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Health Benefits for Hospitals and Health Systems: Five Things Brokers Should Know (California Broker Magazine)

BY KERI DIXON

HOSPITALS AND HEALTH SYSTEMS provide care for the sick and injured, but they’re also employers—some of which are quite large, operating with thousands of employees. As such, they also need health coverage for their own staff.

For brokers, this represents a significant opportunity. In California, there are approximately 400 hospital and health systems bringing in well over $500 billion in revenue. Across the nation, there are more than 6,000 hospitals and health systems with revenues exceeding $3 trillion.

Similar to other types of employers, hospitals and health systems want to provide their employees with a competitive health benefits package, while at the same time controlling their health spend, fostering satisfaction among members, and improving future plan performance.

Due to the nature of these organizations—that they’re directly involved in the provision of care—they have unique needs around their plan design. Brokers should become acquainted with these requirements in order to better serve this market with appropriate programs and  solutions.

1. DOMESTIC NETWORK: PART OF A MULTI-TIERED APPROACH

Unlike other types of employers, hospitals and health systems have their own physicians, clinical staff and facilities. As such, they often want to form their own domestic network. By promoting utilization of these domestic providers, hospitals and health systems can save significant costs and can better manage the  health of their own employees. In addition, payments made on employee health services then go to supporting their own organization rather than a competitor.

However, because hospitals and health systems want to offer their employees a broad selection and choice of providers, they will usually offer their own domestic network as part of a multi-tiered approach. This allows employees the option to seek care outside the domestic network, as long as they’re willing to pay a higher tier-2 rate. This type of plan design—along with a strategically structured network, financial incentives, and member  education—can steer a majority of members, as much as 80%, into the domestic network.

2. CUSTOMIZED REIMBURSEMENT

Hospitals and health systems also want the flexibility to establish their own domestic reimbursement model. This allows them to have more control over the costs of their plan and the amount they pay their internal providers. The plan administrator should be able to coordinate a variety of payment methods, with the most common being a percentage of billed charges.

In addition, hospitals and health systems typically want payments to its providers and facilities to be withheld to maintain their cash on hand. In other words, their funds aren’t tied up in claims processing, but the transactions are still captured for data analysis.

3. THE IMPORTANCE OF MEMBER EXPERIENCE

As brokers know, it’s important to get members to play an active role in their own health. Engaged members are more likely to understand and use their benefits, especially preventive services. This is particularly important for healthcare workers, who know a great deal about health and wellness, but since they’re often busy caring for others, they may not prioritize their own health. A plan administrator—with seasoned care coordinators—can help by putting an emphasis on fully taking advantage of the health benefits provided to them by their employer.

In addition, member engagement must be personalized through a combination of high touch and high tech. In regard to “high touch,” care coordinators must have a deep understanding of the organization’s health plan and domestic network so they can accurately answer members’ questions. On the high-tech end, using data and analytics, plan administrators can target specific members, such as those diagnosed with a particular condition like diabetes, to receive reminders to schedule important services, such as regular HbA1c testing.

If a new plan is being implemented, the plan administrator should provide a member communications playbook with a timeline of touchpoints to engage members from the start. For some hospitals and health systems, a majority of touchpoints will be digital (e.g. customized landing pages and online plan comparison tools). For  others, employees might be better served with print resources, in-person health fairs or teleseminars. No matter what the medium, resources should break down coverage options into easy-to-understand language and consolidate information, so members can find everything they need through a single source, rather than sifting through various documents.

4. COMPREHENSIVE CARE MANAGEMENT TO HELP CONTROL COSTS

Hospitals and health systems also want comprehensive care management to help control costs and improve health outcomes. Care management includes utilization review, case management, disease management, prenatal and other targeted programs.  Hospitals and health systems that have leveraged these types of programs have seen a relatively low healthcare cost trend of 1.9% over a three-year period. By comparison, the industry average increased by 5.8% over the same span of time.

In some cases, hospitals and health systems may prefer to facilitate a ‘hybrid’ care  management model, where the health plan must  collaborate with their own staff. For instance, a hospital may want their health plan to work hand in hand with their  medical director to oversee the utilization review and pre-certification process.

5. SOPHISTICATED DATA ANALYTICS

If data tells a story, then analytics is the mechanism to tell it. In the past, hospitals sorted through piles of static reports. Today, they can tap into real-time data and visualize how their health plan is performing. For example, dynamic dashboards can display key performance indicators (KPIs)—such as total claims spend and out-of-network utilization—all in one convenient snapshot.

In addition to cost drivers, dashboards help hospitals and health systems understand utilization trends, domestic steerage and gaps in care. As such, brokers must ensure that their hospital and health system customers have access to a comprehensive analytics solution. This will enable them to see what’s going on within their health plans, and they can take steps to achieve additional savings and value from their programs.

An innovative mindset

Hospitals and health systems need creative, out-of-the-box solutions to address today’s most complex health challenges. Brokers can bring knowledge of the five factors above to optimize their customer’s plan design, facilitate a white-glove member experience and develop effective cost containment measures.

