healthcare benefit cost strategies for 2012
TRANSCRIPT
Strategies & Opportunities to
Lower Your Healthcare Costs in 2012
www.nyhart.com
Presented by Randy Gomez, FSA
Copyright 2011. All Rights Reserved.
Randy Gomez, FSASenior Healthcare Actuary
[email protected]| (317) 845-3595
Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
Agenda Know your plan
Cost Based Strategies
Design Based Strategies
Know Your Plan
Claims Curve for One Adult
Annual Medical Costs
Probability of Occurring
$0 13.8%
$1 - $3,000 58.0%
$3,000 - $10,000 12.2%
$10,000 - $25,000 10.6%
$25,000 - $50,000 3.6%
+$50,000 1.8%
Average monthly cost is $480
What causes higher medical costs?
• Benchmarking against norms for larger risk pools and the plan’s own history
• Information on cost and clinical outcomes
• Action steps
Best Practices for Ongoing Analytical Services
Evaluation of network discounts
Evaluation of administrative expenses
What is your data telling you?
Raise employee contributions
Cost Based Strategies
Network Discounts
Administrative Expenses
Prescription Drug Contracting
What is your data
telling you?
What do you know about your risk pool?
What happened?
How is your compliance with preventive screenings and medications?
Key questions
• Benchmark against norms
• Incorporate wellness incentives
• Surcharges for working spouses
• Incremental contributions for multiple options
Raise employee contributions
Incremental contributions for multiple options
Traditional Approach
$500 Deductible Option
$1,000 Deductible Option
Monthly cost $600 $570
Employer pays 80% $480 $456
Employee pays balance $120 $114
Incremental Approach
$500 Deductible Option
$1,000 Deductible Option
Monthly cost $600 $570
Employer targets 80% of low cost option $456 $456
Employee pays balance $144 $114
Plan design
Eligibility
Preventive approaches
Utilization Based Strategies
High Deductible Strategies
Value Based Strategies
Targeted Limitations
Eligibility Strategies
“If your spouse has coverage at their job, they are not eligible for
our plan.”
“Are your dependents really eligible?”
Preventive Approaches
Onsite Clinics
What are your experiences?
ANY QUESTIONS?This concludes our discussion
Randy Gomez, FSASenior Healthcare Actuary
[email protected]| (317) 845-3595
Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
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