How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty
-
Upload
epay-systems -
Category
Healthcare
-
view
32 -
download
3
Transcript of How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty
![Page 1: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/1.jpg)
How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty
FEATURING PROFESSIONAL BENEFIT ADMINISTRATORS, INC.
July 27, 2017
![Page 2: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/2.jpg)
Agenda
What We’ll Cover in Today’s Discussion
• Introductions
• What it means to be fully insured or self-funded
• How self-funding with a TPA is helping many companies deal with rising
healthcare costs (including broker fees/commissions)
• How you can control healthcare costs and put more control in the hands
of your members (even if you are already self-funded with an insurance
carrier)
2WWW.EPAYSYSTEMS.COM
![Page 3: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/3.jpg)
About the Speakers
WWW.EPAYSYSTEMS.COM 3
Webinar Host
Michelle Lanter Smith
Chief Marketing Officer
EPAY Systems
Featured Speaker
Ron Walter
Chief Executive Officer
Professional Benefit Administrators
![Page 4: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/4.jpg)
EPAY Systems Overview
CHICAGO BASED
TECH COMPANYFOUNDED 2001
SERVING HOURLY
WORKFORCE
ENVIRONMENTS
PROVIDER OF COMPLETELY UNIFIED,
FULL SERVICE HCM SOLUTIONS75,000+ WORKSITES
FREE PREMIUM CUSTOMER
SUPPORT 24 HOURS/DAY
7 DAYS/WEEK
365 DAYS/YEAR
INDUSTRY LEADER
UNIQUELY FLEXIBLE CLOUD
BASED TIME & LABOR
MANAGEMENT TECHNOLOGY
99% CUSTOMER
RETENTION
4WWW.EPAYSYSTEMS.COM
![Page 5: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/5.jpg)
Legal Disclaimer
The contents of this presentation should not be construed as legal advice or a
legal opinion on any specific facts or circumstances.
These materials are intended for general information purposes only, and you are
urged to consult a lawyer concerning your own situation and any specific legal
questions you may have.
5WWW.EPAYSYSTEMS.COM
![Page 6: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/6.jpg)
What’s the problem with group healthcare?
WWW.EPAYSYSTEMS.COM 6
![Page 7: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/7.jpg)
• The cost of health care has risen 38.3% over the last 5 years (2017 Price
Waterhouse survey)
• During this period, most companies have had pressure to hold the line on
prices or to lower them
• For most companies, cost of medical plan is 2nd or 3rd largest annual
expense
• With the uncertainty of health care reform ─ or the reform of the reform ─
what should we do?
7WWW.EPAYSYSTEMS.COM
The Current State…
![Page 8: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/8.jpg)
Poll: How much have your health insurance costs gone up in the last year?WWW.EPAYSYSTEMS.COM 8
![Page 9: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/9.jpg)
Let’s talk about the options…
WWW.EPAYSYSTEMS.COM 9
![Page 10: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/10.jpg)
Fully Insured vs. Self-Funded
FULLY INSURED
• Insurer accepts full risk
• Insurer determines reserve levels
• Insurer manages reserve capital
• Insurer retains excess reserve/capital at year’s end
• Insurer manages and oversees all services vendors
• You pay fixed premium monthly that increases at every renewal
SELF-FUNDED
• Employer accepts some risk
• Employer determines reserve levels
• Employer manages reserve capital
• Employer retains excess reserves
• Employer or TPA manages service vendors (more control over type/quality/cost of care by service vendors)
WWW.EPAYSYSTEMS.COM 10
![Page 11: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/11.jpg)
Self-Funded Options
SELF-FUNDED WITH ASO
• ASO arrangement with a carrier:
the carrier’s version of self funding
• ASO stands for Administration
Services Only
SELF-FUNDED WITH TPA
• Third Party Administrator – independent administrator
that works for the employer
• Total Plan Administration – provides all admin services
in addition to cost of claims management, claim edits
for improper billings, customer service, plan design
options, total transparency of cost.
• Transparency – disclosure of all costs - administration,
stop-loss, network access fees, commissions, claim,
discounts, subrogation savings, proper claims
administration savings, eligibility management savings.
WWW.EPAYSYSTEMS.COM 11
![Page 12: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/12.jpg)
How can you lower your healthcare costs?
WWW.EPAYSYSTEMS.COM 12
![Page 13: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/13.jpg)
• Get a way to offer meaningful
benefits in a highly-regulated
environment
• Get a way to put more financial
control in the hands of your members
Self-funding may be the answer!
13WWW.EPAYSYSTEMS.COMWWW.EPAYSYSTEMS.COM
![Page 14: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/14.jpg)
Why do more than two-thirds of all employers
choose self-funding over traditional insurance?
