Employee benefits are one of your largest expenses and biggest resources for attracting, retaining, and engaging top talent. This is why your broker needs to carefully select and implement a clear, cost effective strategy for your business’ benefits program.
Not only should your broker be offering the best strategy, they need to be transparent with you as well. You should have clear insights into how your plan is designed and how your broker is making decisions about what is best for your business and ultimately your people.
As an employer and business owner you have the right to access important data, stats and information about your employee benefits plans. The problem is knowing what questions to ask.
Raise your broker’s eyebrows
As health insurance experts and advisors we have put together a list of questions to help you gain the knowledge you need to make sure you receive the most affordable, functional and cost effective benefit program.
Here are some key questions that you should ask your broker so you can better understand your plan and their process.
1. What are the biggest threats to our potential claims this year and what can we do to prevent or mitigate risk?
Your broker should be able to point out specific risks from both your region and your population to take preventative steps to reduce the volatility of claims. These threats need to be managed proactively to avoid costs.
2. Are there specific high-cost claimants that we should be worried about? What conditions do they have that we should be monitoring?
They should have examples of members with chronic or accute conditions that both require high-cost and/or high-frequency care as well as maintenance medications.
Your broker should be able to provide you with data that can help identify future high-cost claimants and recommend strategies that can improve care and lower costs for these members.
3. How can we ensure our members are getting to the highest-quality/lowest-cost care?
They may answer this question by discussing their proprietary doctor rating system which includes doctors who have agreed to certain billing practices and patient acceptance. They may also talk about “Value-Based Payment” which not only amounts to a very small percentage of the provider reimbursement, but also has very few actual quality metrics.
4. What opportunities can we seize to mitigate risk and reduce cost this year?
Your broker is most likely going to talk about the benefits of introducing diabetes and weight-loss programs or gym memberships. But they may miss the opportunity to discuss getting people to the highest quality of care more often as well as using predictive analytics, which can improve patient outcomes.
5. What changes can we make for our formulary to reduce prescription costs?
They may attempt to answer this question by recommending more generic drugs or mail-order opportunities, which may lower costs, but they will be missing the mark completely.
Pharmacogenomics, international procurement and manufacturing assistance programs are all opportunities to keep the same necessary drugs for your population by buying them cheaper or differing cost completely.
6. What J-Codes (Injectable Drugs) are hitting our medical plan? Would it be better for those to hit Rx instead? What is the main site of care for those injections?
If there are J-Code claims on the plan, and they answer this question, they will likely say that the best place for these codes to occur is on the medical side so your broker can utilize the “network discount”.
In reality, running these drugs through the Rx side would present the ability to purchase the drugs more cost effectively or even defer the cost entirely. Not to mention, the site of care could move to a non-hospital environment, which would cost less and reduce infection likelihood.
7. What Rx rebates are being applied towards our administrative costs? How much are they exactly?
Your broker should be absolutely transparent about these costs and the revenue they receive because they could be making money on recommendations made as well as from your group policy. For example, your broker could form a coalition with Pharmacy Benefit Managers and advertise prices as the best deal for your business, which may not be the case at all.
Essentially, if your broker is not clear about costs and revenues made, they could be making more money with their recommendations, above and beyond the fees you’re paying them.
Get the answers you need
If your broker can’t answer the questions you have about your benefits program, or is hesitant to answer them, your relationship may not be mutually beneficial and your benefits might not be working to their fullest potential.
If this is the case, speak to a trusted advisor who can help get the data you need. You have the right to know how your broker is making decisions for your business, and how much they are making on those decisions. Otherwise there is no way of knowing if your benefits plan is fair for your business or your people.
Employee benefits are considered one of the biggest expenses a company has, they should also be considered one of the biggest assets. Because a well designed, cost effective plan has the ability to positively influence employee recruitment and retention.