Health Insurance, A Uniquely American Nightmare

confusedIt’s that time again! Time for choosing and enrolling in health insurance plans. People are rightly concerned about costs and feeling powerless and locked in. There are some considerations and strategies you can use to get the best insurance for your company or family. Here are a few things to think about as you prepare for this uniquely American nightmare.

Companies, Groups

– Know your population.

Consider: age, young and healthy, child-bearing age, older; dependents, for example young families,; health status, smokers, other substance abuse; behavioral illness, prescription medication use, social determinants of health, obesity rate, health literacy, past spending patterns (high utilization, chronic versus situational), risks.

– Remember that a broker (usually) represents the insurance company. While they are providing a service, they are (usually) biased. Ask them exactly how their reimbursement works and who pays them for what. It’s OK, people ask you how you get paid right?

– Check your exchange.

– Don’t be oversold.

There are several considerations to keep in mind to prevent this. See above. Ask questions: is this something you would really use or is this something that you just wish you & your employees would use? An example, gym memberships. Is there a cheaper alternative? Can people get their own gym memberships with some sort of reimbursement? Perhaps something exercisy right at the office?

Here in Minnesota a common add on ($$) is having Mayo in the provider network. I would ask yourself and your employees, is this really necessary? Is there truly healthcare that can’t be obtained locally? I would argue that there is nothing that Mayo provides that Minneapolis can’t provide. Commonly, if there is some very specific situation where care cannot be obtained locally, a request can be made with the insurance company for an exception, for them to cover a particular facility were very specialized treatment can be performed. These are often allowed if you can make the case that this will save the insurance company money.

Other add-ons to think twice about:

Nurse line (insurance company programs) likely have little to no benefit. Most hospitals have their own nurse line, the time to consider the nurse line maybe when you have employees that travel and need access wherever they are, however this could be replaced by a Medical Director program.

Wellness programs. Is it really a wellness program, or is it a screening program? Is it something that you could do yourself or provide yourself? Does it really work? Data is often lacking on particular insurance companies wellness programs and often there is no ROI. Beware. The effectiveness of wellness programs are controversial. Know what you are getting, know what your employees will actually do, and know the real outcomes. If you’ve had a wellness program in the past, did people participate? Ask the right questions. See articles below for more information.

Also, remember that a health risk appraisal and biometric screening’s program’s are not wellness program’s. They identify problems but don’t provide solutions, and often drive unnecessary care. People need to know what all these numbers mean to make changes and most programs don’t provide information beyond a simple sentence on the paperwork.

– Utilize a Medical Director.

Develop a healthcare plan for your company. It is as important as business and financial planning. Encourage health through education and on-site services provided by the Medical Director. Services in addition to customized population health education can include medical advocacy, complex case management and to truly improve the health of your employees  with health and healthcare education. Empower your employees to appropriately and skillfully interact with the healthcare system, obtaining value-driven healthcare.

Highlight these programs while negotiating to decrease premiums. An expert health and healthcare advisor for your employees’ is a unique and meaningful benefit, and happy employees are healthy, productive employees. Develop a culture of health to truly improve health and decrease spending appropriately. Use this data in future negotiations as well.

– Consider a self-funded plan.

It may be more cost-effective in the long run than a fully insured plan because many expenses associated with a fully insured plan are eliminated. The savings achieved belong to the employer and do not become the profit of the insurer.

– Consider providing unique, creative benefits that really impact health rather than the canned “solutions” offered by commercial providers. Targeting the effective management of behavioral illness would provide a significant ROI in most populations. Consider benefits for your entire population such as quarterly counseling sessions, yoga, mindfulness classes or massages on site with time appropriated for attendance. These can be created in house at much lower cost. Empower your employees to take an active role in their health by managing their own health records, help the caregivers in your population (http://alska.com/), make their health and lives truly better.

– Remember everything is negotiable.

