C1: Identifying Objectives

Some of the most common objectives we find when employers are looking to change or improve their healthcare benefits; Lower Costs, Better Benefits, Choices for Employees, Increase Employee Awareness, and Employees having a Financial Stake in their Healthcare Decisions.  Keeping costs lower is not just a benefit but a by product of a market based approach to healthcare, and Consumer Driven Healthcare programs are at the center of a market based approach.  Individual consumers understand that you might need to finance a new kitchen but not a hamburger.  In healthcare terms consumers will learn that the equivalent is using health insurance to pay for a broken arm or pneumonia, but not the flu.  Another cost savings to be realized is through shopping for services.  Calling different retailers to purchase a flat screen TV is the same process used to purchase an MRI, call Radiology companies and get the best price.

C2: Insurance Plan Selection

Selecting a health insurance plan sometimes seems more difficult than purchasing a car.  There are many insurance companies with many options and variables and connecting the specifics together so that the result is a health insurance plan that meets your needs is a tremendous effort for the layman.  One of the variables is that the health insurance plan must be an HRA or HSA qualified plan.  Once that component is complete it is now time to design the specifics of your HRA or HSA Consumer Driven Healthcare Plan.

C3: CDHP Design

A little history of when Consumer Driven Healthcare Plans first became available: in 1978 Flexible Spending Accounts (FSA – Use it or Lose it) appeared, in 1997 Medical Savings Accounts, in 2002 Health Reimbursement Accounts, and in 2005 Health Savings Accounts appeared as the most recent improvement.  Each fall under IRS Regulations and only two of the four give consumers the flexibility they need to be able to control their own health insurance costs.  Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA) are considered the only two plans that can modify peoples behavior.  Behavior modification is the only way consumers will be able to reduce the cost of their own healthcare; they will do this by being educated on how their reimbursements are received, how their employers’ contributions are applied and through shopping for services, medications, and providers.

C4: Third Party Administrator Selection

Benefits Matrix works with the top Third Party Administrators as determined by experience and time in the industry.  There are many third party administrators and one of our requirements for a TPA to be recommended is that they have been working HRA administration for many years.  Third Party Administrators are the organizations who take the employee phone calls, receive claims, process and issue reimbursements.  Their systems are established to accomplish tasks that are specific to certain health insurance plans, so the goal is to find and match a TPA to your specific Consumer Driven Healthcare Plan Design.  That is our job and what we do.

C5: Employee Education

Changing buying habits is the result of educating employees about their healthcare plans.  People do not like to change, no argument. People will change though, given enough pain people will move away from the source of the pain.  Financial pain is a motivator and the healthcare industry has caused enough financial pain to last a lifetime, combine the financial pain with the horribly frustrating quality of service and you now have an employee proactively looking for a solution.

When you tell an employee that they can spend their CDHP money at any pharmacy, or doctors’ office that gives them the best service and price, they will apply their shopping skills to their healthcare purchases.  They will be shopping for both quality of service and price, the best overall value!