Optimizing Self-Funded Health Plans for Increased Cost Containment

According to the Health Care Administrators Association (HCAA), some of the most widely cited reasons to self-fund include:

• The employer can customize the plan to meet the specific healthcare needs of its workforce, as opposed to purchasing a ‘one-size-fits-all’ insurance policy.
• The employer maintains control over the health plan reserves. This enables the employer to maximize income through the investment of premium dollars. Otherwise, those dollars would just go to the insurance carrier.
• The employer is not subject to conflicting state health insurance regulations or benefit mandates. Self-insured health plans are regulated under federal law (ERISA).
• The employer is not subject to state health insurance premium taxes, which are generally 2-3% of the premium’s dollar value.
• The employer is free to contract with the providers or provider network best suited to meet the healthcare needs of its employees.

Of everything listed above, access to data consistently tops the list of reasons why employers make the switch to a self-funded health plan. Access to data is especially important for groups in the small to mid-market insurance segments (50-500+ enrolled) where claims insights are historically nonexistent.

In most traditional health insurance arrangements, employers pay a premium to an insurance carrier and never see what is going on below the surface of their health plan.  This often leads to surprise pricing at renewal time and little to no explanation for rate increases.

Fortunately, VERIS offers an alternative solution with 100% financial and claims data transparency.  This means that groups can see exactly what is going on throughout the year and know where every dollar goes for healthcare.  Any money that is not spent on claims is retained by the employer as “surplus” funds that they can retain and use as they wish.

Once employers gain this level of data transparency, it is time for them to take it a step further and optimize their health plan to understand specific utilization and use it to affect change across their organization and implement point solutions that help drive better health results.  Data optimization and implementation of these point solutions helps create healthier workforces and ultimately helps save employers money on healthcare expenses.

Benecon Analytics, the proprietary data analytics platform that is included with VERIS, consolidates medical and pharmacy claims from a group’s TPA or PBM and presents it in an easy-to-navigate package that helps create actionable insights.  Benecon Analytics also identifies and provides detail about:

• Fixed Cost Reporting
• Preventive Gaps in Care
• Large Claims Tracking
• Block of Business Dashboards
• Carrier Integration
• Total Transparency

For more on Benecon Analytics or to see a demo, visit: https://benecon.com/claims-analytics/.

An important cost containment solution included with VERIS is access to ConnectCare3 (CC3).  By assisting employers with employee wellness, education, and the incentivizing of healthy behaviors, CC3 helps optimize corporate wellness and cost containment.

Another optimization tool offered by CC3 is a data review. Generally, once clients have 6 to 12 months of claims experience, the CC3 team can provide a complimentary analysis that identifies Medical & Rx trends within a group’s claims experience. CC3, the TPA, or an outside cost containment vendor can analyze these trends and then provide cost-savings action to help employers fully optimize every dollar.

We know that groups and consultants who are engaged in the data can help drive outcomes that improve plan and financial performance, all while maintaining a quality member experience.  For more information on CC3 and the array of cost containment solutions they provide please visit https://connectcare3.com/ and https://benecon.com/cost-containment/.