This military strategy is a key to successful health plan management

I never imagined a day when I'd compare health plan data gathering to a lethal military strategy, yet the analogy is just too accurate to waste. 

To quote multi-branch U.S. military veteran, writer, filmmaker, TV host and speaker Wes O'Donnell, "information dominance is the core of the kill chain." I'm also fairly certain he didn't foresee his words about the kill chain inspiring a description of healthcare cost control. 

It's a pretty interesting concept — even for a squeamish, sensitive soul like me — that he described in a recent critique of Russia's battlefield failures. A "kill chain" is the plan of attack used by the military to find and destroy something. The U.S. Air Force acronym for this sequence of events is F2-T2-EA. Really rolls off the tongue, doesn't it? 

Now here's what this military shorthand featuring key words actually means: 

• Find the target
• Fix by attaching specific coordinates to the target
• Track the target's movements
• Target destruction hinges on choosing the appropriate weapon 
• Engage by releasing the weapon
• Assess by evaluating the results

What immediately struck me is how eerily similar this strategy is to what the most effective benefit advisers do for their clients. Consider how it compares: 

Find
What is driving claims costs? Typically, high-cost specialty medications and certain diagnoses are the triggers. It's critically important that your clients know how to obtain their data. There is no excuse in 2023 for not knowing how to get reasonable data about the group health insurance plan. Obtaining this information is no longer carrier dependent.

Read more: Ask an Adviser: Why do average wholesale price discounts not matter?

Yes, actual claims data from the carrier is best and will allow you the most opportunity to understand what is driving costs. However, it isn't always possible. Forward-thinking advisers know how to circumvent an obstinate carrier. 

Fix
Identify the specific occurrences that involve which medications, procedures and facilities are in play. If you have had to use an AI tool, you may not know specifics, but you should receive a risk profile (i.e., what is currently happening and what large claims or Rx are coming up soon). This is a terrific first step. Having this information will allow clients to make better decisions about what to track and target, who to engage with and how to assess progress. 

Let's say an organization is fortunate enough to have actual claims data, not the report that says "we paid out a lot of money, but we are not really going to show you what we actually paid."  Then you can track and target. 

Track
Watch how the claim unfolds. Is it a one-time occurrence? Something that will be repeated? Is the provider a high-quality one? 

Read more: From labor to laundry, supply chain issues are impacting the healthcare industry

Review claims that exceed $15,000. What are they? Most likely we're talking about one-time occurrences that won't be repeated. But is there a trend? Do they have a lot of musculoskeletal issues? Do many folks take diabetes, high-blood pressure and/or high cholesterol medications?  Are they paying the right price for those scripts? 

For a large ongoing claim, is the cost of care fair? Is the treatment high-quality? (Yes, this should be tracked as well.)

Is your client paying the right price for specialty medications? Many employers can reduce their health insurance budget by 10% simply by paying the right price for brand and specialty medications. 

Target
Choose the appropriate solution to eliminate excess costs — both for the employer and employee. Can the medication be alternatively sourced? Does the provider meet the quality metrics set by the plan? (Probably the dirtiest secret in healthcare is that the highest-quality providers are almost always in the bottom quartile of cost.) Can it be done at an ambulatory surgery center rather than inpatient? (This is often safer for and easier for the patient.) Is the provider being paid fairly and timeously?  

Engage
Implement the solution and bring everyone to the party. I firmly believe that we do not talk enough with employees about what health insurance actually costs. We are in the business of buying insurance or purchasing healthcare, so end users need to know what it means to them if we can lower the health insurance budget. 

Read more: Time to update our healthcare communications to motivate and educate employees

The employers we work with re-invest healthcare budget savings back into their workforce. Each employer is unique and here are some of the things that we have seen happen: 

• Reduced employee contributions for employees and dependents
• Lower deductibles and out-of-pocket maximums
• A zero-cost option for employees who use high quality care
• Additional benefits such as employer-paid short and/or long-term disability, a lifestyle account and enhanced mental health services at no cost to the employee

Assess
Evaluate the results. Was it effective at reducing costs? Was the plan simple to execute? Was it easy for the employee? How can we improve the experience even more? 

Et voilà — we can apply a military strategy to solve the healthcare problem!

Surprised? I certainly am. But just think how this take-charge approach can yield amazing results along the battlefield in the war on rising health benefit costs.