Three Easy Ways to Rethink Benefit Plan Design

Redesign health plans to lower premiums for clients, improve benefits for employees, decrease claims and win more business

by Scott Sanford and Pat Sir

Imagine if there was a way to spice up the sale of benefits, look smarter in the process and excite employers about creating a more robust plan at a lesser cost – all the while growing your business and getting lots of pats on the back along the way? Doesn’t sound possible does it?

And, even more challenging is how do you do all that and help employees truly feel that someone really cares about providing them a quality healthcare plan at a price that doesn’t leave them in shock?

Let’s face it, there are only so many ways to be creative with benefit plan design, and, admittedly, creating a plan that addresses the needs of the client while differentiating the broker from their competitors seems nearly impossible. Everyone knows that the health insurance business is ultra-competitive, ever-changing and frequently limited by solution options that offer little in the way of innovation. And, then there’s the fun discussion of co-pays, deductibles, doctor networks and premium increases that too many times only serves to lull your clients to sleep instead of motivating them to action. So, what’s the secret to invigorating benefit design and increasing your bottom line? There are a myriad ways to do it, but here are three to consider now:

1 Stay up to date and use relevant -language that shows you are in the know: Eventually, you need to step back and analyze the marketplace to see what’s trending in healthcare. Where is the industry going? How can I be ahead of the curve? How can I provide the best service to my clients? The national conversation has been around the affordability and accessibility of healthcare. Being relevant means being able to understand and use those buzz words effectively – that lets your clients know that you understand what the important trends are and that you are looking for ways to help them address their group’s concerns.

2 Encourage members to be in charge of their own health destiny: Communicate that plan members can be in charge of their own health care and should be seeking plans that empower them. And now, there are plans that let consumers have more choice than ever, and that choice allows them to reduce healthcare costs without giving up access and without reducing quality. Thinking creatively and educating plan purchasers about solutions that can lead to reductions in claims without ignoring their plan members’ medical needs shows them that you are an expert and one that they can trust to introduce them to new products that help them leverage their plan design for maximum satisfaction.

3 Ask your clients to be open-minded: The hardest thing for many employer groups to do is to be open-minded about how benefit plans are created. Because insurance plans have been created the same way for so many years, it is difficult for people to grasp that there may be a different way to look at building plans that encourage a better use of benefits that yield less cost and more convenience.

In fact, a recent study by Towers Watson highlighted the potential cost savings that telemedicine can deliver. Thirty-seven percent of employers surveyed said that, by 2015, they expect to offer their employees telemedicine consultations as a low-cost alternative to emergency room or physician office visits for nonemergency health issues, and another 34% are considering offering telemedicine for 2016 or 2017.

A Re-imagined Telehealth Model 

What’s one of the best ways to show your clients that you understand the relevant issues they face? And how can you help them be open-minded while embracing the idea that they and their plan members do have the ability to exercise more control of their healthcare destiny? Many brokers are having tremendous success and are looking like benefit plan champs by incorporating telehealth (connecting to a doctor via phone, video, or e-mail for consultation, diagnosis and prescription medication when applicable) into their plan designs to drive claims out of the health plan and thereby creating substantial wins for employer groups, employees and the broker.

Is Telehealth Really a Quality Solution for Employer Groups?

More than 70% of all doctor visits can be handled safely and effectively over the phone according to the Wellness Council of America. This has a huge effect on how you design the benefit plan for a client. But is telehealth safe? The Journal of American Medical Association released findings to its study of 8,000 patients comparing an in-person doctor visit to a telehealth consultation for minor acute issues. The results revealed that telehealth did not have higher rates of misdiagnosis or treatment failure.

The top nine reasons that a patient visits the emergency room for non-emergent issues are almost identical to the top nine issues resolved via telehealth. So, why is telehealth not the first discussion point in an employer group meeting? Shouldn’t this become the center of every benefit plan design, allowing the employee to save money, time and resources? Not to mention, the added benefit to the employer of fewer paid time off days, increased productivity, reduction in health plan claims and costs, and healthier employees.

The brokers who are growing their business with telehealth allow telemedicine to become the center of the discussion. No longer is major medical the lead product. Why should it be, if you can resolve 70% of your healthcare needs via phone or video camera? So, by leading with telehealth, there is more flexibility in the major medical plan options that a broker can provide. Simply stated, you may not need as much medical coverage when you have telehealth. Employees do not visit the ER, urgent care or doctor’s office as often when they have access to telehealth.

To further add value, some telehealth providers include complementary products to continue to drive down claims and costs such as technology-based health management platforms or prescription medication pricing engines. By offering relevant health content at the time of need, the patient is educated and healthier, which may help reduce unnecessary doctor office visits. Offering access to prescription medication pricing engines allows the patient to save on medication with cash price options, which redirects pharmacy claims out of the health plan. The pricing variance by pharmacy location and brand can be surprisingly large. Offering transparency empowers consumers to be smart shoppers. Not only does this trifecta of telehealth, wellness and price comparison tools save money, but it also puts employees in charge of their healthcare, giving them more choices than ever.

The key to achieving these results for your clients is to make sure you choose the right product provider. It’s tempting to gravitate to the lowest cost provider. However, the low-cost provider may not be the best choice, as the utilization may be very low and customer experience may be sacrificed. Then again, if the products are too expensive, the value may not match the cost.

At the end of the day, utilization and a positive consumer experience win. And, by showing that you are up-to-date on the latest ways to build designs and that you encourage plan members to be in charge of their own destiny puts them in the position to be more open minded. Remember, you can offer the best benefit in the world, but if nobody uses it, or if employers aren’t on board, what difference does it make? The brokers that have embraced telehealth and complementary benefits are growing their business, retaining clients, and most importantly, providing the best solutions for the needs of their clients. q

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Scott Sanford is co-founder and chief growth officer at Scottsdale, Ariz.-based Healthiest You, a telehealth and wellness delivery innovator. He resides in Scottsdale and can be contacted at scott@healthiestyou.com .

Pat Sir is President at Healthiest You and previously spent 9 years working at UnitedHealth Group. Pat is based out of Minnetonka and can be contacted at pat@healthiestyou.com.