By Steve Purkapile, Dan Openshaw and Barbara Hawes

This year has been more destabilizing than any could have imagined on so many levels. That makes it an imperative to start now on the hard work needed to address the impact. That includes imbalances in benefit packages and planning that were identified before the pandemic and associated economic downturn. A financially viable health plan strategy is as critical as a healthy workforce. Here’s how you can get further ahead of the curve on offerings and costs.

Data: The key to actionable insights

The ability to integrate diverse benefits utilization data sets like pharmaceutical claims, onsite clinic visits outside lab results into a single repository is only the beginning of the data journey for benefits managers. Slicing and dicing benefits data sheds light on evolving behaviors and preference patterns with different employee population groups. But to get ahead of the curve takes predictive analytics – today’s new norm. Bumping benefits data against benchmarks and norms allows you to better predict the future costs of less strategic benefits planning – not just in 2021 but in 2031 and beyond. Data analytics provide the actionable insights that inform effective health plan strategies.

Building a financially viable health plan strategy

Being on top of trends that are driving plan costs is one thing. You also must be prepared to implement strategies to manage the highest cost drivers. Three strategies that data analytics can inform include:

Strategy #1: Manage high costs of serious or chronic conditions

Chronic conditions are among the top drivers of the majority of health plan costs. Use analytics to identify which are prevalent among your employees. Look into adding programs that will engage workers in ways that improve their overall health and also make positive lifestyle changes. Various marketplace solutions are available to help employees – at a manageable cost to you. Your employees may have lost some ground with the pandemic, so stay on top of trends with these conditions and “new normal” programs that might help.

Strategy #2: Comparison shop health services without sacrificing quality care

Your employees and your plan will fare better when equipped to understand the variations in costs of healthcare procedures. Quality of care and the member experience matter, too. Analytics that compare your claims costs for procedures to third party data help on costs. Advocacy and transparency tools allow them to compare providers according to more than just costs and procedures, but for quality indicators and hospital affiliations, independent reviews, languages and distance. When evaluated to potentially couple with models like Reference Based Pricing, such measures can add financial stability to your plan.

Strategy #3: Optimize your pharmaceutical program

Your pharmaceutical program must be reviewed annually to maximize contract terms and ensure plan mechanics are in place to appropriately handle the growing issue of specialty drugs. This is a complicated, multi-faceted endeavor best coordinated through your pharmacy benefit manager (PBM) or your health insurer. The review should include:

  • An update to your contract terms and conditions. Ensure they are competitive and cover:
    • A review of your pharmaceutical pricing – transparent (pass-through) versus traditional (spread);
    • Rebate transparency.
    • Contracts through a third party administrator, captive, or group/coalition purchasing
  • A review of spending trends for generics, brands and specialty drugs. These will signal whether changes in benefit design are appropriate to drive different behaviors and relieve cost pressures.
  • A review of your alternate funding program for trends in high cost pharmaceutical claims. The options – manufacturers’ co-pay, coupon cards or patient assistance programs – can be tricky to navigate, so you need to have someone in your corner making sure the mechanics line up.

HUB International’s employee benefit specialists consult with employers of all sizes and in all industries on every aspect of employee benefits program planning and management.