If you are not working on self-funded medical plans, or are unfamiliar with the concept, now is the time to get up to speed. Last month's EBA was full of great tools and ideas, but most of them will only work well with self-funded plans. You need access to the guts of a medical plan and its data - you don't get all of that with fully-insured plans.

 

Better shop around

Reading the article Are your clients paying too much for health care? (p. 18) reminded me of story about the varying cost of MRIs. The hospital charged $1,500 and used older equipment, while a free-standing facility a block away used state of the art equipment and charged $400. That's a huge difference for a block away. The problem? Employees did not know to shop for the MRI. Often, their physician tells them where to go, and who is going to question their doc? So it is refreshing to see a solution that can help. I've seen these programs work wonders with specialty medication, diagnostic services and imaging centers. However, the specialty benefits manager must always be mindful of quality versus price, and communication of the programs to the employees. But to know these cost overruns exist in the claims the process should start with effective data mining of the claims experience and benchmarking the costs.

 

Clinic questions

The Doctor is in (p. 34) - well sounds like he certainly is! I've just begun my education about onsite clinics and enjoyed reading the cover story. These clinics are a great idea - not only as a money-saving tool, but a time saver as well. I think of that busy attorney who would lose a ton of time (and billable hours) driving to a physician's office, waiting to be seen, and getting back to the office. What a great employee benefit to have a clinic.

While I totally understand the concept and benefits of having the onsite or dedicated employee clinic, my detail-oriented side wonders about all the little details. How does an employer insulate themselves from liability and privacy issues? Could a malpractice suit be passed through to the employer if that physician is on company payroll? I am sure that there are answers and solutions to all my questions. But hopefully you see my point that this concept is not something you just "wing" without knowing the details.

 

Self-funding and fees

Let's talk a little about the shift from commissions to fee-basis (Ensuring your business model survives reform, p. 61). Here in Texas, one fully insured carrier has already removed commissions from cases of 51+ lives. A per-head fee is agreed upon between adviser and client, and the carrier will bill for this as a courtesy. I've had this per-head fee arrangement for years with self-funded business. But self funded is a different animal - one that provides ample opportunity to meet monthly with my clients to discuss claims, plan design, etc. The limited information and control available from fully insured plans doesn't offer the same opportunity, so how to show your true worth on a monthly basis? Just like Jack Kwicien suggests, be a resource and long-range planner for those clients. And maybe your three-to-five year plan for your client is to transition to a participating or self-funded plan. Be an information resource that your clients depend on, and touch them monthly by delivering timely information. Create your strategy and information tools now, in a year it will be too late.

Reach Bryant, founder of SB&K Benefits, at todd@sbkbenefits.com.

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