2025 Renewal Planning 2

January renewals are coming up more quickly than you can imagine.  I am posting this for the benefit of employers and brokers. 

 For employers:  If you are managing your Health Plan within the “new” rules of transparency and disclosure and are shocked by what you see, or maybe do not see, you should reach out to your broker and ask them to bring you solutions that allow you to “see” the data and to make decisions based on that data for the benefit of your members.  Not only is this in your best interest from a cost-benefit perspective, but it may also be your FIDUCIARY responsibility to “be in the know” about these things.

 Is your Plan utilizing a network? Do you have incentives for members to use High-Quality, lower cost providers?  Do you have a medical manager that can help “steer” your member to those?  There are alternatives to “traditional” networks that do NOT have secret deals and “gag clauses” (now disallowed) that can provide full transparency and the highest quality care. Pay attention to the prescription drug costs as saving money here can be a low-hanging fruit of cost containment with the right PBM.

 For brokers:  Become a “trusted advisor!”  Stop relying on spreadsheets with numbers from the BUCAs and do research into innovative plan solutions, starting with an independent Third-Party Administrator (TPA). Find out if they can provide concierge/medical management services that may include direct contracts with high quality facilities and professional providers that are based on a “bottom-up” or Cost Plus process.  Check out the data that is provided—is it clear and understandable?  Also, work with Stop Loss carriers that truly understand the features that are included in the Plan. Many Stop Loss carriers are merely commodities that have very little interest in the underlying cost-management provided in the Plan.  Payment Integrity programs can save big money on not only large claims, but aggregate claims as well.  Aggregate claims are important in any small- to mid-market plan, especially any “level-funded” arrangement.

 Have a great renewal season—there is still time to make a HUGE positive impact!

Give us a call or email and we will get on it!