Today’s business climate has drastically changed and there is no longer “business as usual.” We are inundated with information, and cutting-edge technology and innovations are becoming available more quickly than ever. It’s no longer considered an add-on or bonus to offer creative options and strategic solutions. They are a requirement to keep pace in today’s environment. At L.R. Webber, we are constantly evaluating better ways to deliver value to our clients and are committed to keeping pace with your evolving needs.
Group Health Care Programs
Throughout the years, businesses and organizations have seen a seismic shift in the way health care plans are designed and priced. From the major medical plans in the 80’s, to the high deductible health plans in the early 2000’s, we have witnessed an evolution in the way employers pay for their health care programs. One of the key components to this evolution was the shift in the way we think about what causes high premium rates and what types of control measures we can implement to reduce the costs to the organization, as well as the employee.
In conjunction with several large state associations, L.R. Webber has created a number of self-funded group health care consortiums, which help association members gain control their healthcare costs.
WHAT IS A CONSORTIUM?
A consortium is joining together for the advantages of economies of scale and cost efficiencies. Each member organization can choose the benefit plan design and employee contribution structure that best suits its needs while paying its own rate. The rates are based on the organizations’ demographics and historical claims experience.
The Consortium model is a unique-funding mechanism for a health care plan. These programs permit each organization to maintain its own level of benefits, employee cost participation and plan designs. The idea is to use the self-funded model to lower administrative costs, secure exposure with a proprietary stop-loss package and gain access to the member’s specific claims data. The rates are then determined by the organization’s demographics and historical claims experience. By joining together and using the purchasing power of the participating members, we are able to provide a level of predictability that is otherwise not attainable through other health insurance options. These consortium models are run by the members, not an insurance company and not by an insurance agency. Because of this, the interests of the participating member organizations, and their employees, are evident in every decision made.
As the state of healthcare continues to change, a self-funded program will aid each organization in positioning themselves to better control long-term costs. Additionally, the sharing of “Best Practices” within the group has proven to be invaluable to all of the members. The value of these programs is based upon the collective efforts of the entire group. Every addition to the membership only reinforces the ability to tackle whatever is ahead in the health care landscape and control your own destiny.
To learn more about the associations we work with, and the benefits of the consortium model, click on the logos below…
The use of data analytics, in all facets of the business world, has become more and more prevalent over the last several years. This trend will continue to increase as organizations seek to better understand their customers and gain useful insights into consumer behaviors!
This could not be more true when it comes to employer provided health care programs. Just as retailers use data analytics to predict consumer buying habits, with the appropriate data obtained from medical and prescription claims, well designed Health Risk Assessments, detailed biometric screenings targeting certain tests, and eye exams, the use of this information can have a huge impact on claims costs in the future.
Our DataSmart Health Solutions program utilizes extensive data analytics to review provider networks and discounts, claims patterns, cost drivers and pricing opportunities to present packages to our clients that meet the goals that are desired by both the organization and its plan participants. We all want to know that we will have coverage when we need it, where we want it, with help and direction to centers of excellence for best outcomes. And, our clients want to know that they will have a say in advanced cost control methods to pay fair and reasonable charges, to know that someone is auditing the results and looking out for their best interests, and the plan will put them in a position to attract and retain top talent.
DataSmart Solutions represents the best choice in data warehousing and analytics. We have more experience in healthcare-facing data warehousing, higher-powered predictive analytics, superior industry resources, and a proven track record of saving our clients' customers more money than our competitors. In short, we can give you a significant competitive advantage in your own market place.
For more information regarding this progressive data analytics tool, go to https://thinkdatasmart.com
DATASMART Health Solutions gives companies a smarter way to provide healthcare coverage through technology. Employers spend $1.2 trillion on health benefits for over 155 million workers, making them the best partner in the pursuit of better healthcare.
DATASMART Health Solutions starts by looking at historical data. We run these data through the DataSmart Solutions proprietary analytics Engine. Our care management team reviews the results. With these results, decisions can be made about health, interventions, and suggested actions to build healthier lives in plan members. Over time additional data from claims, wellness, and treatment & care is then fed back into the analytics engine providing even better results.
With the only platform that can connect and administer an entire health benefits ecosystem — health plans, benefits programs, spending accounts, member services — DATASMART Health Solutions enables employer sponsored health plans to optimize their healthcare investment while giving employees the best coverage possible. DATASMART Health Solutions utilizes the largest independent administrator of self-funded health benefits in the country.
