You may have seen in recent news, three corporate giants are teaming up to combat what billionaire Warren Buffett calls a “hungry tapeworm” feasting on the U.S. economy: health care. Well, that’s exactly what the team at L.R. Webber Associates has been achieving for years now. Here’s their story with supporting facts on how effective these efforts have been to make health care affordable.
Many employers today are suffering from the F.L.U. – they are Frustrated with the current health care system and spiraling costs, they feel Lost in the system and don’t know where to turn, and they are Unwilling to make changes to their employee benefits plan.
Similar to Henry Ford’s famous statement, “you can have any color automobile that you would like as long as it’s black!” many schools feel the same about their options when it comes to health care providers in Pennsylvania today. However, market changes, carrier expansion, and new alliances have created a need for new solutions. Schools want to offer affordable options with quality coverages within a top-notch provider network. Our job is to consider the entirety of your medical program, break it down into its separate parts, and see how those parts may be best assembled to meet the goals and objectives of the school.
While carrier changes have resulted in a variety of choices for employers in our state, these changes have also created confusion and concern in many markets. In the end, employees want to know that they will receive quality care at the time of service. According to recent surveys, the name on the card is not as important to employees in today’s workforce as is the access to care and the outcome of results.
Additionally, the battle to attract and retain top talent is constant and, in some ways, accelerating. Employees want options and choices. They embrace technology in new ways and yet need assistance in terms of education as it relates to health care. We all want to be healthy, and often times we enter the health care system at the scariest moments of our lives. We may be facing a health crisis for a family member or ourselves. We need help and guidance when navigating the system. Access is critical, but cost no longer matters to an employee seeking answers and cures. The medical system is an enormous part of our economy (more than 18% of our GDP), yet very little information is made available to help us be well-informed consumers. This all needs to change.
We strive to create solutions for clients where we can connect the D.O.T.S.: data, options, technology, services. Let us look at each of these areas and how they help our school clients take control of their medical programs.
DATA analytics has become critical in many parts of our business by enabling us to:
- Understand customer-spending patterns, underwrite loans, and develop marketing programs.
- Control our health care spending by shining a light on WHAT is happening in our claims spending rather than leaving us to wonder WHY costs are rising.
- Know how to address plan design and to develop advanced care management programs that truly affect the bottom line while helping our employees achieve better health outcomes.
- Identify issues such as the 70%+ emergency room costs that may be moved to telemedicine or urgent care outlets with proper employee education.
- Identify employees who may have health issues that have not yet been addressed as the data algorithms match medical, drug, screening, and vision information.
The top 5% of claimants drive 50% of costs, yet less than 40% of these high claimants repeat each year. We need to know what is happening inside the group health wise and data can help us do that.
While attempting to control costs, employers have long battled with carrier changes, coverage limitations, and cost sharing. In most of these situations, a) there are no more changes to pursue, and b) the employee ultimately pays more out of pocket in terms of co-pays, deductibles, and payroll deductions. This creates an environment where the employee views the plan as “poor” and looks elsewhere for work. Employees want OPTIONS in today’s workplace. They want to be able to choose plans that fit their needs, whether that be high or low deductible, health savings accounts, health clinics, little paperwork, multiple plans, etc. Fitting the “all-for-one” program just does not work as well today as it did in the past to meet the varying needs of employees.
TECHNOLOGY is a major factor in our world today. However, providing technology to employees as it relates to health care is a relatively new process. Automated enrollment is only scratching the surface. PC-based access to consumer information and vast search engines are required. Mobile applications are part of the need as employees must be able to access medical information on the go. To be successful, our systems must also be PROACTIVE. They must REACH OUT to employees to make them aware of upcoming appointments, prescription refills, and alternatives to care (going to the urgent care center rather than the emergency room). Consumer-driven COST data must be at their fingertips. If we are able to find this data while shopping for a TV or a vacation, should we not have it when choosing a provider for an MRI, filling a prescription, etc.? This solution is now available within our systems!
In all other areas of the U.S. economy, we have technological tools to help us move through the system. Sites such as Amazon, Google, Travelocity, and Yelp have gone far beyond the days of “Consumer Reports.” They provide reviews and pricing information that guide our purchasing patterns. We feel confident in what we spend and decisions we make based on the millions of others who have been through the process with us. We trust the data. Health care NEEDS to move into this frontier AND we need to have this information made available to us if we are going to be able to control long-term costs while improving the health and well-being of plan participants.
Finally, nothing works without the SERVICES to back it up. Health care can be scary. These are big decisions often made at a very vulnerable point in time. Employees need to have competent staff available to them, teamed with credentialed clinicians, who can provide help and guidance. The HR and finance staff of the school must have support to deal with education, finance, and regulatory needs. Documentation and compliance are a part of daily living. All of these functions are wrapped up and highlighted within the best programs today. We serve as part of the team and as advocates for your employees. They do not need to “go it alone” – there are resources and services available to them to help for better outcomes.
In the past, clients exploring the transition to self-insured status have faced an intimidating list of tasks in order to build a plan and ensure efficient, effective use of health care resources. These tasks may include finding the following:
- Affordable claims administrator
- Medical network
- Pharmacy benefit manager
- Prescription drug networks
- Stop-loss carrier
- Actuarial support
- Market-proven data analytics
- Clinical care coordination
In addition, the list of post-transition administrative duties adds more hurdles: pre-certifications, subrogation, HSA account management, SPDs, compliance monitoring, etc. No wonder clients are often persuaded to opt-out for the simplicity (and expense) of integrated, fully-insured plans.
DataSmart Health Solutions
Our DataSmart Health Solutions (DSHS) program utilizes extensive data analytics to review provider networks and discounts, claims patterns, cost drivers, and pricing opportunities to present packages to our clients that meet the goals that are desired by both the school and its plan participants. We all want to know that we will have coverage when we need it, where we want it, with help and direction to centers of excellence for best outcomes. Moreover, each school wants to know that it will have a say in advanced cost control methods to pay fair and reasonable charges, to know that someone is auditing the results and looking out for its best interests, and that the plan will put the school in position to attract and retain top talent. We have the experience, data, and testimonials to support these suggestions.
The historical success of this program can be seen below in reference to the Maryland Bankers Association:
DataSmart has combined forces contractually with a hand-selected group of best-in-class service providers to present our clients with a unique solution. L.R. Webber Associates and DataSmart will begin by providing clients with an “Opportunity Analysis” as a strong support tool to assess the potential economic advantages of switching to DSHS. As a school sees the merits of this package, contracts with the client will be put in place with favorable terms and pricing that are pre-negotiated. Each service provider is waiting and ready to board new customers. We have a solution for the F.L.U. for those who are interested in exploring!