Network selection may be the most overlooked area of cost savings in the healthcare benefits industry. Our executives analyze reports that determine where a given employer’s participants are spending their dollars. For example, which hospitals and physicians are most sought after for a given group? Using historical data, our experts match up the specific group to the best networks offering the richest discounts for those particular hospitals and/or physicians. Our teams can also negotiate direct hospital contacts in certain cases. Network selection and negotiated discounts at the network level can play a huge role, if not the most significant role, in overall plan costs. Our customized network analysis and selection process sets our network analysts and negotiation teams apart from the majority of the market.
Plan Design Evaluation
Our proprietary predictive modeling technology, designed by internal teams of actuaries, allow employers to “try on” a variety of plan designs and know the immediate and long-term financial impact of making any plan design change. Most often, our teams are dedicated to evaluating plan design options with the current vendors where the client satisfaction has been strong with the incumbent carriers or vendors. Our philosophy is not to promote change for the sake of change, but rather change focused only around what is not working or that which places the program closer to meeting the employer and participant priorities.
PremierSource aggressively and proactively negotiates on behalf of its clients. Because of our collective volume and unique business model, we have pre-negotiated preferred arrangements with more than 30 major vendors in the healthcare industry. In addition, on a case-by-case basis, we negotiate with underwriters to reduce premiums based on specific claims information and quantifiable, predictive outcomes. Our pool of staff underwriters have been in the business of underwriting for most of the major providers at one point or another and know how to work the underwriting process in favor of the employer.
Vendor Review and Possible Replacement
If a plan experiences high claims within the year, premiums may be subject to an increase based on the claims. We sometimes find this happens even when the claims are temporary in nature (e.g. pregnancies). While we always like to work with the incumbent carrier whenever possible, in these cases, it sometimes makes sense to renegotiate with the vendor once the temporary claims are complete so that the claims volume for those temporary situations doesn’t affect the long-term pricing for the entire plan. Also, in the fully-insured business, carriers tend to come in and out of favor depending on the claims experience of their collective pools. Replacing a vendor can sometimes mean relieving a client from subsidizing other groups in the pool and bringing in a carrier with a more favorable claims trend to manage premiums.
Out of Network Claims Negotiations
PremierSource not only customizes the network selection strategy, but also customizes the out-of-network negotiation process. When claims fall out of network, PremierSource brings resources to the table to negotiate those claims with the hospitals to get the claims discounted.
Unbundling the Components
Evaluating the various components of a self-funded program independently can sometimes lead to greater efficiencies. For example, the provider with the best network discounts may not be the provider with the best prescription benefit management program or the most aggressive reinsurance negotiator, and so on. Our approach is to evaluate these components separately, then bundled, to determine the most cost-effective and highest quality solutions overall.
Active Prescription Benefit Management
Our preferred prescription benefit management programs are actively managed, meaning that the prescription claims of the plan are closely monitored on a routine basis to determine whether there is abuse of name brand drug selection, heavy concentration of particular drugs that are driving the costs up, etc. For self-funded plans, our providers offer customized solutions around the specific experience and trends of each employer group. Our consultants sit on national advisory panels with many of the fully-insured providers and are able to influence change where needed on this component as well.
When a client selects PremierSource, they get the added value and depth of expertise of the employee benefit attorneys in our model. Clients often prefer a second opinion relative to ordinary legal and regulatory matters. Our model brings this added support system without the added cost of traditional models.
As a provider of employee benefit services, we believe it is our role not only to assist you with your employee benefit needs, but also to actively promote informed decision-making on the part of the participant. We take a proactive approach to helping your Human Resources group educate and inform participants on ways to control drug costs, utilization, and maximize the value of their employee welfare plan. We have developed interactive employee education programs that reinforce the long-term value of employee participation in your group’s customized plan.
Our model further includes a communications group that focuses exclusively on the development and design of tailored materials for our clients. Whether you are implementing a disease management program, communicating the value of an HSA, or simply preparing your Summary Plan Descriptions, our communication teams stand ready to assist in the development of effective communication program design and strategy. This resource offers tailored payroll stuffers to communicate important messages to employees and includes fully-customized materials in both English and Spanish.