Imagine a situation like this:There are several people involved in making a decision about ahealth plan.  Each has a different perspective on how toevaluate the plan and as they focus on it, they realize they allhave different goals for what they want the plan to accomplish.

In this article, I present a simple four-question model foradvisors and clients evaluating a health plan so that the peoplewithin the organization use a common goal to guide decisions.Everyone on the team involved in making the decisions at the clientlevel should go through this model to avoid the tug of war thatoften occurs.

1. What is your current PEPY and what do you want it tobe?

The per employee per year (PEPY) is the claims cost, medical,and pharmacy claims combined. It is the allowed amount,not the paid amount. Suppose the organization is movingtoward a complete coverage health plan so  they can waivedeductibles and copays to make health care free for theiremployees. The reason to look at the allowed amount is that it willeventually become their entire responsibility. They will take onboth the plan and the patient responsibility when they move into at100 percent coverage model.