Highlights
- Rising healthcare costs are straining small and midsize businesses, with family coverage premiums up 20% in just five years.
- You can take control of these expenses through cost containment strategies and maintain affordable insurance premiums for you and your employees.
- Reviewing your claims data and using pass-through Pharmacy Benefit Managers can lower healthcare costs.
- Strategies like consumer-directed health plans, such as HSAs and FSAs, give employees more control over healthcare spending while lowering premiums.
- Using out-of-the-box solutions like telemedicine, employee well-being programs, and joining a self-funded group captive can help your business maintain low premiums during inflation.
Navigating the financial challenges of running a small or medium-sized business (SMB) has become difficult in the face of rising inflation. Providing quality health insurance to your employees has become increasingly difficult as the cost of health insurance premiums keeps climbing.
Inflation is one of many reasons why health insurance keeps getting more expensive. American families, as well as employers, are having difficulty keeping up with escalating premiums.
The average premium for family coverage has soared by 20% over the last five years and 43% over the last decade. By adopting strategies commonly used in self-funding models, you can gain control and achieve affordable insurance premiums, providing a better life for your employees.
Regularly Review Your Claims Data
With a traditional fully insured plan, you might feel like you’re flying blind when it comes to understanding your premiums. But with a self-funded approach to health insurance, you get to be the co-pilot. Self-funding allows you to regularly review your claims data with the help of your benefits advisor and data analytics tools to gain valuable insights into where your money is going.
This helps you spot trends in coverage uses and enact proactive changes — like negotiating better contract terms or fine-tuning your coverage — to keep your insurance costs in check, even in a challenging economic environment.
Adopt a Consumer-Directed Health Plan
Consumer-Directed Health Plans (CDHPs) are an excellent way to give your employees more control over their healthcare spending while also lowering your overall insurance costs. This approach pairs well with self-funding, giving you and your employees more flexibility and choice.
Health Reimbursement Arrangement (HRA)
An HRA is an employer-funded account that employees can use to pay for qualified medical expenses. By adopting an HRA, you control how much goes in, and unused funds can often be rolled over, offering an incentive for more mindful spending on healthcare.
Health Savings Account (HSA)
An HSA allows employees to contribute pre-tax dollars to an account earmarked for qualified medical expenses. The advantage here is triple-tax savings: contributions, withdrawals for medical expenses, and any interest earned are tax-free. Plus, the funds are theirs to keep, adding a layer of personal ownership. Unspent dollars in an HSA typically roll over and can be used in subsequent years.
A 2023 study found nationwide savings for those using HSAs to manage chronic conditions could equal $17.6 billion by 2025.
Flexible Spending Account (FSA)
An FSA is another pre-tax account but is typically use-it-or-lose-it within the plan year. While it doesn’t have the long-term savings potential of an HSA, it’s great for anticipated, short-term medical costs.
Encouraging employees to use FSA funds for anticipated healthcare expenses can reduce high-cost, unexpected claims and lower overall premiums.
Work With a Pass-Through Pharmacy Benefits Manager
To keep insurance premiums affordable, consider a pass-through or transparent Pharmacy Benefit Manager (PBM), which can deliver considerable savings in a self-funded health plan. Unlike traditional PBMs, who mark up drug costs and pocket the difference, a pass-through PBM charges a flat fee for services and passes the actual drug costs straight to you.
This transparency means you’re fully aware of what you’re paying for, which is often lower than with standard models. This approach aligns perfectly with a self-funded health insurance plan, giving you the control and clarity you need to manage pharmaceutical expenses effectively.
Conduct an Annual Benefits Review
Conduct an annual review of the benefits package to assess its effectiveness and make necessary adjustments. This can include renegotiating contracts with providers or switching to a different insurance carrier offering better rates.
With self-insurance, you can do even better. You have the option of ongoing review with no need to wait for annual renewal time. A self-funded health insurance plan provides flexibility. Because your company owns your claims data and directs your own benefits plan, you can review your data and make cost containment changes at any time.
