Are you prepared to navigate the ever-changing landscape of employee health benefits while safeguarding your business' financial stability?
Managing health plan risks has become a challenge for employers of all sizes. As businesses strive to provide comprehensive and cost-effective health coverage, it's essential to explore innovative strategies that not only mitigate potential pitfalls but also enhance the well-being of your workforce.
In this blog, we cover common health plan risks, how to identify risks facing your business and ways to decrease your risks so you can improve employee health outcomes and increase your company’s financial stability.
What Are Health Plan Risks?
Health plan risks refer to the potential challenges, uncertainties and negative outcomes associated with providing healthcare benefits to employees through health insurance plans.
Risks to your health plan can cause unexpected financial strain, decrease productivity and have a negative impact on employee satisfaction and company culture. It is crucial for your business to understand the potential risks you face and how to proactively reduce them.
Common health plan risks include:
Financial Risks – Has there recently been any unexpected increases in your healthcare costs, including medical treatments, prescription drugs and medical procedures that can strain your budget?
Compliance and Regulatory Risks – Are you adhering to healthcare regulations, such as the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA) and state-specific mandates? Failure to comply can result in significant penalties and legal repercussions.
Plan Coverage Risks – Does your health plan provide sufficient coverage for necessary medical services, prescription medications or preventive care? Are you leaving your employees vulnerable to financial hardships and delayed treatment?
Employee Dissatisfaction Risks – Does your company offer limited coverage, have a complex claims process, lack transparency or recently had unexpected changes in benefits? This can all lead to employee dissatisfaction with their plan.
Employee Population Health and Wellness Risks – Does your employee population have unmanaged health conditions or unhealthy lifestyles that can reduce productivity and increase your healthcare costs?
Emerging Healthcare Trends Risks – Are your health plans outdated or misaligned with emerging healthcare trends, technologies and treatment options?
Identifying Health Plan Risks
Employer groups can measure their health plan risk through various strategies and analyses that provide insights into different aspects of their health benefits program. Here are some methods to help employer groups measure their health plan risk:
Claims Data Analysis – Analyze your claims data to reveal patterns of healthcare utilization, high-cost claims, prevalent health conditions and prescription drug usage within your employee population. This data helps identify potential financial risks and areas for targeted interventions.
Health Risk Assessment (HRAs) - Conducting an HRA with employees helps gauge their health risks and behaviors. This information helps identify potential health-related risks within your employee population.
Employee Satisfaction Surveys – Analyze this data to identify how satisfied employees are with your current health benefits offerings, spot potential gaps in coverage and uncover any communications issues.
Provider Network Analysis – Evaluating the effectiveness and accessibility of your provider network can identify risks associated with the options offered to employees seeking medical care. In a previous blog, we discussed how doctor performance has a direct impact on your claims costs.
Compliance Audits – Your broker should regularly be reviewing if your health plan is meeting regulations and legal requirements to mitigate potential risks associated with non-compliance and penalties.
Wellness Program Engagement and Outcomes Analysis - Monitoring employee participation and engagement with wellness programs and tracking health outcomes and improvements can provide insights into potential health risk reductions and overall program effectiveness.
Benchmarking - Comparing health plan metrics against industry benchmarks can provide a perspective on potential areas of risk and opportunities for improvement.
Reducing Health Plan Risks
Reducing health plan risks is crucial for your business’ bottom line, employee satisfaction and retention and overall productivity. It also leads to an increase in employee financial stability, improved health outcomes and a more positive workplace culture.
Third-Party Administrators (TPAs) Using a TPA can be a highly effective way for business owners to reduce health plan risks. TPAs have extensive knowledge of healthcare costs and pricing, enabling them to manage costs by negotiating favorable rates with healthcare providers, pharmacies and other services providers.
Through a TPA, you have access to robust analytics that identify potential health risks within your employee population, allowing you to take proactive measures to prevent and manage these risks. These analytics also allow you to track utilization patterns, which can help you anticipate high-cost claims to adjust your plans accordingly.
Also, TPAs stay current with regulatory updates, helping business owners remain compliant and avoid costly penalties.
Wellness Programs
Employers can effectively reduce health plan risks by implementing a well-designed wellness program that focuses on improving employee health, promoting preventive care and fostering healthy lifestyles.
Wellness programs can offer your employees workshops, seminars and educational materials that help them make informed decisions about their health. Some workshops that can be offered include nutrition guidance, stress management or smoking cession.
Offer preventive care incentives to encourage employees to undergo regular health screenings, vaccinations and check-ups. It’s as easy as offering reduced premiums, gift cards or additional paid time off!
Provide employees resources to engage in regular physical activity, such as gym memberships, fitness challenges, or onsite exercise classes.
Through a wellness program, you will also be able to offer employees mental health resources, counseling and Employee Assistance Programs (EAPs) to address mental health challenges and promote emotional well-being.
Employee Empowerment and Engagement Employers can significantly reduce health plan risks by fostering employee empowerment and engagement in their healthcare decisions and overall well-being.
When employees are actively involved and invested in their health, they are more likely to make healthier choices, effectively manage chronic conditions and utilize healthcare resources wisely.
Employers should have an effective communications strategy—provide employees with clear and accessible information and educational resources about their health plan options, coverage details, costs and any changes to their plan.
When you provide employees with access to their benefits 24/7 through benefits administration technology, employees will have the opportunity to make more informed benefits and healthcare decisions.
Reducing Health Plan Risks for Better Outcomes
Identifying your business’ unique healthcare risks is an ongoing process. Our experts at Ascela work with you to understand, identify and manage your unique health plan risks to create a healthier and more productive employee population. We provide actionable insights to implement strategic changes that reduce financial burdens and enhance coverage.
Contact us today to learn more about our tailored benefits solutions that drive employee wellbeing, financial stability and organizational success.