970-349-7707

frank.stichter@strategichpc.com

You’ve probably heard of, and or acted upon, numerous ways to cut your healthcare costs. I’m sure some you can relate to these: some you may have implemented, some sound too good to be true, and some are the same old, same old methods.

Many employers tend to rely on the “Definition Of Insanity” for their healthcare costs – they do the same things over and over and expect different results. Those same techniques range from changing: fully insured to self funded, wellness programs to cost shifting, changing insurance companies or administrators, changing stop loss carriers, changing networks, etc. All of the approaches are temporary solutions to the long-term problem, and none are going to actually lower the cost of healthcare – for the employee or for the employer.

Many of these proposed alternatives are a ‘Leap Of Faith’ for the employer. In other words, there are no real, quantifiable savings prior to their implementation. Certainly, one can quantify premium savings for the first year with stop loss insurance or fully insured premiums, etc., but to the extent programs that are designed to presumably lower the actual healthcare costs – everything is a projection. And through this ‘Leap Of Faith,’ desperate employers implement programs and in many cases sacrifice employee goodwill in doing so, or fail to reach any consistent savings.

We’ve developed an alternative to the ‘Leap Of Faith.’  I call it a Benefits Audit. Essentially it’s a total forensic evaluation of your current plan: contracts, summary plan descriptions, claims data, wellness programs, education and communication programs, oncology management, and many others. There are actually a total 14 areas that we look at within the Audit. The goal is to identify and quantify compelling opportunities within the plan to dramatically lower healthcare costs without changing benefits for employees. In most cases there isn’t even a need to change your vendors.

In order to do this, (with your permission of course) we gather all of the contracts and data claims data needed for the Audit. This is confidential – meaning that only your company, my company, and your insurance company/TPA knows that this analysis is occurring. Your current broker or consultant has no knowledge of this exercise unless you care to inform them. This is simply done with a Letter Of Permission or Authorization which is placed on your letterhead and is signed by you and addressed to your insurance company and/or TPA. I provide them with a ‘Laundry List’ of information needed and they send the data, information, and contracts to me.

Upon receipt, we actually go through all of your contracts looking for areas of risk that you may not be aware of; contractual terms that may put you at risk; opportunities with plan design; and actually reprice your claims data utilizing unique programs that we have access to. An example of this is prescription drugs: once we receive two years of your prescription drug claims, we forward them to one of our preferred PBM’s that actually reprice each and every drug claim. This is done by repricing the exact same name-brand and/or generic drug, the same quantity, the same dose – exactly the same drug. There are reasons that prescription drug companies have different pricing which I can go into another time but believe me, the savings achieved our incredible.

Further, we will reprice dialysis claims, oncology claims, hospital claims, and many others. Also, there may be areas that are not quantifiable because perhaps you haven’t had oncology claims for example, or perhaps your administrator cannot provide the detailed data. In this case, we will identify whether the opportunity may be significant, moderate, or insignificant with respect to savings opportunities.

At the end of the day the results of the Audit provide you with a quantifiable identification of compelling opportunities that can be achieved within your health plan without cost shifting to employees. It’s a method that doesn’t require a ‘Leap Of Faith’ with programs that brokers or insurance companies experiment with, and hope that their proposed outcomes are achievable. All the results that are identified within the Audit and are based on your actual claims data and contracts.

If you’d like to learn more about how the Audit can benefit you, please give me a call or reply here and I can get in touch. And tell you more. I know you won’t be disappointed – in fact you’ll be shocked.

The benefits business is one which is over-promised and under-delivered.  You don’t know what you don’t know.