Who are the influencers in your company?

Think for a minute. The answer may seem obvious at first. But have you ever surveyed your company to understand how the power and influence structure really works?

-Are the people or departments that should be working together doing so?

-Are the managers in your company actually adding value to the work product?

-Who are the diamonds in the rough? Those people that are the quiet ones but that others look to for advice and support?

- How does HR fit in? Is there an arms length relationship with employees or are they viewed as an integral partner?

As anyone in HR knows, their job goes way beyond benefits, but the typical benefits broker only looks to solve the "rates and plans" problem. In order to be a better trusted advisor and add greater value to clients, the broker must think outside of the box.

To that end, technology now exists that allows you to easily survey your employees and graphically help you understand how your company is humming.

This is social network analysis on the corporate level and I’m not talking Facebook! This is a methodology that can quickly help you affect positive change in your company especially if you’re planning a reorganization, restructuring, implementing large scale change, measuring employee perceptions, doing leadership development or simply looking to improve internal communications or employee productivity.

Recent clients have found some interesting patterns in their employee communications and discovered employees that have significant influence that were people that generally "flew under the radar".
 

Benefit Strategy: Medical Networks are a' changin'

As a nod to Bob Dylan visiting Sacramento this Saturday...the times they are a-changin':

Many employers continue to offer their employees significant choice in the way they access care. That means that a full network plan (Sutter, Mercy, UC Davis and beyond) is generally offered next to Kaiser. In order to lower costs, carriers have begun to offer more limited network options.

We now see Sutter only (offered through HealthNet, United Healthcare and soon to be offered by Sutter themselves), Western Health Advantage (offering UC Davis and Mercy), and other limited products offered through Anthem, Blue Shield, United HealthCare and others. Blue Shield recently launched Blue Groove which is an accountable care organization (ACO) model with their partner Hills Physicians.

Kaiser can be considered the "ultimate" accountable care organization as they are their own limited network including the hospitals, medical offices and doctors. Due to Kaiser's integration, many health systems will take years to catch up to them technologically and culturally. They have the benefit of being the insurer and health provider.

But none of this carrier innovation will matter until employers decide to limit their employee’s choice. If an employer is serious about controlling their health care costs, they should consider the inconvenience of change in the short run in order to get long term cost control.

Why? The old model of offering choice is losing effectiveness as the carriers want deeper partnerships with their employer groups to roll out critical care, chronic illness management and wellness programs. Carriers can offer many resources to help an employer control costs such as employee education and wellness resources, but it is difficult to manage in a multi-carrier environment. Carriers want participation and don’t like to share your employees with other carriers. There are a few exceptions, but employers should begin to consider this in their employee benefit strategy.

As hospitals and insurers continue to innovate to reduce costs, they need a willing employer populace to come along for the ride.

Make strategic benefit planning a priority

After a busy hiatus, it's time to relaunch my employee benefits blog. Stay tuned for weekly updates and feel free to give me feedback on this and other topics you might like to see.

Strategic Benefit Planning Is The Way to Go!

Whether you are a large group or small one, rates for benefit plans never cease to rise. This is exceptionally true in northern California where there is limited competition in the major metropolitan areas like Sacramento where Sutter, Mercy, UC Davis and Kaiser dominate the landscape.

Ten years ago, when the cost of health and welfare benefits represented about 2% of payroll, most C-suite executives left all the decisions up to the HR staff. They developed a comfortable relationship with a local broker and over the years managed the renewal process trying to minimize disruption. The rules have now changed.

Now, the cost of health and welfare benefits represents 15-25% of the cost of payroll and the existing process to evaluate renewals has not yet changed to meet the new realities. If the broker delivers a low increase, everyone breathes a sigh of relief and moves forward with open enrollment. On the other hand, if the broker delivers a 20% increase, the wheels fall off the wagon and everyone begins the annual firewalk to decide what gets changed: insurance carrier, broker, employer contribution, plan design, etc.

If you have a $350 composite single health insurance rate today, it will grow to over $800 in 5 years if you continue with 20% increases. No matter your scenario, health insurance will continue to cost more, so how will you bend the curve in your favor?

Perhaps the best approach is to consider a strategic benefits planning process that allows for scenario analysis so that no matter what happens, you have a plan. In future posts, I'll be discussing:

- Choice of medical carrier and carrier mix

- Managing employee well being

- Changing your employer contribution

- Making benefit planning a year round activity

- Developing an employee communications plan

- Making sure your broker is compensated fairly

and other great topics.

