Luke Moo,
Senior Consultant
August 27, 2018

“Prevent Defense” is a strategy used at the end of football games when a leading team takes a very conservative approach defending the opposing team, hoping to hold on to victory while the clock runs out. Typically, the offense is able to move the ball down the field, bit by bit, just not get any big plays—all while the defense hopes they can stop them from scoring. Popular opinion has it that the only thing a prevent defense does is prevent you from winning. Likewise, playing prevent defense in managing health plans is not a long-term strategy that will allow you to win in providing the best benefits at the most effective cost. Too often, employers feel that this is their only strategy in managing their health plan. Well, it’s a new season! I’ve broken this post down into a few sections to lay-out how we manage running a more “1985 Bears defense” approach to proactively manage your health plan.

Many employers see health insurance as a necessary evil and feel they are beholden to one of the large insurance carriers (the BUCA’s: Blues Cross Blue Shield, United Healthcare, Cigna, or Aetna companies). While these carriers may offer some value, most don’t view themselves as insurance companies anymore—rather they are service providers. Some of these services include offering network options that provide “discounts” from providers, offering products to share risk among many employers (fully-insured plans) and technology platforms for members to navigate care. My question to many employers is if your insurance carrier is a service provider, do you evaluate them as such? What motivation do they have to control costs with a self-funded arrangement? How do we take advantage of their offerings and build ways to navigate the health system with more ease and understanding for employees?

We strongly believe in helping employees through wellness campaigns (traditional or direct primary care providers) and education to help them avoid a costly and detrimental medical event. Corporate wellness programs from biometric screenings to team-based competitions are a good start but only the tip of the iceberg. There are so many tools available when choosing a proactive approach. An employer needs to be equipped with the right tools like data analytics and digital health solutions, and have a coordinated plan to help their unique population improve well-being. From there, an active partnership with the consultant, plan sponsor, and the service partners works together in implementing the right tools that help employees engage, get healthy and stay healthy.

The process for identifying gaps in care and preventing large claims we’ve created for our clients has proven to be effective. We use all our resources in analyzing the best approach for each client individually. We explore with our partners options to engage employees and increase awareness. Our partners in the market appreciate our thinking and work alongside us to root out the status quo. Our client’s employees are living healthier lives because of our work—and isn’t’ that our goal? Let’s not wait for the offense to come marching down the field—let’s stop them and take control of the ball and our benefits plan, employees and boss/shareholders will be thanking us.

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