Employers are putting real effort into managing their healthcare costs. But few are being shown what is driving those costs in the first place.
Renewal season comes around, and the conversation stays at the surface: negotiate the rate increase, shift more cost to employees, raise the deductible. Rinse and repeat.
If you are not addressing what is causing costs to rise, none of those changes will stick. You are treating the symptom, not the source.
The real driver? Claims.
Specifically, where and how care is being delivered, and whether anyone has ever sat down with you to walk through that data.
A real example: Imaging costs
We reviewed a manufacturing company’s claims and found they were spending more than $180,000 a year on imaging alone. When we dug into where those scans were happening, the picture became clear: employees were going to hospital-based imaging departments for MRIs and CT scans, even though independent imaging centers nearby were 3 to 5 times less expensive.
In some cases, employees were paying $800 to $1,200 out of pocket for a single MRI.
The fix was simple. The company made independent imaging centers $0 deductible, $0 copay. That one adjustment saved employees roughly $950 per scan and saved the plan nearly $65,000 in the first year.
No carrier change. No contribution shift. Just better information and a small plan design tweak.
Another example: Pharmacy
We recently looked at a health plan covering 1,500 employees and found more than $1,000,000 in potential savings tied to just six medications.
Nobody was forced to change their medication. Employees simply started buying those medications from a different source. That is it.
Employers are trying to solve a claims problem by negotiating renewals. It is not an apples-to-apples fix, and that is why the frustration keeps building year after year.
A few questions worth sitting with:
- Do you know your highest-cost claim categories?
- Do you know where your imaging and specialty prescriptions are being filled?
- Has anyone walked you through the claims data behind your increases?
If the answer is no, that is worth a conversation. Getting visibility into your plan is more straightforward than it sounds, and the savings on the other side are often significant.
DM me for more information.