• The freedom to customize their health plan
• Addressing company objectives and employee
needs
• Gaining the potential for savings
• And finding ways to reduce future claim costs
14WWW.EPAYSYSTEMS.COM
![Page 15: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/15.jpg)
WWW.EPAYSYSTEMS.COM 15
How does a self-funded health plan work?
![Page 16: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/16.jpg)
16WWW.EPAYSYSTEMS.COM
Rather than funding your plan
with non-refundable
premiums, a self-funded plan
treats claims as expenses.
![Page 17: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/17.jpg)
What are the Benefits?
WWW.EPAYSYSTEMS.COM 17
• If claims are at or below anticipated levels, you immediately realize savings
• You avoid - reserves, contingency margins, insurance company profit,
advertising costs and most premium taxes
• ERISA governs all plans; self-funded plans can avoid state requirements
• You can avoid – many state and ACA-mandated coverages
• Transparency – you finally know what you are paying for in plan
administration, insurance, commission, claims
![Page 18: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/18.jpg)
The total of administrative costs,
stop loss premiums and potential
claim costs are typically no
greater than the premiums paid
to an insurance company.
18WWW.EPAYSYSTEMS.COM
![Page 19: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/19.jpg)
Stop Loss Insurance Limits Your Liability
(Your Financial Umbrella)
• Specific stop loss covers excess
individual catastrophic claims
• Aggregate stop loss covers excess
claims for the entire covered group
19WWW.EPAYSYSTEMS.COM
![Page 20: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/20.jpg)
In a fully insured plan,
premiums are held and
invested by the carrier.
WWW.EPAYSYSTEMS.COM 20
![Page 21: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/21.jpg)
In a Self-Funded Plan…
• You pay the fixed costs monthly
• The actual claim costs are paid weekly as
they come due
• You hold and invest the reserves
AND
• Service issues are usually less and easier
to resolve
21WWW.EPAYSYSTEMS.COM
![Page 22: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/22.jpg)
The maximum cost of a fully insured
plan is the total of all premiums
paid.
Fully Insured vs.
Self-Funding
WWW.EPAYSYSTEMS.COM 22
![Page 23: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/23.jpg)
In a self-funded plan, the cost equals the
sum of…
• Administrative expenses
• Stop loss premiums
• Claims charged prior to any stop loss reimbursements
• In addition, there is always a maximum claims cap
Fully Insured vs. Self-
Funding
WWW.EPAYSYSTEMS.COM 23
![Page 24: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/24.jpg)
In contrast to a fully
insured plan, a savings
will result if claims are at
or below the maximum
cost, in addition to lower
fixed costs.
![Page 25: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/25.jpg)
Case
Example:
Company
with 203
Employees
100%
Non-Refundable
Premium
$2,267,186
Fully
Insured
Partial Self-
Funding
Administration
$112,783
Stop Loss
Premiums
$464,866
Actual Claims
$1,198,548
Actual Savings
$490,989
25WWW.EPAYSYSTEMS.COM
![Page 26: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/26.jpg)
In this case, an insurance company
would have retained $1,068,638.
$112,783
$464,866
$490,989 Your Profit
$1,068,638
Partial Self-
Funding
Administration
$112,783
Stop Loss
Premiums
$464,866
Actual Claims
$1,198,548
26WWW.EPAYSYSTEMS.COM
![Page 27: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/27.jpg)
If the plan were self-funded, the
employer would pay $577,649 for fixed
expenses and fund the monthly claims
totaling $1,198,548 for the year.
Partial Self-
FundingAdministration
$112,783
Stop Loss
Premiums
$464,866
Actual Claims
$1,198,548
27WWW.EPAYSYSTEMS.COM
![Page 28: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/28.jpg)
Your Savings Belongs to You
With a self-funded
plan, you would
keep the $490,989.
28WWW.EPAYSYSTEMS.COM
![Page 29: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/29.jpg)
Reserves Remain With Your Plan
A reserve is needed to cover
claims presented for payment next
year. However, a significant reserve
has been established with these
savings, with plenty left over.
WWW.EPAYSYSTEMS.COM 29
![Page 30: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/30.jpg)
Another Benefit of
Self-Funding:
Access to valuable data on
plan utilization and claims.
WWW.EPAYSYSTEMS.COM 30
![Page 31: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/31.jpg)
Poll: What is troubling you regarding your current health insurance program?WWW.EPAYSYSTEMS.COM 31
![Page 32: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/32.jpg)
An Independent TPA will
Use Relevant
Information…
…to identify cost drivers and manage costs.
…help those with chronic health conditions
receive the on-going care they need.
