Employee Health Plan Costs Too High? Try These Five Ways To Maximize Its Value

| September 6, 2018

Employee health plan costs have become a major issue for large and small businesses.

Employee health plan value and expenditure is a concern that permeates organizations from employees to Human Resources to the C-suite. A recent survey found only 44 percent of employees fully understand the value of their benefits.[1] While education is a significant component in engaging employees in their benefits program, there are efforts to be made in the building of a health plan that’s optimized to provide value to all parties, including quality care for employees and cost savings for employers.


With that in mind, consider these five ways to transform your health plan for increased savings and better employee health outcomes:


1. Choose better care over a thicker index of physicians.

A major shift in the industry today focuses on improved healthcare delivery and better quality of care. High-performance networks represent one of the innovative strategies employed to deliver better outcomes and reduce costs. Simply put, a high-performance network is a carefully curated, select number of high-quality, cost-effective providers who have agreed to be measured by specific metrics to maintain high patient outcomes and efficiency in practice. These networks improve employee health outcomes while saving more money than a traditional network model.[2] It’s no wonder that the number of employers implementing high-performance network-based models has jumped 267 percent since 2014.[3] It’s clear: volume is not the same as value.


2. Focus on preventive, primary care in a value-based care model.

The four most costly health conditions in the U.S. are angina pectoris (chest pain), high blood pressure, diabetes and heart attack — all potentially preventable with early detection and care management.[4] However, the current healthcare system is based on a fee-for-service model, which doesn’t offer compensation for providers helping patients make more proactive, primary care-level changes to improve their health. New, value-based care models incentivize primary care physicians, supported by a team of healthcare professionals, to engage with their patients more frequently, for longer periods of time and between office visits with the goal of delivering integrated, coordinated care at the right place and the right time. When members maximize preventive care methods overseen by a proactive, engaged care coordination team the cost of insuring them goes down, lowering premiums. Taking a prevention-first approach with a value-based, care-focused employee health plan reaps benefits in the workplace as well. An unhealthy employee population suffers higher rates of absenteeism, low productivity, and on-the-job injuries.


3. Identify and manage the health of high-risk populations.

U.S. healthcare costs for chronic diseases such as heart disease and diabetes totaled $1.1 trillion in 2016.[5] When lost economic productivity was included, the total economic impact was $3.7 trillion, equivalent to nearly 20 percent of the GDP.[6] As these high-risk populations are driving up premiums for employers, health plans have begun embedding care coordination to help identify those who might be suffering from a chronic disease or at risk for developing one. Care coordination programs supported by a robust data analysis and reporting platform utilize predictive modeling algorithms to identify risk profiles for enrollees and track and report patient interactions that are implemented by care managers. While it’s difficult for employers to quantify value in dollars they aren’t having to spend on their employee health plan (for example, premium increases due to hospitalizations, emergency room visits, and prescription drugs), the benefits of care coordination can make a lasting, positive impact in the workplace.


4. Take back control of your data.

For the past several years many employers have been struggling with covering increasing healthcare premiums while having no visibility into what’s causing the rise in costs. Organizational politics and turf wars over data ownership limit access to information that could help employers identify gaps in care and their biggest cost drivers, such as those high-risk populations referred to earlier. Healthcare Highways coordinates data from all corners of care, including pharmacy, converting that data into useful information that’s accessible to payers online through a dashboard of comprehensive reports, including predictive modeling to identify future high claimants, patterns of excessive use, and wellness tracking to help our clients determine the cost effectiveness of their benefits plan. We know there’s no accounting for value without data. If it’s your plan, it’s your data.


5. Bring on the competition.

Disruptive innovation in an industry often delivers a new level of value for consumers, and the healthcare industry is no different. The absence of a transparent healthcare marketplace contributes to dissatisfied consumers that justifiably believe they have limited choice and a confined understanding of whatever options they do have. The lack of transparency and competition in the market is detrimental to the employees who need it, the businesses that sponsor it, and the providers who deliver the greatest value. Employers should not only invite competitive bids on health plans, they should insist on having more than one option (and not more of the same) for their employees to select from during open enrollment.



[1] https://www.statnews.com/2018/05/31/chronic-diseases-taxing-health-care-economy/

[2] http://www.milkeninstitute.org/publications/view/910

[3] https://www.canopyhealth.com/en/brokers/articles/high-performance-network.html

[4] www.pwc.com/us/medicalcosttrends

[5] https://www.cdc.gov/chronicdisease/resources/publications/aag/workplace-health.htm

[6] https://fulfillment.lfg.com/CF/LFG/EF/64138/THT-ENG-WPR001_Z02_VIEW.pdf


Chris_Wilson_Senior Vice President of Health Plan for Healthcare Highways


CHRIS WILSON Senior Vice President of Business Development Mr. Wilson brought his experiences founding brokerage firm CJW & associates, LLC and serving as Senior Producer for Arthur J. Gallagher to the role of Vice President of Sales for Healthcare Highways. Now Senior Vice President of Health Plans of Healthcare Highways, Inc. his dedication to excellence has proven invaluable. Mr. Wilson holds a Bachelor of Science in Communications from University of Texas at Austin. Read more of his industry insights here.