How to Mitigate Healthcare Costs for Employees with Chronic Conditions

How to Mitigate Healthcare Costs for Employees with Chronic Conditions


Managing a chronic illness or condition can be costly, there are options and benefits from different health insurances that can help.

How to Mitigate Healthcare Costs for Employees with Chronic Conditions.

 

Many employees on corporate health plans rarely use their benefits.  Other unfortunate individuals, however, suffer from chronic illnesses like diabetes, heart disease, or Lupus, and tell a different story.  The health plan these employees utilize can mean the difference between living life to its fullest or just muddling along, or worse! It can also mean the difference between financial solvency or medical bankruptcy.

For employees managing a chronic illness on a traditional BUCAH (Blues, United, Cigna, Aetna, and Humana) health plan, the biggest concern likely becomes the Out-of-Pocket Maximum (OPM) exposure, because they will most likely hit it each year, up to a maximum of $8,700 in 2022. This happens because they have no one in their corner ensuring that they are getting the right quality are, at the right place, at the right time, and lastly, at the right price and because of rising deductibles, copays and coinsurance calculated off egregiously inflated bills, this adds up quickly.

An employee managing a chronic illness on a Fair Cost Health Plan that Mitigate Partners constructs and oversees, however, has a whole different experience. Some of the “bricks” in the house that we build for a high-value, actively managed, employer-built health plan are the following:

Direct Primary Care (DPC) is the foundation of the plan where a member selects a DPC doctor and has 24/7 access to the services provided.  There is a true and “direct” doctor/patient relationship that is established that harkens back to Dr. Marcus Welby and the good old days. It is estimated that a DPC provider can handle 70-85% of the medical needs of any patient, including one struggling with an on-going illness that needs monitoring.

Cost and Quality Guidance and Navigation is a crucial component in managing cost and improving health outcomes for patients by making sure that if care is needed outside of the DPC model that they are pointed to providers and specialists of the highest possible quality with the best possible outcomes.  Consequently, the misdiagnosis, infection rates, readmission rates, complications and, logically, the costs, all come down when the quality of care goes up.

Pharmacy Benefit Managers (PBMs) that are transparent and pass-through will commit to “passing through” all discounts and rebates to the plan sponsor ensuring they get the best possible price on needed medications.  The DPC can also ensure on a personal level that the patient stays compliant with any prescribed and necessary medications.

Defined Benefit Pricing Strategies ensure that the employee and the plan are paying a fair and agreed upon price before the service is rendered.

Depending on the employer, other “bricks “or risk mitigation strategies might also be included, like Medical Bill Review, Direct Contracting, Active Data Mining, Telehealth, Second Opinions, Centers of Excellence, Onsite Clinics or carveouts for Joint Replacements or Transplants.  All these strategies can help alleviate the financial burden of managing a chronic illness while providing a higher quality of care and a more personalized care experience. 

 

If you would like more information on how to build a value-based, actively managed, employer-built health plan, please call Liz Antaya at (863) 397-9500 or find me on our Mitigate Partners website.

 

Liz has been in the Employee Benefits space since 2009 and has worked at Stahl & Associates Insurance, one of the largest privately held insurance agencies in the state of Florida, for the last seven years. She is NAHU Self-Funding Certified and a Certified Health Reform Specialist.  In 2021 she completed her master’s degree in Health Benefit Design and Health Informatics from the University of Lynchburg, VA.  In 2020 she became a certified Health Rosetta advisor and a member of Mitigate Partners, a Risk Management, Cost Containment, and Employee Benefits Consulting consortium made up of independent benefit advisors collaboratively solving the biggest challenges in the health care industry. 

 

To reach Liz Antaya:

Liz.Antaya@Stahlinsurance.com

(863) 606-6063 direct office line (863) 397-9500 cell

 

 

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