WWW.EPAYSYSTEMS.COM 32
![Page 33: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/33.jpg)
Over time, self-funded
plans can help promote a
culture of wellness that
benefits members.
WWW.EPAYSYSTEMS.COM 33
![Page 34: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/34.jpg)
Once a self-funded plan is
in place, you will notice
little difference in the way
it operates.
WWW.EPAYSYSTEMS.COM 34
![Page 35: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/35.jpg)
Moving from an insurance
carrier’s ASO program can…
• Lower your costs even more
• Gain more flexibility
• Gain greater transparency
• Avoid state required benefits
WWW.EPAYSYSTEMS.COM 35
![Page 36: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/36.jpg)
What exactly does a third party administrator do?
WWW.EPAYSYSTEMS.COM 36
![Page 37: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/37.jpg)
A third party administrator
handles your administrative
needs including:
WWW.EPAYSYSTEMS.COM 37
• Enrollment & eligibility
• Claims administration
• PPO & PBM contracting
• Management reporting
![Page 38: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/38.jpg)
Regulatory Compliance
A TPA will keep your plan in compliance
with ERISA, HIPAA and ACA Restrictions
and all associated reporting
requirements.
WWW.EPAYSYSTEMS.COM 38
![Page 39: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/39.jpg)
How self-funding may be
beneficial for your
company…
• Increased financial control
• Happier employees
• A healthier bottom line
WWW.EPAYSYSTEMS.COM 39
![Page 40: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/40.jpg)
How do you begin with a self-funded plan with third party administration?
WWW.EPAYSYSTEMS.COM 40
![Page 41: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/41.jpg)
• Review your current plan and prior claims
experience
• Determine the amount of risk your company
wishes to manage
• Determine an appropriate level of stop-loss
insurance to cover excess claims and limit
your risk
• Review the results and potential savings
WWW.EPAYSYSTEMS.COM 41
![Page 42: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/42.jpg)
Integrated HCM to Help You Manage Your Employees and Benefit Programs
42WWW.EPAYSYSTEMS.COM
![Page 43: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/43.jpg)
43
Pre-Hire to Retire:One Seamless Platform
ACATAX MANAGEMENT ANCILLARY SERVICESPAYROLL OUTSOURCING
DELIVERED AS A SERVICE
CLOUD-BASED SOFTWARE
APPLICANT
TRACKING
BENEFITS
ADMINISTRATION
HUMAN RESOURCES
MANAGEMENT
PAYROLL & TAX
MANAGEMENT
TIME & LABOR
MANAGEMENT
SELF SERVICEMOBILE ANALYTICSREPORTING
WWW.EPAYSYSTEMS.COM
PERFORMANCE
MANAGEMENT
![Page 44: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/44.jpg)
Onboarding & Benefits Enrollment
WWW.EPAYSYSTEMS.COM 44
▪ Capture accurate employee data one time only; data feeds
seamlessly to HR and payroll
▪ Make sure proper tax forms are completed based on employee
work sites and residences
▪ Ensure I-9 compliance with electronic processing and approvals
▪ Provide new hire training, policy review and more, and capture
electronic signatures for sign-off
▪ Customize electronic benefit enrollment workflows, ensuring only
applicable benefits are available to employees
Also available in SPANISH
Speed New Hire Onboarding
![Page 45: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/45.jpg)
Benefits Management
WWW.EPAYSYSTEMS.COM 45
![Page 46: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/46.jpg)
•Private Cloud
•Dedicated Servers
EPAY HCM Highlights
Superior Tax
Management &
Garnishment
Compliance
Premium
Customer Care
Program with
24/7 Support
Included
Robust Time &
Attendance with
Flexible Pay
Rules
Single Sign-On
System
Seamless
Onboarding
Gets New Hires
Up and Running
Quickly
ONE UNIFIED, EASY-TO-USE SYSTEM
46WWW.EPAYSYSTEMS.COM
![Page 47: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/47.jpg)
Questions?
![Page 48: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/48.jpg)
48
Connect with
Us on Social
Media
Request today’s slides
Take the exit survey
Request a demo of EPAY HCM
Visit Our
Website
www.EPAYsystems.com
877-800-3729
WWW.EPAYSYSTEMS.COM
![Page 49: How to Lower Healthcare Costs in the Face of Healthcare Reform Uncertainty](https://reader030.fdocuments.in/reader030/viewer/2022020301/5a651c6e7f8b9a5f428b4b43/html5/thumbnails/49.jpg)
Contact Us for More Information
Unified Human Capital Management Technology
www.EPAYsystems.com
877-800-3729
Third Party Plan Administration
http://www.pbaclaims.com/
630-286-4646
Program Manager
http://www.christopherfg.com/