The word “Praxis” is talked about regularly in personal development arenas. It refers to an integration of belief with a change in behavior. In other words, if you truly believe in something, you must willingly change your behavior to achieve the results you desire. The health insurance industry is one that is very resistant to organic changes. Changes are generally driven by cost; an increase in cost leads to forced decisions to make changes to benefits. That has become the accepted practice – double digit rate increase, cut benefits, cross your fingers for the next year.
A recent article recognized that the national healthcare system is failing the middle to lower classes who are drowning in bills. Deductibles were adopted much later than the rest of the country, and were supposed to help “consumerism.” In reality, it has actually caused people to avoid or delay the care that they need, compounding the issue.
Why are larger organizations (500+ employees) the only ones accessing specialized programs to help control their population health risk, while many mid-market employers (50-500 employees) are left with little to no resources?
Why don’t organizations fundamentally take a different look at medical insurance and dive after the issue?
Why are we okay with the “It is what it is” view of health insurance?
“Praxis” – At RogersGray, we plan on being an industry leader to create the belief, and then provide the action steps to help make a change.
1. Cost Transparency: Providing proactive tools for employees to understand and seek low cost, high quality alternatives. As consumers we price shop for everything, but we don’t for insurance. Why? Lack of tools and resources is the “accepted” answer… We plan to change that.
2. Alternate Funding: Why are self-funding or captive arrangements reserved for large employers? Smaller employers are generally not given the resources and data management that they need to help mitigate the overall risk of self funding. We not only have an exclusive Captive offering for those groups of 50+ employees, we are also prepared to bring a Dynamic Analytics package to the mid-market. Claims trends, gaps in care, case management, predictive analysis; all the tools needed to mitigate your claims exposure. EVERY employer should thoroughly understand their options outside of the fully insured market.
3. Prescription Alternatives: One of the leading causes for high medical costs are prescriptions. One of the most important reasons to understand Alternate Funding, is that you have the ability to shop your Pharmacy Benefit Manager (PBM). Combined with a strong data analytics package, you can pinpoint your risk and search out low cost alternatives; potentially accessing manufacturer/government discount programs, or even sharing in the rebates on your overall pharmacy spend.
4. Employee Communication Tools: This is the single biggest gap in the 50-500 marketplace. Many organizations receive Cost Transparency; a very select few receive options for Alternate Funding; of those, even fewer receive Dynamic Analytics or Prescription Alternatives; and finally, little to none receive what we can bring to the table with Employee Communication Tools. Employee Communication Tools offer a means to proactively communicate to employees that are managing conditions or are at risk. All of the data in the world does no good if you cannot effectively communicate a need for a change in behavior with the at risk parties. Would it be effective if you could reach out to all of your employees with Diabetes, or those at risk, and remind them to get their A1C test via email/text message? Multiply that by all employees managing various conditions and you can make a measurable impact on your risk exposure, and thus create an environment for long-term cost control.
Health insurance costs are not going to fix themselves. It takes an active community that wants a change and is willing to take the steps to make that change. Massachusetts is a pioneer in the healthcare industry across the country. At RogersGray, we are prepared with a knowledgeable team and the right resources to help start a new trend.
Reach out to me via LinkedIn or use the form below to contact me with any questions.