Look at the Drivers
Specialty drugs, large claims and utilization patterns can be managed even when the rate cannot be negotiated. A small number of members and drugs can account for a large share of cost.
Attack the drivers of cost.
A small number of members and drugs can account for a large share of cost. Understanding them opens options such as care management, pharmacy programs and stop-loss decisions.
The aim is to reduce avoidable cost without harming care.
Managing Drivers Instead of Accepting the Rate.
Cost is concentrated. A small number of members and drugs often account for a large share of spending. Looking at large claims, specialty drugs and utilization patterns tells you what is driving the increase and where management might help.
Tools differ by funding. Fully insured groups have limited control over claims but can still influence plan design, pharmacy and care management programs. Self-funded groups have more data and more levers.
Management has to respect privacy. Employers do not see names, and the focus is on categories, patterns and programs.
A few more questions.
Can high-cost claims be managed?
Often in part, through care management and programs, though some costs cannot be avoided.
Does this apply to small groups?
To a degree. Small groups have less data but can still review plan design and pharmacy.
What kinds of programs help?
Care management, pharmacy programs, centers of excellence and navigation are common examples. Suitability depends on your group.
Do small groups have the same options?
Fewer, but plan design and pharmacy can still help.
How do we see claims without seeing people?
Reports are aggregated and de-identified, and privacy rules apply.
Related guides.
Employee Benefits Strategy Consulting in Michigan
Funding, contributions, vendors and compliance.
Look Ahead
A multi-year plan reduces the odds of repeating the same difficult renewal.
Can you help if our renewal is flat and there are no savings?
Yes. We look at contribution design, plan design, pharmacy and vendor terms, and multi-year planning rather than rate alone.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program: cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →