Ten Indications That Your Health Plan is Ill:

Lacks a Brokerage Contract and Specific Performance Criteria:

Employers trust their health care broker too much. While core brokerage services are often essential, their recommendations usually leave employers with few options and higher costs. How detailed is your brokerage agreement? What performance criteria are written into the agreement? How is your broker compensated? Does your broker talk a good game but your costs keep rising?

Lacks Cost Control Incentives:

What is your broker and health care teams’ track record for achieving credible competition and cost control on your behalf? Does your broker tend to place the vast majority of contracts with the same carrier? How come? How does this practice benefit you?

Lacks Large Medical Claim Audits:

How are you tracking the cost of large medical claims? How does your carrier or TPA actually audit claims and provide reports? Would you know how to read such reports? If your broker, carrier or TPA doesn’t audit large medical claims and provide you detailed reports you are being underserved.

Lacks Medical Necessity Reports:

How do your broker and carrier identify costly medical claims that are medically unnecessary? If your consultants don’t show you costly medical claims they stopped or corrected for reasons of medical necessity you are probably being underserved.

Lacks Plan Compliance Reports:

How does your team track compliance with prescription drug and medical plan procedures? If your plan doesn’t follow-up with employees and dependents you are probably being underserved.

Shifts Costs to Employees Year After Year.

Do your broker and carrier recommend benefit reductions and cost shifting to employees as a key strategy for cost reduction? If your plan relies too heavily on these approaches, you are being underserved. Your broker lacks creativity and your carrier is just paying claims at your cost.

Lacks a Comprehensive Wellness Program:

To what extent are your employees and dependents actively engaged in a wellness program that includes blood draws, goals, incentives and education with significant attention paid to chronic illnesses? If you don’t have an active wellness program with these and other features you are probably costing yourself significant dollars and may be missing an opportunity to help employees become healthier.

Lacks a Comprehensive Disease Prevention Program:

To what extent do your employees and their dependents follow guidelines for sex and age specific preventive tests? If all of your employees and dependents are not part of a rigorous prevention program, they may be experiencing unnecessary illness and – you (and they) are probably underserved.

Uncertainty over Vendor Accountability:

If your broker and carrier say they are doing the above, how would you verify their performance on your own behalf? How do you track, review and set expectations for their performance on your behalf?

Lacks an independent and knowledgeable voice who is the employees # 1 HealthCare advocate.