Healthcare terrifies many Americans. Patients stumble through a confusing system, bumping into mysterious prices and other consequences of misaligned incentives.
It can feel like the industry is out to get you, but Insurance executives don't enter the industry aspiring to be villains. Most come with the good intentions, only to find something sinister when they pull back the curtain.
Who's genuinely thrilled with the current state of healthcare? Patients' needs take a backseat to corporate profits as
But that doesn't mean we can't fix it. We can. We should. We are.
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Despite the optics portrayed in the media, producing profits dominates publicly traded insurance carriers' attention, meaning employers' premiums rise annually to secure revenues. The Affordable Care Act's medical loss ratio ensures nothing changes. It simply limits to 15% the maximum premium dollars carriers can allocate to overhead and profits. So, shareholders only see gains if premiums increase. Hitching your client's wagon to an entity with this conflict of interest can't work.
Also, broker commissions and bonuses depend on employer premiums and retention rates. Those brokers who endure a fair amount of heat for annual increases, but feel it's worth it when a trip to Cancun is on the line, are just humans trying to thrive in a maze of conflict of interest.
Employers that smash the easy button and surrender to each renewal increase must realize this passive approach unnecessarily haunts their budgets. Hands-on self-funding puts employers in the driver's seat, headed toward higher-quality, lower-cost health benefits.
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First-rate and affordable patient-centered healthcare starts with price and compensation transparency. Employers prioritizing their human resources forge partnerships with client-focused,
Likewise, other key members of the benefits team like the third-party administrator (TPA) and the pharmacy benefit manager (PBM) must be compensated to put the member and employer first.
Linking arms with a
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Some say, self-funding appears risky on the surface. Misled, employers abandon control over their health benefits, not realizing the self-funding road is well traveled and whatever disasters they thought were lingering around the corner don't exist.Scores of trailblazers went before us and seized victories with their health benefit packages. With the help of advisers, they built and refined effective models customized to their organization's unique needs.
A hands-on health benefits strategy doesn't mean going it alone. Building a robust, cost-effective plan is a team sport. It's a journey, not a sprint, along a well-worn path. The benefits adviser, TPA and PBM supply the tools and talent to transform the employer's plan. The treats along the way include grateful employees, lower turnover, increased productivity, and reduced absenteeism while attracting and retaining top talent.
Even if your client tiptoes into self-funding, digging a way out of rising healthcare costs that threaten to bury them alive requires you do something. Start by harnessing all plan data, then use it to make calculated decisions about next steps.
By facing the issues lurking within the healthcare system, partnering with industry changemakers and courageously investing in HR, employer-provided health benefits become a huge win for businesses and employees alike.
