Employer-Sponsored Health Plan Strategies

Employee #HealthPlan Case Study - Purdue University Keeps Trend at 1% Per Year Since 2016... National Average for University Trend is 6% Per Year. #How Purdue Did It: 1) #OnsiteClinic 2) #Tiered In-Network Benefits with #Tier1 (lower deductible and coinsurance) for doctors and hospitals that are paid based on outcomes (Value-Based) and #Tier2 (higher deductible and coinsurance) for providers that are paid traditional fee-for-service. 3) All health plan members are on a #ConsumerDirectedHealthPlan with an HSA incentive to have an annual physical and perform other activities to keep themselves healthy. 4) #SpecialtyPharmacy is carved out from their PBM... for most employers specialty pharmacy is 51% of their total pharmacy spend. #Results: 1) Purdue has saved $149M since 2016 and the employees have saved $50M. That is an amount of money equal to 1,637 4-year scholarships for Purdue students and $2,778 in the pocket of each and every employee. 2) #Mammogram rates went from 52% to 72% and #colonoscopy screening rates went from 28% to 60%. #Why Purdue Was Successful: The Senior Director of Benefits, Candace Shaffer, M.S., CWPM, said Purdue's Success was due to her benefits team of 26 professionals. Not her vendors. Not her consultants. Purdue's own internal benefits employees were the key to success. Twenty-six employees is A LOT of employees for benefits. Conversely, the Head of Benefits of a 7,000 employee manufacturing company and the Head of Procurement at a Fortune 500 company both said the #LACK of their own internal robust teams was their #barrier to a high-performing employee health plan. You can't get something for nothing. If you want to reduce your employee health plan claims costs and improve healthcare quality for plan members, then you have to spend #money on the internal #employees to make it happen. Thank you for Dean Jargo for bringing this case study to my attention. Sources at AHealthcareZ YouTube Channel HERE: https://lnkd.in/gjpzEsNF

Joined Farzad Mostashari to publish this piece in Employee Benefit News offering guidance on how employers can become more actively engaged to expand accountable care and ultimately create a better experience for their insured populations. Interested in your thoughts - please share below. Most importantly, we must change the economic incentives within employer-sponsored health care. For too long, payment models have incentivized providers for the number of patients they see or services they perform, rather than improvements in patients' overall health. The good news is that innovative models are changing this paradigm. Companies like Aledade, Inc., are built on the premise of aligning their business success with better care for patients and lower costs for employers – and they are delivering real results. In the piece, we highlight JPMorgan Chase & Co.'s partnership with apree health in Columbus, Ohio, where we have achieved a Net Promoter Score of 86.1 and high usage rates to drive better primary care. We also highlight Aledade, Inc.’s partnership with Florida Blue, which has reduced hospitalizations and emergency room visits by twice as much as the regional trend and produced nearly $14 million in savings. As employers seek to drive greater value for their health care offerings, we offer three strategic imperatives for them to consider in the contracting process: - Demand better primary care. - Drive to outcomes-based payment. - Strongly empower the patient. Check it out and let me know your thoughts.

You Get What You Pay for in Health Benefit Plans Most Employer Health Benefit sponsors have two important but different compensation structures relative to their health plan. 1. Most plans have a third-party broker who makes more money when plan costs increase and less money when plan costs decrease. 2. Most plans have a key internal decision maker (HR, etc.) who makes the same whether plan costs increase or decrease. Should any of us be surprised when health plan costs increase materially each year? There's an easy fix here. Flip the compensation structures. 1. Pay your broker/advisor a fixed fee (with a possible bonus for lowering costs and/or improving clinical outcomes) 2. Pay your key internal decision maker more for improving the plan (costs and quality) and less for the opposite. This is one of the most easily measured items in your business. It's equally easy to pay for performance. Don't wait. Fix this now. Nothing gets better while incentives are misaligned.

Fascinating discussion between Brian Marcotte and 🎙Spencer Smith, CSFS® this week @ ParetoHealth’s member meeting. Brian is the former CEO of Business Group on Health and famously kept Honeywell’s 500M healthcare & benefits budget flat for 5 years. How did he do it and what can other HR leaders at any company learn from his success? - Focus on the overall number (annual budget) when planning for the year and getting buy in from the executive team. Learn to speak the same language as the finance team. - Start with the data. For example, if cancer is your top driver of high cost claims, build a program that promotes advanced screenings, earlier detection, and active cancer management - Explore surgery decision support programs that are bolstered by an HRA incentive. This has a positive impact on MSK spend and reducing unnecessary surgeries - Set your out of network deductible as a % of the employee’s salary - Advanced primary care for members. Providers in this model are incentivized to reduce the total cost of care, they are multi disciplinary, and provide effective care navigation. Make this no cost or low cost for members to utilize. #benefits #hr #healthcare #strategy #employers