Health Care

Today’s health care environment is riddled with complex plan designs and rigorous government regulations, leaving many employers to feel as though their hands are tied when it comes to unique, innovative and cost-saving solutions. However, there is new technology that enables employers to identify risk, influence behavior and ultimately control cost.

“The ability to anticipate claims or predict claims costs has not been available in the small group market due to the absence of claims data from the insurance companies . . . until now,” said Jessica Galardini, representing PTC Corporate Coverage Group (PTC CCG). Newly developed technologies include risk analysis and predictive modeling tools that make it possible to take a deeper dive into the health composition and risk factors of a workforce. For example, companies can proactively identify markers for chronic illness in order to predict health costs and determine whether a fully insured plan or alternative strategy, such as self-funding, is viable.

“The ability to anticipate claims or predict claims costs has not been available in the small group market due to the absence of claims data from the insurance companies . . . until now,” said Jessica Galardini, representing PTC Corporate Coverage Group (PTC CCG).

A self-funded plan differs from a fully insured plan in that it offers an employer more control over the health plan. In addition, self-funding provides protection against excessive costs in years with high claims, opportunity to keep profits from favorable years, and the availability of medical claims utilization.  While self-funding is not a new concept, it is new to the smaller employer – with many insurance companies now offering level-funded premium options to groups with as few as 10 employees.

The deeper dive risk analysis begins with the collection of employee data, captured through a custom access portal. The portal is an insurance company-accepted, Affordable Care Act-and-HIPPA-compliant online benefits application tool. The online process is designed to reduce the amount of time, cost and paperwork for employers.

Employees are asked to complete an online enrollment interview. Once completed, the employer receives a confidential de-identified aggregate report that includes an overall analysis of the employee population. This expert analysis and data empower PTC CCG consultants to guide the business owner through the benefit decision process. Gaining insight into the composition and health status of the employee population means plan design decisions can be strategic and fueled by actual data.

The same portal technology also reduces many administrative burdens by providing the added support of employee enrollment, communication and plan elections. The solution is a faster and more efficient approach to benefits. This means the employer can essentially build its own health plan, which can lead to generous cost savings, greater transparency, understanding and better overall cost control.

A staggering 50 percent of the average employer’s insurance premium budget is spent on members with preventable health conditions. The time is now, and the strategies and technologies exist, to help even small employers take control of their health plans. Talk to the advisors at PTC CCG to learn how risk analysis tools can guide you to an effective benefits strategy that ultimately reduces cost.