Innovation in Employee Healthcare Benefits

Episode 3: In today’s episode, JP Barta, CEO of The Legacy Benefits Group, will address some of the solutions his company offers to help brokers and employers to address health insurance plan issues.

Healthcare Innovation

There are many opportunities in the market. Often, it’s the sum of several smaller actions that yields a significant result for the employer and its employees. Wellness programs are a common example. However, it’s not usually the people driving the healthcare costs who actively participate in these programs.

innovation in employee healthcare benefits

Identifying and attacking cost drivers can be an effective approach. Specialty medications are usually a significant cost driver, depending on the age and health of the employee group. JP referenced a study which reported that less than 2% of the population take specialty medications, but those prescriptions account for more than 50% of the US pharmacy spend.

Manufacturers may offer assistance programs to deal with specialty drugs. International sourcing is another alternative. Kentucky has the Kentucky Prescriptions Assistance Program (KPAP). Good Rx is another cost saving option. These approaches require a small effort on behalf of the employees, but they often result in significant cost savings and work to minimize premium increases in subsequent years.

It’s Not about Limiting Access to Quality Healthcare

The Legacy Benefits Group looks for other ways to help employers to reduce healthcare costs. Using free-standing clinics instead of hospitals is a familiar option. Helping employees to use transparency tools, telehealth options, direct contracts with medical providers and other innovative approaches can easily be integrated into how people think about consuming healthcare.

People often worry about these measures potentially limiting their access to care. It’s often less about access and more about the site-of-service impacting the overall cost of healthcare for an individual and the company at large.

JP understands the challenge inherent to changing behavior patterns. However, as he mentioned in a previous episode, his company was able to work with a community mental health center client to reduce their overall costs. The center was facing a 48% rate increase. The Legacy Benefits Group was able to secure the group a first-year increase in the mid-teens. For the second year, there was a 0% increase, with a 2-year rate guarantee. This resulted in significant savings in the cost of healthcare for that organization.

Working for Reductions in the Out-Years

There a many variables related to the overall cost of healthcare for an employer. While JP doesn’t guarantee he can achieve a first-year cost savings, the rates will be competitive. More importantly, the systems and options he’ll provide will lead to a more sustainable program for the employer. These second, third and fourth year savings can result in higher satisfaction, less pressure on benefit costs and wider use of the existing healthcare options among the employee base.

Cost Containment Doesn’t Have to be a Negative

Most people hear the term and they imagine restrictions and limitations. JP explains that it’s not always the case. Educating people about how they consume healthcare is an eye-opening experience. Many people simply haven’t looked at it this way. Actually, the industry has trained us not to think about it. That’s part of the reason we’re in the situation we often complain about, related to healthcare costs.

Leveraging the Power of Third Party Administrators to Reduce Costs

Third Party Administrators (TPAs) can be an effective ally in reducing a company’s cost of healthcare. The Legacy Benefits Group offers multiple ways to structure a health insurance benefits plan, but there are proven ways that are highly effective. TPAs can work with the employer and employee to accomplish expense objectives.

Advisory Health and Wellness is a program administered via a local TPA. It integrates many of the steps JPs described to benefit smaller employers. It gives them access to some of the larger employer advantages.

Reducing the cost of healthcare is often predicated on changing mindsets, which leads to changes in decisions and activities.

JP discusses a CNBC article which explained how many people delay healthcare treatments because of budget constraints. They simply can’t afford to have them done. The Legacy Benefits Group can work with brokers and employers to enable employees to get the medical treatment and reduce overall costs, at the same time.

How Attractive is Your Group to other Insurers and their Programs?

Unfortunately, as JP explains, companies often wait until they’re hit with huge renewal increases before they decide to look for a new relationship. As he explains, this is probably the worst time for you to shop your contract. If you’re receiving a significant increase, it’s often because the previous year’s claims were high, resulting in a higher premium renewal.

The best time to shop your program and coverage is after you’ve had a good year in terms of your claims. This is when you’ll be much more attractive to competitive options. The problem is often that the employer doesn’t have access to the right data. The Legacy Benefits Group may be able to help.

The Legacy Benefits Group wants to empower you to become a better consumer of healthcare. This can be achieved if the employer and employees have the tools and resources to do so.

Self-Funded Plans

These plans operate very much like a full-insured, meaning you know your maximum exposure. The Third Party Administrator (TPA) is used to administer self-funded plans. They provide access to pharmacy benefits managers (PBMs) to reduce pharmacy costs. TPAs can assist with clinical review and nursing, and many more actions to help companies and employees.

This may be a more employee-friendly alternative when compared to the larger insurance options.

Finding a Retaining Employees Is a Growing Challenge

This is a reality for many small to medium sized businesses. Offering affordable healthcare coverage is an attractive benefit. The Legacy Benefit Group can help to craft a sustainable program enabling the employees to leverage an innovative approach to the cost of healthcare.

The goal for the Legacy Benefits Group is to be able to offer comprehensive, major medical coverage without restricting access to quality care. Again, part of that capability is proven by educating people about how to be better consumers of healthcare.

Are You a Proactive Health Insurance Broker?

It costs you nothing to get a quote. It may enable you to offer much needed solutions to your clients and their employees.

Contact Us via Our Website:

Call Our Phone Number: 855-321-0741

Email JP:

Thank you for listening. We’ll be back in 2 weeks with another episode. In the meantime, please SUBSCRIBE to our podcast to avoid missing upcoming episodes.

The Legacy Benefits Group is here to help you to get the most benefit from your benefits.

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