Connect with me on LinkedIn or Twitter to stay abreast of what I have to say.

Taking control of your medical care

Two recent medical experiences highlighted to me how if you're going to be a consumer of medical care, whether voluntarily or involuntarily, you had better not be shy about asking questions. We all have the ability to combat rising health costs and it starts with us asking our providers questions.

First, a friend was visiting an ophthalmologist for what she thought was a routine eye exam. This eye exam lead to:
a. the routine part
b. putting plugs in her tear ducts without discussing the dangers or alternate treatment options after her eyes were dilated and asked to sign a release she couldn't possibly read
c. being referred to get an MRI for an unrelated condition rather than being referred to the right specialist
d. an error at the providers front desk causing a trip back
e. another appointment to review the MRI where they did yet another routine exam and the doctor wasn't prepared at all for the consult

We complained to the practice manager about what had occurred because of a relationship I have with the manager and in the end the physician was "counseled" on the issues. The practice manager was appreciative that we took the time to complain because they never get that level of detail in their usual patient surveys.

Second, my son recently had surgery at an outpatient surgery center and I was told that they would be using a device to help circulation in his legs during the procedure. I was also told that this was optional and if we get billed, to simply ignore it. Well, my insurance company certainly did get billed to the tune of a few thousand dollars and smartly denied the claim. Today, I get a statement from them saying that the amount is my responsibility. Since the nurse told me to ignore the bill, I certainly will. And if they persist, I will also call the manager of that practice to make it go away.

But this all leads me to wonder how many people simply go down the path of health care simply nodding their heads like deer in the headlights. By the nature of what I do, I understand the path to care and perhaps are sensitive to the feeling of being taken. In our system, everyone is trying to make a buck because they only get paid if a service is performed or a device is used.

It's up to us to ask, "is this necessary"? And if we all begin to do so, maybe we put providers on notice that we won't be charged for things that simply run up the bill.

One New Savings Strategy - Networks, Deductibles, and MOOPs - Oh My!

How are health insurers going to keep employer insurance premiums increases lower? One way that we are already seeing is by limiting network access. Health insurers negotiate terms directly with providers such as hospital systems, physicians and other health providers. Each contract has different levels of discounts and terms.

The costliest plan can only be as inexpensive as the most expensive provider contracted with. For example, in the Sacramento area, with 4 major health systems (one staff model HMO plan and 3 fee-for-service), insurance plans with all 3 fee-for-service networks included are the most costly for a given level of copay, deductible and maximum out of pocket (MOOP).

As network access is reduced to 2 or even 1 provider network that is accessible, premium costs start to decrease. One local HMO offers two networks and is very price competitive. The staff model HMO (self-contained provider and insurer) and is also very cost effective.

Carriers that had been offering all 3 of the major networks are now realizing that to be cost competitive they must reduce premiums and one approach is to reduce the number of networks offered. Premiums are not quite yet approaching the limited access HMO plans, but hopefully will.

The implication for employers is that they must decide between network access for their employees vs premium. Many employers don't want to inconvenience their employees forcing them to change doctors or other providers, but as employers continue to feel premium price pressure, they will have to make these difficult choices.

Health Reform's Evolution

Don't believe everything you hear. Various pundits will have you believe that the law is all but dead and that the Supreme Court is ready to throw the whole thing out. While that is one possibility, one must open themselves up to the many other possibilities that may ultimately occur:

1. People begin to like the law and how it helps them. How about the person who's child is not in college but needs insurance but couldn't qualify for an individual plan? The law has already worked for them.

2. People who will have access to insurance in 2014 simply don't buy it until they need it, happily paying the penalty instead.

3. Companies drop coverage because it's too much of a hassle to administer and pay penalties instead.

4. Companies use health insurance to snare the best talent with better benefits vs. those that don't offer them.

5. Congress cuts funding for key organization expansions necessary to administer and implement the law.

It would be easy to go on for days in this vein trying to run by the hundreds of scenarios that might unfold. It all might work, might not work or fester for many years to come. The law is the law for now, so learn as much as you can to help you make good decisions for yourself, your family and your company.


Stay tuned!

Health Insurance for Uninsured California Children

Please review this important information regarding new health care options for uninsured children.  The open enrollment period for the new health care options for children who are uninsured ends on March 1, 2011.  If individuals wait and apply for coverage after March 1st, they could face much higher premium costs since there are no limits on premiums outside the open enrollment period.  Thank you.

http://www.insurance.ca.gov/0100-consumers/0020-health-related/CAOpenEnrollment.cfm