The status quo in health insurance is not solving anything these days – in fact it’s creating havoc.

Who on your healthcare “team” has an incentive for your costs to go down? Well, let’s define the “team” – hospitals and doctors, drug manufacturers, insurance companies, brokers and consultants, stop loss carriers, PPO networks, and maybe more. The reality is that no one on your “team” has an incentive for your costs to go down – in fact they all make more money when your costs go up.

Your healthcare “team” wants to continue the status quo and is going to push back on change, but you’re never going to save more than 30% doing the same things you been doing. Providers have no incentive to change – they want to keep the status quo – discount off of ever increasing charges. Brokers want to continue the status quo because change is too much work for them, they have no financial stake in your plan (they make more in commissions when your costs go up) and quite frankly, their interests are not aligned with yours. Insurance companies certainly want to maintain the status quo because they are making so much money, and PBMs are doing the same.

Costs are going to continue to increase – the question is what you can do about it? You can continue the status quo and do the same things you’ve done in the past like:

  • Cost shifting to employees through higher deductibles, co-pays, and out-of-pocket exposures
  • You can continue to raise employee contributions;
  • Change insurance companies who purport larger discounts
  • Add wellness and disease management plans with limited success
  • Change pharmacy benefit managers
  • Add tools for transparency


You can challenge the status quo by looking at your healthcare plan and your healthcare expense differently.

Adaptability leads to opportunity

  • An Unbundled, partially self funded plan
  • Reference Based Pricing is a game changer and reimburses providers more favorably for you than the PPO “discount off of what”
  • Another option – direct contracting – gives employees access to high-quality care at fair, predictable rates and strengthens community relationships
  • Consider on-site or near site clinics for primary care. This can improve health outcomes, control costs and positively impact employee productivity
  • Specialty drug programs that eliminate the cost of expensive drugs

Upcoming renewals of health insurance this year are going to be very unpredictable. I’ve seen everything from 7% to 40% from the prognosticators. While we are beginning to see a return to the opening of nonessential and elective procedures and testing, we have yet to see what the outcomes of this will be. COBRA claimants also present challenges for underwriters because no one knows when the state of emergency will be lifted.

It’s very easy to financially determine what these opportunities could present to you versus your current plan. It never hurts to get an unbiased second opinion from an impartial, independent source (keep in mind what your healthcare team wants you to do). There’s plenty of time to do this, and now that were getting back to some sense of “normalcy” you can refocus on changing the status quo.

If you want to learn more about the financial feasibility study to determine whether there are compelling savings opportunities within your plan, you can give me a call at 970 – 349 – 7707 or email me at frank.stichter@strategichpc.com. It’s free and no obligation!