Perspectives taps into BenefitsPRO's partners to provide leading insights on pressing topics shaping the industry. This podcast will feature news on the technology, regulations and best practices that are impacting today's benefits professional.
How a personalized health plan is turning health benefits into a real benefit
Bind is changing the way we think about health insurance. According to Tamra Lair, Chief
Analytics Officer, Bind “took apart health insurance and “now it works,” Or more simply,
consumers are getting “more of what they need and less of what they don’t.”. As the Bind
analytics and reporting leader, Lair talks about how creating a more personalized health plan is
Health insurance had seen little change until Bind entered the market. According to Lair, Bind is changing how people think about health care as well as how they seek care. By providing cost clarity and a condition-first approach, consumers can make better decisions and achieve more affordable, intuitive and personalized care. Bind data shows that the vast majority of its members find their plan understandable. In an industry that is known to be complex and confusing to consumers, that statistic alone sets Bind apart. The cost savings are remarkable as well: Bind members’ annual out-of-pocket pharmacy and medical expenditures are less than half of the national average. Additionally, compared to industry benchmarks, Bind is seeing double-digit savings when it comes to total cost of care for members and employers.
Listen to Lair connect the dots by breaking down costs and the effect savings is having on
Why Personalization is the Future of Health Insurance Design
Bind CEO Tony Miller talks about how health insurance should work like the other useful
services in our modern daily lives. Clear, flexible health plans that can be personalized to meet
our individual needs are the future of health insurance design.
How to move the needle on pharmacy benefits management
All pharmacy benefit managers offer similar services around formularies and manufacturer rebates, as well as clinical programs and network options to manage ingredient cost trends for their self-funded employer customers. There’s also little distinction across their reporting, customer service, account management and claims processing. But there are important differentiators to consider when selecting a PBM partner, according to Cindy Brigman, director of PBM solutions at UMR, Inc., a UnitedHealthcare ASO solution.
They include understanding pass-through pricing agreements and knowing whether the PBM is managing its own rebate contracts, formularies or networks. It’s also helpful to know what’s included in their pricing (i.e., ancillary fees and clinical review or prior authorization charges), as well as an ability to determine return on investment. Another critical area to examine is whether the prescription drug area is carved in or carved out, and if prescription and medical rates are underwritten together.
Since pharmacy is the fastest-growing segment of healthcare costs, Brigman suggests key cost-management strategies for employers. They include understanding what they’re paying for, as well as implementing a limited or exclusionary formulary across all categories of medication and utilization management programs. Educating health plan members to become better prescription consumers will also go a long way toward improving adherence and clinical outcomes.
In this podcast interview, she explains the concept of real-time accumulators for managing deductibles and out-of-pocket maximums and whether it’s worth investing in this area. Finally, Brigman offers several inventive strategies for managing rising specialty scripts that drive prescription trends, such as using grants from drug manufacturers.
Hit play to learn more.
The power of harnessing timely and actionable health plan reporting
At a time when data analysis has never been more important for managing employee health benefit costs and clinical outcomes, reporting is critical for self-funded customers that customize their health plan coverage. Timely financial reporting is necessary to know how much they’re paying in medical claims, while utilization reporting helps them understand the types of services health plan members are receiving. This drives decision-making around plan design, incentive solutions and member advocacy, all of which are critical to the success of a health plan, explains Jason Stephen, vice president of information and analytic services at UMR, Inc., a UnitedHealthcare ASO solution.
The key is to access data in a way that’s timely and actionable, he says. For example, UMR offers employers access to self-service reporting tools that are updated daily with only a two-business-day lag versus waiting for carrier or TPA reporting to be refreshed on a monthly basis. Another solution is for employers to contract with health analytic vendors to create their own data warehouse.
Stephen notes that the more employers understand which conditions are driving their healthcare spend, the easier it is to decide on specific care management solutions. Drilling down into claims data can help customers understand their utilization patterns and ensure that members are receiving the right care in the right setting by a high-quality provider. He predicts artificial intelligence will continue to spot trends lurking in the data, noting that sophisticated algorithms extract insights quickly and efficiently.
Hit play to learn more about health plan reporting.
Looking Ahead: Lessons Learned for Investigations
In this episode of the Perspectives podcast, sponsored by Control Risks and hosted on Law.com, we’ll hear highlights from the July 29th presentation titled, Looking Ahead: Lessons Learned for Investigations.
The COVID-19 pandemic forced many organizations to revisit their approach to investigations. In recent months, investigators have been dealing with challenges in identifying, preserving, and reviewing data, holding remote interviews and collaborating from their homes. Michele Wiener, Partner in Control Risks’ Compliance, Investigations and Technology practice in the Americas region, and Michael Zimmern, Partner in Control Risks’ London office, address best practices and lessons learned for investigations to prepare for whatever the future may hold.
The full on-demand webcast can be found here:
Excerpts from Data Privacy: Where Are We Now? Plus, CCPA Updates and Impacts