This is not an exhaustive list of possibilities, every business is different. I hope to give you a good start on some of the considerations in procuring health insurance. For more customized discussion please contact me and I’d be happy to discuss how I can help.

Individuals

– Know yourself, your health and healthcare philosophy.

– What is most important to you? Your doctor? Location of services (what healthcare system is nearest your home or work)? Is this the system that you would most likely use?

– Know your family history and its relevance, your health risks.

– Like financial planning, what is your risk tolerance?

– Consider your past utilization of healthcare services. Do you see a doctor regularly? If so, note co-pays.

– What services are covered by a particular plan? Are they the services you use?

– Do you take any medications?

– Do you want an HSA (Health Savings Account)?

– Check your exchange.

– Remember that a broker (usually) represents the insurance company. While they are providing a service, they are (usually) biased. Ask them exactly how their reimbursement works and who pays them for what. It’s OK, people ask you how you get paid right?

– Don’t be oversold. There are several considerations to keep in mind to prevent this. Ask questions: is this something you would really use?

Here in Minnesota a common add on ($$) is having Mayo in the provider network. I would ask yourself and your employees, is this really necessary? Is there truly healthcare that can’t be obtained locally? I would argue that there is nothing that Mayo provides that Minneapolis can’t provide. Commonly, if there is some very specific situation where care cannot be obtained locally, a request can be made with the insurance company for an exception, for them to cover a particular facility were very specialized treatment can be performed. These are often allowed if you can make the case that this will save the insurance company money.

– Compare plans from several tiers. Compare on TOTAL cost (premium, deductible, co-pays, co-insurance and prescription coverage), not just on premium or deductibles. Use your personal information noted above to estimate total cost. For example, if you see a doctor four times a year, that would be four co-pays.

– Remember everything is negotiable (though this is not as true on the individual market as if you are a company negotiating with an insurance company).

If you have questions or have had experiences or successes that you think others can learn from, please share them with me.

 

Resources:

There is a lot of info on the internet as you know. It’s always good to get a few opinions on a subject, but, beware of bias, put your critical thinking cap on! I do not endorse any of these specifically.

http://healthaffairs.org/blog/2016/10/24/the-off-exchange-individual-market-and-small-group-market-new-hix-compare-data/

Use a comparison tool. https://mn.checkbookhealth.org/hie/MN/2017/index.cfm?data=eyJGT1JNIjp7fSwiVVJMIjp7IkNPVkVSQUdFIjoiSW5kaXZpZHVhbCIsIkxBTkciOiJFTiJ9fQ%3D%3D

http://kff.org/interactive/subsidy-calculator/

http://www.healthcostinstitute.org/news-and-events/study-finds-consumer-driven-health-plan-enrollees-spend-15-times-more-out-pocket-tho

https://archive.ahrq.gov/research/findings/factsheets/costs/expriach/

Addressing costs for people with chronic conditions.

http://www.ey.com/Publication/vwLUAssets/Health_Industry_Post_population_health_management/$FILE/Health_Industry_post.pdf

http://www.businessnewsdaily.com/8682-self-insurance-plan.html

I think the following article is biased, somewhat self serving, ad may have some errors (how does it size up compared to you experience?), but it does make some important points, primarily in the title.

https://www.linkedin.com/pulse/employers-overpay-10-50-health-benefits-time-second-opinion-chase?trk=hp-feed-article-title-channel-add

 

For those with BCBS of MN Healthcare: Heads-up

Effective Jan 1, 2017 BCBS PPOs will exit from the exchange and only offer Blue Plus HMOs in the state of MN. To find out how this could affect you please contact BCBS (651) 662-8000 or 1-800-382-2000.

You can also research brokers or visit the market at https://www.healthcare.gov/.

One broker (this is not an endorsement, just here for easy access, #came across my desk. IF you call them, tell them it’s because of McIntoshMD!)

Gravie Agency, help@gravie.com or 1-800-501-2920 (open M-F 8a-6p).