Hope Is Not A Strategy

You might not believe it but this happens alot when I reach out to employers about theri upcoming health insurance renewal – “I hope we don’t get a big increase!” After they get the increase that they were hoping to avoid, their strategy is to increase employee payroll contributions and/or increase everyones deductibles, copays, out-of-pocket expenses, etc.

There are a few different definitions of Strategy – “a plan of action or policy designed to achieve a major or overall aim.” “Strategy is an action that managers take to attain one or more of the organization’s goals.”  “Strategy is a general plan or set of plans intended to achieve something, especially over a long period.”

 In the health insurance world, having a strategy or strategic plan is essential. Simply reacting to what is received by an insurance company, especially with very little time for change is ridiculous – but that is exactly what happens all too frequently in the absence of a plan.

Strategies for a health plan take basically 2 categorical approaches – 1) The benefits to be offered to employees, and 2) the best way to pay for those benefits.

Regarding #1 – here a few things to think about:

  • What are the benefits that are most meaningful to employees? Is it a one-size-fits-all approach or is it a customized one with many options?
  • What benefits and plan designs are most desireable and affordable?
  • Networks of providers and their charges?
  • HSA or HRA?
  • Transparency tools
  • Fiduciary liability

Regarding #2 – a few more things to think about:

  • Fully insured, level funded, or partially self funded?
  • Administration by an insurance company or independent Third Party Administrator?
  • PPO or Reference Based Pricing?
  • Stop loss through an insurance company or independent reinsurer?
  • Pharmacy Benefit Managers’ pricing
  • Fiduciary liability

When we discuss strategies with our clients, our conversations center around what is needed to attract and retain employees, provide for their health and well being, be competitive in the marketplace, and make it affordable for both the employee and the employer for the long term.

Our clients don’t like surprises when it comes to their health plan – whether it’s financial or service. They want coverage they can count on along with the service they expect, and budgetable costs from year to year. We look at historic costs and trends, programs that can manage their high risk individuals, specialty drug spend, tools for employees to navigate providers and costs, as well as concierge service to members. When we take these basic strategies as well as other customized approaches for each client, we also take care of their fiduciary liability needs that they have with employees.

If you don’t have a strategy for your next upcoming renewal, you might want to think about it now. Hope is going to put you back on the proverbial insurance hamster wheel that you’ve been on for years.

If you would like to talk about strategies for your company, please call me at 970-349-7707 or email me at frank.stichter@strategicphc.com and we can chat.

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Strategic Healthplan Consulting LLC