HR leaders will face big challenges in the year ahead — including, another year of rising health plan costs and worsening population health. To understand how HR plans to move forward and what support they’re receiving from insurers and plan administrators, Maestro...
Featured in HR.com: How HR can make employee health plans more people-focused
By Anne Brunson, Vice President of Service Operations
Originally featured in HR.com.
HR faces the same situation time and time again: an employee comes to them with a benefits question or issue. Sometimes, HR has the answers and sometimes they don’t. And unfortunately, it’s affecting employee engagement. In fact, a recent survey from Maestro Health found that 39% of workers don’t feel well-supported with resources or know where to go to find information about healthcare.
The reality is that many HR teams are vastly under-supported and struggle to manage their ever-growing responsibilities, including the management of healthcare plans. But with the right health plan administrator, HR can get the support and resources needed to administer a suitable healthcare plan for their employees.
To find the right health plan administrator, HR leaders should look at what a vendor can bring to the table as a partner for both the employer and the employee.
Better Data and Support.
Good healthcare plan administrators can support HR teams and their brokers with access to insights like health claims and plan data. These valuable data sources enable HR teams, along with their brokers, to build an organizational health plan that helps their company’s bottom line and meets the needs of its employees. For example, if an employer has access to demographic risk analytics of its employee population, they can better design a plan that provides care and resources for these risks at an affordable rate.
A good health plan administrator should also offer administrative services that go beyond basic needs to help HR teams manage the logistics of their organizations’ healthcare plans. Look for services like:
- Personalized health plan member engagement resources
- Customizable dashboards and data analytics tools
- Online benefits portals and mobile applications
Without these informative employee education materials or an easy avenue to ask questions, managing a health plan can be a time-consuming and burdensome process for HR to handle. As a result, employees turn to HR for questions about their healthcare plan — a substantial undertaking given how difficult the system is to navigate. And when HR teams don’t always have the answer at hand, employees end up lost in their search for answers.
Finding the Right Partner.
Some organizations currently work with a traditional carrier administrator through a fully-funded health plan — a plan where employers pay a premium to an insurance carrier to offer health insurance to employees. However, these fully-funded plans and their administrative services often leave complex healthcare puzzles for HR teams to constantly solve and interpret to employees without any support or guidance from the plan.
An alternative health plan option is a self-funded benefits plan — a plan that is run and funded by the employer. A self-funded health plan affords employers more flexibility and transparency about the plan, from costs to utilization. These plans are also often handled by a self-funded third-party administrator (TPA) to ensure benefits administration runs smoothly and to ease the management responsibilities on HR.
If your current plan doesn’t offer the support HR or employees need to understand their benefits, then a self-funded plan with a TPA could provide you with a better experience. By asking potential self-funded TPA vendors the right questions, you can find a partner that will take the burden of plan management off HR and help your team better support employees’ wellbeing.
Three Questions You Should Ask a Potential TPA Partner.
1. How do you help me understand my data?
The most effective healthcare plans are those that address the needs of their members. Without health claims data, employers are essentially building a plan that may neglect specific employee member considerations.
Find a self-funded TPA that gives access to this data free of charge and helps you analyze it. Insights such as utilization metrics can enable you to tailor your organization’s plan to meet the needs of the employee member population. Data on high-cost members and potentially avoidable ER visits and hospital admissions can help HR teams educate members on how to find more affordable care options in their plan.
2. What level of administrative support is offered?
The more personal and human a vendor’s services are, the better. A good vendor should enable HR teams to focus on their employees rather than the tedious administrative work required to manage a healthcare plan.
Consider partners that offer a dedicated client experience manager to act as your health plan concierge for potential needs and questions that arise. Ask if the vendor can completely offload time-consuming tasks like open enrollment, coordination of benefits and claims processing so you can focus on the people at your company. Look at the accessibility of their customer service to determine if it’s easy for members to ask questions about their plan.
3. What is your member engagement strategy?
Informative, easy-to-access materials and user-friendly tools help demystify benefits and keep plan members engaged with their healthcare plan. Identify a partner that possesses engagement materials you can distribute to plan members for educational purposes.
Some self-funded TPAs also offer member education websites and mobile apps that provide plan members a single resource to access health plan information, their benefits portal and more.
Our country’s healthcare system may be broken and difficult to understand, but HR leaders can piece it together for employees with the right self-funded TPA. Ask the necessary questions to find the best partner for your organization and set up your healthcare plan to do what it should — take care of people.
