Here are five cost-reducing ideas you can implement to achieve this goal.

1. Choose the right Third Party Administrator (TPA) for claims adjudication

There are so many reasons why this is the way to go when you’re looking to reduce costs and even increase the efficiency of a plan.

An expert claims payer will:

  • Quickly and correctly pay claims per the established benefit contract
  • Minimize mistakes, fraud, waste or abuse by members and providers
  • Provide reporting that will allow brokers and employers to analyze and determine trends in activity

2. Implement a Surgery Benefit Management Program

This will be a quality-assured and separate bundled provider network for high cost surgeries. Whether or not a provider is included in the network is based on the quality of the provider, not the location. Case rates are transparent to employers and members, and are pre-negotiated by the companies providing the network. As a result, the incentive for the member becomes finding the best provider, not necessarily the closest.

Here’s one employer’s story:

An employee needs a common knee surgery, so the plan would offer two options:

  1. Stay in town and use a provider who is in-network with the plan. The employee will pay for their deductible and all out-of-pocket costs, as usual.
  2. Choose a surgery center from the Surgery Benefit Management provider list, which happens to be in a city six hours away. The employer pays flight costs for the family, accommodations at the local four-star hotel for the recovery time, and all costs associated with the actual surgery. The employer also gives the employee a $5,000 bonus. This option is SO much more cost-effective that the employer still saves thousands to their bottom line.

Which do you think most employees would choose?

Note that this can be a complicated process, so look for networks that have an additional concierge service to help employees navigate the choices.

3. Provide high quality telehealth and ehealth services 

Telehealth and ehealth are making their way to becoming the leading options for inexpensive and convenient health care. Start by choosing a vendor that will support the plan with an employee engagement and awareness campaign. This increases utilization and delivers ROI. When used to its full potential, these services will:

  • Redirect general practitioner, specialist, urgent care and emergency room visits away from the health plan.
  • Save the employees money, time and anxiety, allowing them to be more productive.
  • Help employees get customized care and information from general practitioners and specialists. The ehealth service is particularly helpful in getting second opinions from specialists, saving money on what could have been a costly visit. 

4. Include an advocacy service

An unbiased advocate “shops around” for employees getting cost estimates for procedures, while staying in-network and maintaining quality.

With this service, employees don’t have to do the legwork when investigating issues or questions about their bills, benefits or diagnoses. An advocate can perform a full medical bill reconciliation and then negotiate on behalf of your employees as needed.

As with anything, another set of eyes minimizes mistakes and overbilling. Employees feel more comfortable with plan changes, become better consumers, and are more productive at work, all while accessing help to get the most out of their insurance plan. This service can also be a huge help to the HR team and your office.

5. Add health coaching access to the plan

This type of service provides employees with diet, lifestyle and fitness sessions on a consistent timeline while incentivizing them to follow the advice and guidelines. This will increase awareness, enabling employees to make better choices in these areas.

The bottom line

An innovative self-funded plan can be an excellent way to get control of one of the biggest expenses organizations face. It makes sense for employers to consider this option. The trick is to implement complementary win-win tools that help both you and your employees.

Photo by nitsuki 

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