For more information regarding this progressive data analytics tool, go to https://datasmarthealthsolutions.com
Although we have the smartest, most qualified doctors in the world, the largest research teams ever assembled and tremendous breakthroughs in disease detection and prevention, problems still exist when it comes to day to day primary physician care. Consumers are experiencing expensive, unexpected bills, distrust in their doctors, overcrowded waiting rooms and fear of procedures and bad news. What if there was an alternative that would:
- Focus on the patient
- Center on health care improvement and quality care
- Have transparency to all parties
- Lower costs to ensure that the model is sustainable
- And have care delivered in the right place, right time and right setting
Now there is! Empower3 is an innovative new model of healthcare that will change the way you experience primary care. With Empower3 you get unlimited access to your primary care physician, plus so much more…for so much less. Empower3 is a Direct Primary Care (DPC) practice, which means members pay one flat monthly fee and no insurance is involved. With this program, there are no office copays, deductibles, coinsurance, formularies and other restrictions on care. Patients simply pay a monthly membership fee.
The cornerstone to all care should start with the patient, not the insurance companies. Unfortunately, many individuals go without care just because they don’t have insurance or their deductibles and co-pays are too high. At Empower³ Center for Health, we aim to change that. By expanding access to primary care, we are offering a simpler approach to better care and the peace of mind you deserve.
To learn more about Empower3 and the locations it serves, go to https://www.empower3cfh.com.
One of the key advantages of our self-funded health care programs is our team of actuarial partners that are focused solely on risk management, optimal pricing of your plan and driving the renewal process and rates. L.R. Webber uses Contribution Health to help with the actuarial calculations and stop loss negotiation services on behalf of our consortium group participants.
The actuaries at Contribution Health negotiate a sensible risk management strategy for your self-funded benefit plan by addressing the core principle of appropriate spread of risk. Does your current insurance company have a risk management philosophy? Sure. Their philosophy is to manage their risk, not the employer's. They are overloaded with underwriters to make sure they screen for groups that don’t threaten company profits and offer their best prices to groups most likely not to need insurance. When a group of employees is no longer a good risk for the insurance company, watch out, the employer won’t be treated well.
Their philosophy is to manage the self-funded risk of employers. What the employer needs is entirely different from what the insurance company needs. Employers need insurance when they need it. Employers need stable year-to-year costs. When there is an occasional bad year or catastrophic claim, employers ought to be treated fairly and with respect and be in a risk pool that is willing to share the risk.
Rick Burd is the chief actuary at Contribution Health. He has 40 years of diversified experience in both insured and self-funded business models. Mr. Burd's expertise is in the area of the mathematics and underwriting of group insurance programs, including pricing, trend analysis, claim modeling and projections, demographics, credibility and statistical concepts. He is a Fellow of the Society of Actuaries (FSA) and a Member of the American Academy of Actuaries (MAAA). As an insurance company executive, he has managed underwriting, product development, and actuarial departments, and has served as Chief Actuary of a regional group insurance company.
He specializes in small and mid-size group rating and underwriting and has worked in the brokerage sector, representing hundreds of employers in their purchase of stop loss programs. Using his prior expertise in small group risk management, particular success was achieved developing unique methodologies that allowed transition of small fully insured employers into self-funded risk pools. Mr. Burd is widely known in stop loss circles and has been published in the Self Insurer, the magazine of the Self Insurance Institute of America.
For more information about Contribution Health, you can find them on the web at http://contributionhealth.com.
L.R. Webber has been collaborating with Benecon on several state association healthcare consortiums since 2007. The Benecon Group specializes in developing innovative and effective employee benefit solutions for companies, governments, and non-profit cooperatives. Their mission is to help employers effectively control benefit plan expenditures and design programs that meet the strategic needs of the employer and the personal needs of the employees.
L.R. Webber relies on the Benecon’s quantifiable models and analytic tools that can result in real cost savings and value enhancements for our clients, including:
- Consortium development
- Rate Development
- Actuarial analysis
- Funding Development
Benecon has been building purchasing cooperatives for over 25 years and currently manage 13 public and private group cooperatives. They currently employ over 100 employees, and their team consists of former corporate benefit managers, municipality managers, insurance company executives, credentialed actuaries, employee benefits attorneys, and seasoned consultants.To learn more about Benecon visit their website at www.benecon.com.