As discussed, analytics is a vital tool in monitoring performance, addressing gaps in care and targeting high cost areas. In addition, the technology supporting these health plans must be flexible enough to accommodate customizations and “plug and play” integration with other vendors, such as a pharmacy benefits managers or other care management programs. Hospitals and health systems want their members to also have access to high-tech tools, such as online portals and mobile apps, to engage with their benefits. Together, these capabilities foster a recipe for success at every level.

Chad Harris

Chief Executive Officer

 

Chad Harris serves as the CEO of HealthComp and is a value-driven healthcare leader with over twenty years of experience running business process and information technology businesses as a senior executive. Chad has a reputation for creating and controlling rapid growth by focusing on the intersection of customers, market dynamics, and the new digital world.

 

Chad has held many senior executive positions and led global teams of more than 10,000 people across dozens of counties. Chad has grown both large and small businesses, from those with less than $100M of revenue to those producing multiple billions of revenue, focusing on delivery, customer satisfaction, and innovation to create market leadership.

 

Chad's philosophy is to inspire change by doing what comes naturally, putting the needs of others before his own, working incredibly hard, and focusing on "how" to accomplish things, never "if they can be accomplished."

Thomas Martel

Chief Growth Officer

 

Tom serves as the Chief Growth Officer at HealthComp. In this role, Tom focuses on strategic initiatives aimed at accelerating HealthComp’s growth nationwide. His passion lies in assessing market and enterprise structures and creating efficiencies that enable teams to deliver best-in-class performance.

 

Previously, Tom led Cigna’s largest employer segment, largest region which was comprised of several health plans including the two largest health plans. He worked closely with Market Presidents and their leadership teams to develop and execute local market strategy and deliver growth for the enterprise. Tom earned his degree from Saint Anselm College and holds certifications from The Wharton School and the Darden School of Business at the University of Virginia. In his spare time, he enjoys sailing and holds a Master Captain’s license with the U.S. Coast Guard. He is also active in community outreach programs including local food bank and shelter services.

Sanoj Balakrishnan

Chief Technology Officer

 

Sanoj Balakrishnan serves as the Chief Technology Officer at HealthComp. In this role, he oversees the company’s overall technology strategy and architecture, building secure and highly scalable distributed systems.

 

Most recently, Sanoj served as Head of Healthcare Digital Business and Technology at Cognizant, working with payers and providers in developing solutions that reduced healthcare costs and provided a best-in-class experience for members. Earlier in his career, he worked at technology organizations in a variety of software engineering and architecture roles. Sanoj earned his B.S. from University of Mumbai and Computer Systems Management from National Institute of Information Technology.

Justin Tran

Executive Vice President, Product

 

Justin serves as the Executive Vice President of Product at HealthComp. He has 8 years of experience in developing and delivering solutions that reduce health care costs, improve quality, and provide a best-in-class experience for members. Most recently, Justin was an Associate Partner and business unit leader at McKinsey & Company where he helped large carriers and healthcare technology companies build new clinical services and solutions for fraud, waste, and abuse. Justin earned his B.S. in Accounting and Data Informatics from Indiana University, Bloomington.

Tucker Stein

Chief Financial Officer

 

Tucker serves as the Chief Financial Officer of HealthComp. Tucker previously worked for The Boeing Company in a number of finance and strategy roles, most recently as a finance lead for the Transactions and New Business Development group. In this role, Tucker led investments and strategic partnerships for Boeing’s Space and Communications portfolio. Tucker earned his MBA at Stanford’s Graduate School of Business and his Bachelors of Science at the University of Redlands.

Tom Georgouses

General Counsel

 

Tom is involved in multiple areas of HealthComp including Operations, Compliance and Legal Affairs. Tom was admitted to the California Bar in 1990 and started his legal career with Stammer, McKnight, Barnum and Bailey, LLP. When he left the firm to join HealthComp in 2014, he was the Managing Partner (he had represented HealthComp since 2003). In private practice, Tom’s areas of focus included healthcare and transactional work. Tom holds a Bachelor of Science Degree in Business Administration-Finance from California State University Fresno and received his Juris Doctorate from San Joaquin College of Law.

Rishab Bansal

Chief Transformation & Operations Officer

 

Rishab serves as the Chief Transformation & Operating Officer at HealthComp. Rishab focuses on transforming and modernizing HealthComp’s operations to provide delightful and distinctive experiences to its members, providers, and clients. His agenda includes integrating all entities towards a One HealthComp vision, driving profitable growth, and delivering value and business outcomes.

 

In his former work over the last 2 decades, he has helped clients across industries to transform themselves by bringing industry-leading practices and digital and data-led disruption. As the trusted advisor to the C-suite, Rishab helped his clients leapfrog on their transformation journey to accelerate business outcomes and helped them unlock new opportunities to drive profitable growth, profitability, and enhanced experience for their employees and clients.


Elaine Davis

Chief Human Resources Officer

 

Elaine Davis serves as CHRO for HealthComp. Elaine previously served as CHRO for Continuum Global Solutions and has served in executive leadership positions for Xerox and GlaxoSmithKline. Elaine holds Bachelor’s and Master’s degrees from the University of California at Berkeley.