Employee Education and Communication
Educate employees on how to use their benefits wisely. Regular communication about preventive care, generic drug options, and available in-network providers can lead to smarter healthcare choices and cost savings, even during times of high healthcare inflation.
If you opt to self-fund your employee insurance benefits, your employees stand to save money when you do. This represents a great opportunity for you to encourage self-advocacy among your workforce. When you educate them to be smart healthcare consumers, everyone wins.
Consider Direct Primary Care
Direct Primary Care (DPC) allows employees to pay a flat monthly or annual fee for unlimited access to a primary care physician. By encouraging early intervention and preventive care, DPC can lead to the early detection of health issues, when they’re generally less expensive to treat.
DPC often results in healthier employees who are less likely to put off seeing their doctor because of expensive copays and more likely to follow through on routine care for chronic conditions.
A DPC program can also lower overall healthcare costs by reducing the need for specialist visits.
Implement an Employee Well-Being Program
Implementing an employee well-being program can help keep your insurance premiums affordable. These programs focus on preventative healthcare and promote healthy behaviors among your team, from fitness challenges to nutritional workshops and mental health support.
The idea is simple: A healthier workforce is less likely to incur high medical costs. In a self-funded arrangement, you can customize the program to address the specific health risks driving up your claims, such as smoking cessation programs or stress management workshops.
Well-being programs can enhance employee satisfaction. They also offer SMBs a more sustainable way to manage premium costs through proactive, preventive healthcare.
Experiment With Out-of-the-Box Solutions
In an environment where every penny counts, sometimes traditional methods of controlling insurance premiums just aren’t enough. For SMBs, experimenting with out-of-the-box solutions for pharmacy spending and healthcare access can help with sustainable healthcare management.
Pharmacy Spending
Tackling the high costs of pharmaceuticals involves a multi-pronged approach. Consider implementing policies like prior authorization for prescriptions, quantity limits, and step therapy, where members must try less expensive drugs first.
Steer members towards low-cost medications by covering the full cost of generic drugs or excluding costly brand-name medications from coverage when a generic version is available. You can also explore options like mandatory mail orders for maintenance medications.
Telemedicine
Leverage telemedicine as a low-cost alternative for non-emergency care. Encourage telehealth use through reduced co-pays or other incentives to redirect less serious cases from expensive urgent care or emergency departments. This offers convenience to your employees and can contribute to significant cost savings in a self-funded health plan.
Incentives to Use Low-Cost Care
Create a rewards program that provides financial incentives for employees who choose lower-cost healthcare options, such as opting for an MRI at a freestanding radiology center over a hospital. For example, these employees may pay a lower co-pay when choosing telemedicine or a primary care visit over the ED or urgent care.
Join a Self-Funded Group Captive
Joining a self-funded group captive insurance plan is the most direct way to gain control over your healthcare costs. In this model, multiple employers pool their healthcare risks and funds, offering the advantage of risk-sharing and the customization generally reserved for self-funded plans.
A well-managed self-insured group captive plan can provide more stability and predictability in premiums, even in economic uncertainty. It gives you greater transparency into your claims data, control of your plan design, and the flexibility to implement cost containment strategies based on how your employees use their benefits.
As a pioneer in this space, Roundstone was the first to offer a group medical captive in the self-funded health insurance space. When you join a group captive with Roundstone, we guarantee you’ll save over five years, or we’ll refund the difference.
In fact, two-thirds of Roundstone customers save enough in their first four years to entirely pay for their fifth year of claims. And 100% save money, full stop.
It’s all part of our mission to provide quality, affordable healthcare and a better life for all. We have returned $72 million in unused premiums to our clients since 2003. As a member of our own group captive, we’ve kept our own premiums at the same level over the past eight years.
Imagine maintaining employee premiums at the same rate for eight years. Read our case study to see how we did it.
For organizations looking for a tried-and-true way to control healthcare costs, partnering with Roundstone could be your ticket to lower costs even during times of high inflation.
If you’re ready to take a proactive approach to affordable health insurance premiums, join the Roundstone Captive and start saving. Speak with a team member today to learn how you can take control with self-funding.
