Businessolver Blog

Rusty Old Health Plan? It May be Time for a Tune-Up!

Rusty Old Health Plan? It May be Time for a Tune-Up!
Posted on Friday, November 9, 2018 by Businessolver Team

Is your health benefits plan running like a well-oiled machine? Or is it pulling a little to the left? Is the AC low on refrigerant? Has it really been that long since you replaced the air filter?


Just like our vehicles, maintaining a health plan requires regular maintenance. This is especially important as the war for talent heats up; you can’t afford to be seen in a busted old jalopy when your competitors are driving around in new sports cars.

Whether you’re a do-it-yourself benefits mechanic or tend to turn to the professionals in keeping your plan running smoothly, it helps to have an owner’s manual. More importantly, you need to know what to look for throughout the plan year, not just during annual enrollment or as you’re preparing to issue an RFP.

As a follow-up to our webinar, “Navigating the stormy seas of publicly funded benefits,” Businessolver recently published a guide featuring the five most important questions to ask to keep your health plan firing on all pistons. Tune-up or Overhaul? 5 tips for a high-performance health plan is designed to help benefits administrators think critically about several key elements of their self-funded or fully insured health plan.

Here’s an excerpt.

Chapter 3: Do I have the right network and plan designs?

Location, location, location. It’s a phrase used to talk about gaining the advantage in business. And indeed, if your employees don’t have access to your network, it’s the same as not offering them any benefits at all. But location isn’t everything. Think beyond the geographical footprint of the network you use. You also need to consider your negotiated rates and the providers’ ability to provide the kind of care that keeps your members as healthy as poss

Specific questions you should ask include:

  • How transparent is the monthly billing process?
  • What methodology do providers use to establish their rates and how often do they change?
  • How do rates compare to those established by Medicare Plus?
  • Are any differences among providers justifiable in terms of geographic location or other factors?
  • How does balance billing work and what’s the impact on my members?

Also consider whether your employees have access to value-based care. These payment models differ from a fee-for-service approach in which providers are paid based on the volume of services they deliver. The “value” in value-based healthcare comes from measuring health outcomes against the cost of delivering those outcomes. Examples include accountable care organizations, medical homes and hospital value-based purchasing programs. These payment arrangements between the network, provider and, in some cases, the employer, encourage primary care physicians (PCPs) to provide the kind of quality care that results in lower long-term costs. Then make sure your plans are designed to take full advantage of this value-based care. For example, plans that require your employees to work closely with their PCP can prevent disorders such as opioid addiction, as outlined in Dave Chase’s The Opioid Crisis Wake-up Call.

Specific questions you should ask include:

  • What are the quality ratings of my network compared to available options?
  • Have I been offered a stake in quality outcomes?
  • What happens when a value-based care organization fails to meet quality requirements?
  • How active has my network been in addressing emerging disease/disorder trends?
  • Is my network at risk for acquisitions, mergers or other changes that could impact my negotiated outcomes?

Download the full guide today to learn about the five most important questions to ask to keep your health plan running smoothly.