You want better benefits at a lower cost … it’s time to consider self-insurance

Oct 29, 2020

It’s never been easier to take control of the 2nd or 3td largest expense after payroll … health insurance.

As a result of rising healthcare costs, many employers are transitioning away from buying fully insured health plans from the well know carriers (BCBS, United Healthcare, Cigna, Aetna) and they’re establishing partially self-funded health plans.

On average, our clients are saving 26% per year when they finance their health plan via a partially self-funded arrangement. The key is hiring the right benefit consultant who understands which solution providers to consider and how to educate and incentivize employees to be great consumers of healthcare.

Partially self-funded health plans can provide the same or richer benefits as fully insured health insurance carriers. The main difference is that employers will have access to data and the ability to effectively manage risk and reduce healthcare spend. Rather than the carriers earning the underwriting profit, the employer keeps the underwring profit.

Stop-Loss protects employers from unpredictable risks. Self-funded Employer’s should buy stop-loss insurance to protect against severity and frequency of claims. With a properly designed stop-loss policy, self-funded health plans can have the same or less exposure than fully insured health plans. Rather than paying a carrier hundreds of thousands of dollars, why not consider a plan that allows you to keep much of the money that would otherwise be paid to a carrier.

The healthcare industry is plagued by misaligned interests. It is critical to work with a benefit consultant who understands the misaligned interest that exists in the healthcare industry. Insurance carriers, PBMs, hospitals, insurance brokers can have misaligned interests and cause overspend. Choosing the wrong PBM can increase rx costs by 30%.

There are four main drivers of healthcare spend … pharmacy, hospitalization, physicians, and facilities. There are solution providers that effectively steer members to the best providers and most cost effective hospitals and facilities,

Who wants a doctor with many malpractice issues and a high complication rate operating on them?

Why go to an MRI facility that charges 10x for the same MRI with the same machine?

Why pay 2x-10x more for name brand and specialty meds?

Low hanging fruit … mitigating rx spend. ScriptSourcing, LLC helps self-funded employers prevent, mitigate, and transfer risk by providing innovative prescription risk management solutions. We have seen self-funded employer’s reduce their prescription spend by 50% by implementing a Fiduciary PBM combined with ScriptSourcing’s services and solutions. ScriptSourcing makes available $0 rx copays for many maintenance name brand and specialty meds. Our programs are voluntary to health plan members and if they feel that ScriptSourcing’s $0 copay mail order program are in their family’s best interest, they’re welcome to participate. If they’d rather pay their $50 monthly copay at their local pharmacy, it’s their choice.

Recommendations

1. If your company is fully insured, use a free service offered by Enlighten-Analytics to determine if your company is a good fit for self-insurance.

http://www.enlighten-analytics.com

2. Use a Fiduciary PBM whose interest are aligned with the plan sponsor, not shareholders

http://www.us-rxcare.com/

http://www.southernscripts.net/

3. Use an Rx Mitigation provider that’s able to source name brand and specialty medications at a fraction of the cost domestically.

http://www.scriptsourcing.com/

4. Use a medical management company so employees can have access to the best providers who are fairly priced.

http://www.aim-m.com/

5. Hire a NextGen or Health Rosetta benefit consultant who can provide unbiased, consultative services

http://www.21stcenturyagency.com/

https://healthrosetta.org/

Show Buttons
Hide Buttons
Web Analytics