You are currently viewing A Shift in Mindset may be all that is standing between your Company and a High-Performance Health Plan

Top performing executives including HR Directors have one thing in common, they are growth minded.  They understand the value of tomorrow and the opinions of the other growth minded people around them.  We’ve all heard the expression if your not growing you’re dying.  Like a great chess player these growth minded leaders are usually thinking 10 moves ahead.  This is the quality and the value that they bring to their organizations; it’s the reason they got to the top and stay on top.  They ask ‘Why’?  They do not simply accept that something is the way it is, they ask why it is that way and can it be better?  Can it be better?

As a benefits advisor, this is the question we ask of our prospects and clients.  Can it be better?  Far too often, even the most extreme ‘growth’ minded benefit decision makers are ‘fixed’ minded on their companies group health insurance plan.  Why is this?  Why would the quality that makes these great leaders so successful not follow them and their companies into one of the costliest items within their organizations.  Why would they throw everything out the window when it comes to the most important benefit they include in their total rewards?  A benefit that touches the lives of the greatest asset and their families?

Could it be that they do not ask ‘why” because they have been conditioned not to?  Is it possible that these growth focused giants simply take a pass on tackling the health insurance spend at their organizations because it has eluded them for so long that they have thrown in the flag?

I think there might be something to this.  Winners like winning and when the chances of winning are minute only the best of the best continue to move forward.  Managed Care changed the landscape of group health insurance plans.  Since the early 90’s employers have been trained in the art of ‘the renewal”, HIPAA and cost shifting.  I believe these three items account for even the most growth minded leaders becoming fixed minded when it comes to benefits.

The Renewal – Most employers pay next to no attention to their health plan nine months of the year.  It’s only on their radar from 60-90 days prior to the renewal until just after open enrollment is complete.  They expect no actionable data during the course of the plan year.  Many never get any meaningful data and when they do it is simply to justify the rate action of their carrier.  The renewal takes their eye off of the ball.

HIPAA – The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.  Many employers feel that HIPAA precludes them from receiving any meaningful data from their health insurance carrier.  For this reason many employers never ask for any information to support the carrier renewals. They do not questions large claims and avoid asking employees to answer health questions even if they are necessary to shop for competitive stop loss, pharmacy pricing or enhanced medical management; all of which could help the employer and their members better control costs and enhance coverage’s.

Cost-shifting – this occurs after the employer has secured the best renewal option from the incumbent carrier.  Underwriters at insurance carriers are expert negotiators.  They never show their hand too early and always lead with a negotiable first offer.  It makes the benefit team feel like they are in control of the situation.  Once the best offer is had there is generally an option to further reduce the rates by increasing member out-of-pocket costs.  Here’s the problem, after 20 years of cost-shifting many employers have reached the ceiling on out-of-pocket costs.  Many have HSA compatible health plans with first dollar deductibles of $5,000 or more.  Even those with richer benefits may not have benefits that make them attractive to the ideal candidate.  When no further plan changes are feasible, they only other way to cost shift is to increase member share of premiums.  This can also price them out of the market for talent.

The point is the renewal, HIPAA and cost-shifting gave even the most growth minded leaders a way out.  Rather than ask ‘Why” and demand more, they simply pass it on and do what they have already done.  Here’s the problem, the consumer has finally figured out that health care and health insurance are’t broken after all.  Benefit experts and the 2% growth minded leaders that stayed the course can now lift the hood on your companies health plan, provide actionable data and control costs & improve outcomes with enhanced benefits.  It turns out that over-utilization wasn’t the problem after all. The problem is the prices.  For too long when employers caught on to the game, the rules where changed.  They couldn’t see behind the curtain so they just assumed health insurance couldn’t be fixed.  I am here to tell you it’s time to start asking “why”?  If you ask the right advisors you’ll get a brand new perspective and be re-energized.  It’s time to get back in to the fight.