How to Boost Quality and Maintain Affordable Group Employee Benefits

Getting More From Employee Group Health Plans

Getty Images

The current health care system poses unique challenges for employers and employees alike. A new administration threatens to remove all health care reform as we know it now. Others are concerned about the increasing complexity of administering affordable group health care plans, rapidly escalating costs for even the most routine health care diagnostics, and added government bureaucracy that continues to throw road bumps in front of progress.

Employee Benefit Costs Expected to Increase 

According to recent reports from PwC’s Health Research Institute, the 2017 projections for medical costs are expected to remain the same as 2016 — at a steady 6.5 percent growth rate. Interestingly enough, the driving force behind this price increase is the cost of benefits, not the actual utilization of benefits. The PwC report found that around half of all medical costs have originated from hospital fees, for inpatient and outpatient care. Doctor fees account for one-third of this cost, and prescription drugs are around 17 percent of the total costs for hospital care. The rest of the costs come from the use of hospital facilities and equipment, as well as administrative management of medical claims.

As an employer that’s required to provide your employees with affordable health care insurance, the challenge comes down to reducing costs without compromising on quality of health care services and support.

How can your company ensure that you are offering the best possible group health benefits in order to compete for talent and retain a healthy workforce?

Controlling and Reducing Costs of Managing Group Health Care Benefits

First and foremost on employers’ agendas is to make sure that employee benefits costs can be budgeted for in the coming year.

Plan choices have been tougher this year, with the average employer selecting three-tiered high deductible health care plans. Very few even offer any kind of PPO or other major group health plans that put most of the financial burden on employers. Instead, employees are asked to assume a greater share of the cost with each New Year. This happens simultaneously while annual out of pocket fees also increase.

There are some measures that an employer can take now to help reduce the cost of health care insurance plan premiums. This is not an exhaustive list, but it’s a start of a strategy to eliminate some of the costs, while giving employees a chance to take advantage of their health care coverage.

Offering a Health Savings Account

A very effective way to reduce health care costs by as much as 25 percent is the approved use of health savings accounts with high deductible health care plans. A health savings arrangement can be simple to set up and pre-tax dollars used to fund copayments and other out of pocket medical expenses. Start employees off right with a small dollar for dollar match up to a certain amount.

Providing Access to Telemedicine

Telemedicine and virtual medical support are growing as ways that technology is supporting better use of health care insurance.

Instead of heading straight for the emergency room, employees can pick up the phone or engage in a video enabled call with a real physician, saving them a costly trip to the office. In many cases, minor health concerns can be managed by a call to the pharmacy for a script or a check in with the employee’s general practitioner.

Reducing Costs With a Local Health Care Network

When employers partner with health care centers, great things can happen. First, the employer can negotiate for special discounts on routine health screenings, flu shots, and more. Second, it supports the local economy when health services are kept nearby.

Exploring Spousal Benefit Cost Savings

Employers may want to ask all employees to check with their spousal health care plans to see if they can obtain insurance at a better rate, then reimburse employees for the difference.

Employees may also be able to maintain their own insurance plans while their spouse maintains theirs at the same time. Cost savings can be found many ways, and this is one option that can reduce the administration of new plans.

Corporate Wellness Program Support

Studies have shown that when a company offers a corporate wellness programs, for every $1 spent there is a $3 savings on health care costs. Employees who have the support to gain better control over their health habits are more likely to be mindful of staying healthy and using their benefits less for catastrophic medical care.

Educating Employees on Emergency vs. Preventative Care

Employee benefits education can also be a boon to reducing costs for health care insurance premiums. When employees are continually provided with tips on preventing health conditions, reducing smoking, losing weight, and getting age-appropriate health screenings and tests completed — this can help stop serious illness from happening.

Discounting Prescription Drug Coverage

Companies do not have to choose the standard prescription plan coverage offered by the medical plans. Instead, they may explore and offer an equal or better option for saving money on prescriptions. This can include mail programs and 90-day script approvals.

Shopping Around for the Best Plan Rates

It should go without saying but all companies need to be mindful about shopping around for the best health care plan rates for their employees. One plan administrator can offer an identical plan for as much as 10 percent less than another, based on an approved rate that’s been grandfathered in from year to year. The same goes for finding the best value in voluntary benefit programs.

Eliminating Dental and Vision Benefits

Studies have shown that although employee’s value dental and vision benefits, they often never use them during a plan year. This is because dental visits and trips to the eye doctor are considered extra and employees don’t take time off from work unless there is a serious problem.

Improving the Quality of Healthcare Coverage for Your Employees

There are many things that an employer can do to improve the quality of health care that employees are receiving, even with plans that include less covered services. Employers are tasked with providing the best quality of health care plans in order to attract future employees, retain current employees, and support the well-being of employees.

Methods to improve the quality of health care plans, while maintaining lower costs, can include:

Verifying Claims Processing Efficiency

When selecting the health care plan administrator for your group insurance program, it’s important to note how well the company processes and handles medical claims. Efficiency often equates cost savings, as claims are handled and paid quickly. Every company should have a rating with the Better Business Bureau as well as a relationship with benefits associations.

Using a Digital Enrollment Platform

One way to help streamline the quality of health insurance programs is to work with a fully digital enrollment platform. This enables all employees to quickly access plan information and enroll in their annual benefits. At the same time, a digital platform provides around the clock access to plan documents, claims information, and physician directories where employees can learn more about their benefits.

Monitoring Medical Center Ratings

Keeping abreast of the quality ratings of medical groups that your benefits participate with can be key to ensuring that employees are getting the best possible care for their health needs. This can be verified by checking with Medicare, which maintains an active database of local hospitals and health care centers. There are also independent reports based on consumer data, often published in websites like US News, and others.

Educate Employees on Responsible Health Insurance Use

Keep a mission of educating employees about how to make the best use of their health insurance coverage. This can include how to ask for time off for doctors’ visits, when to see a specialist, how to select the best health care for children, dealing with large medical expenditures, and more. Make education the center of your health care package, and support employees as they seek out quality health care services in the area.

Maintain a Directory of Trusted Providers

Over time, there will be a number of reviews made by employees concerning the best doctors and medical centers to visit. Maintain a running list of these providers. Give them a call and work with them personally to ensure your plan members are making the most of their benefits. Act as a liaison between their billing department and the plan administrator to solve any claim issues. Improving quality of health care starts with a central point of contact in every human resource office who is knowledgeable and helpful to employees as they navigate their benefits. 

The above guidelines are just a start. Work with your plan administrator to find ways of increasing quality of medical insurance while maintaining a reasonable employee benefits budget for 2017 and beyond.