For most employers, the decision to build high-performance health plans almost always starts with a fundamental mindset shift of questioning the norm. If you routinely ask yourself why procuring healthcare benefits for employees follows no other logical purchasing model that you adhere to in your business, then you’ve likely embarked on a mindset shift. Employers need to understand what’s hidden in plain sight by those who benefit from “the way it’s always been done.”
There is no better example of health insurance winners and losers than what has happened over the last decade. Let’s look at a few stats. Since 2010, when the Affordable Care Act (ACA) was passed, profits and shareholder gains for companies like United Healthcare (UHC) have increased exponentially. UHC is not alone; the profits of the big six insurers (Anthem, Centene, Cigna, CVS/Aetna, Humana, and UHC) have soared along with their revenues. In 2021, they made $60.7 billion in profits collectively, compared to $16.9 billion in 2010.
And then there are the prescriptions. The big three pharmacy benefit managers (PBM’s) of the big six insurance companies (CVS/Aetna, Optum/UHC, and ESI/Cigna) now manage nearly 80% of the national PBM market and generate more profits than their health plan businesses.
All in all, a dismal state of affairs for sure. Insurance company profits grow exponentially while access to care and health outcomes plummet. Shareholders gain, and we lose.
At BCF Group, we work tirelessly to help employers create a new healthcare purchasing model. As a Health Rosetta Advisory firm, we use various tools to effect a much more positive outcome. One such tool is Health Rosetta’s LOCAL 5-step continuum to help our clients build high-performance health plans.
Step 1 is “L” for LEARN.
Learn how to be liberated from the status quo. How do employers become liberated from the status quo? Having walked this path with many local employers, we believe it’s a combination of education, hope, courage, and a proven Guide Path.
Education
If reading about the power, greed, and influence that health insurance companies and PBMs exert on consumers makes you a bit unsettled, especially considering your year-over-year renewal increases, then you may want to consider adopting a high-performance health plan. Education is not only about unshrouding the hidden revenue streams and egregious self-serving policies within the healthcare industry, it’s also about learning how other companies purchase healthcare differently. How they have regained the control they lost over their own finances to chart a new, more sensible way forward.
Hope
Once you meet the pioneers from around the country—and from your own community—who are successfully bucking the system, you can’t help but be instilled with hope. Hope that sanity can be restored. When hopelessness falls away, you become empowered, and you begin to see the possibilities. Hope and optimism are necessary realizations that help employers become “unstuck” on their journey to a better way.
Courage
Courage cannot be underestimated as a fundamental tenet for anyone who decides to challenge a $4.3 trillion industry that accounts for 18.3% of the U.S. Gross Domestic Product (GDP). Yes, health insurance is the proverbial 800 lb. gorilla, but for most high-performance plans, and the employers who manage them, it’s all about doing what’s right for employees and their families to preserve access to high-quality healthcare at a reasonable cost.
The Guide Path or BCF Group Playbook
We include using Health Rosetta’s LOCAL 5-step continuum and any number of our own “go-to” cost-saving solutions that have been vetted over time. The BCF Group Playbook avails proven cost-saving interventions that help employers reduce member and plan costs.
For example, in today’s world most health plans report that specialty medications are a significant cost driver. To effectively manage this risk, self-funded health plans must maintain a specialty medication strategy. However, in doing this, experience and a deep understanding of the options are essential. Legal dispositions, court cases, big pharma, and nuanced PBM solutions bring forth a dizzying array of important considerations. Our recommendation is to use experienced advisors to navigate this exceedingly complex space.
To learn more about charting a new path, we encourage you to continue reading our Healthcare Done Differently blog series. Next, we’ll dive into the “O” for OPTIMIZE health plan Infrastructure within Health Rosetta’s LOCAL 5-step continuum and touch on another go-to cost-savings solution from the BCF Group Playbook.
Acknowledgments:
HEALTH CARE un-covered, Wendell Potter, April 4, 2022, A decade-long look at how Big Insurance profiteers American taxpayers and the sick.
CMS.gov The National Health Expenditure