For many, the decision about which health plan to go with comes down to one thing: how much are the premiums?
While cost is certainly an important consideration, the strong focus on premiums misses a more significant measure of comparison: value. Brokers play a key role in helping clients compare plans and integrate questions and considerations of value into the conversation to help clients choose a plan that addresses their unique needs. In today's complex health care environment, value is important to both employer clients and plan members, so it's necessary to look at how insurers are driving value.
Value for health plans means providing products, services and cost savings to members by guiding them in their health care journey. To achieve value, health plans must not only provide affordable access to care, but also help plan members understand their benefits and how to optimize them. But the question remains: How do health plans drive value for plan members? One way is through population health management. It's likely that the term "population health" means little to your clients and their employees, but it is important because it essentially encompasses the health outcomes of the individual.
If you are explaining what this means to an employer, a good way to think about it is that there are many factors that impact a person's health. Treating just a symptom or solely the disease may miss underlying factors that are exacerbating that issue or a chronic condition, resulting in higher costs for care over time. There are factors, like access to healthy food or food insecurity that are not directly associated with medical care but do increase utilization, which in turn increases costs across the board.
Pursuing innovative partnerships can drive an enormous amount of value. On one hand, this means negotiating with providers and pharmaceutical companies to contain costs. But it also means pursuing value-based contracting, which aligns the motivations of patients, providers and payers, leading to better outcomes for everyone. Value-based contracts are agreements between a health plan and provider or pharmaceutical company that ties payment to certain outcomes to ensure efficacy of care or a specific therapy or treatment. Emphasizing the need for the right care, at the right place and at the right time, is key to ensuring people are achieving desired health outcomes and not unnecessarily driving up costs.
Unfortunately, value does not have a neat metric to sum it up and can be hard to measure, unlike comparisons of cost which are pretty straightforward. Our health care system is complicated, and just like consumers often look for a guide to navigate it, so too do employer clients. Employers often look to their broker to help them decide which health plan will meet their needs and intangibles like value and customer service.
Brokers play a critical role in guiding clients to view their choice of insurance plan through a holistic lens. While low premiums are certainly attractive, they do not get at the root causes of rising costs. Encourage your clients to ask health plans about their value.
Beth Roberts is senior vice president of commercial business at Harvard Pilgrim Health Care.
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