Ertel & Company | Employee Benefits and Insurance Solutions

Total Benefits Solution

We apply a combination of critical analysis and technology to every aspect of your employee benefit program. Through the combination of expertise and technology, we are able to implement comprehensive and affordable solutions. Total Benefits Solution is an approach that evaluates and measures your group medical insurance plan. We use technology to find inefficiencies, understand and manage cost drivers, improve communication and education flow, develop consumerism and promote heath and wellness programs. Total Benefits Solution is a critical part of executing a comprehensive strategy for controlling healthcare costs. In most cases, the key objectives of an employee benefit plan are:

Overall cost control through efficient plan design(s)
Reduced current and future medical plan related cost trends
Productivity (healthy employees equal productive employees)
Maintain or increase ability to attract and retain quality employees

Comprehensive Strategy for Controlling Plan Costs

A. Establish guiding principles

Understand and support your business strategy
Engage employees
Establish financial and cost control objectives
Efficient delivery

B. Benchmark

Analyze and adjust costs for design, demographics and geography
Benchmark adjusted costs to competitors
Compare value
Evaluate current position versus the marketplace

C. Make choices consistent with guiding principles

Structure Plan design(s)
Pricing/contribution amounts
Partner management
Education and communication

D. Execute

Implement
Communicate
Verify

Basics of an Effective Group Medical Plan

A. Efficiency

Utilizing the latest techniques to conduct a critical analysis of all aspects of your employee benefit plan typically results in the discovery of certain inefficiencies. Inefficiencies can occur in all aspects of employee benefit plans:

Utilization review
Large case management
Disease management
Health and wellness promotion
Plan design Insurance and reinsurance companies
Provider networks
Third party administration
Stop loss coverage
Prescription drug coverage
Employee communication
Broker fees
HIPAA compliance

The elimination of inefficiencies in these areas will result in substantial improvements in controlling skyrocketing costs.

B. Consumerism

In addition to the elimination of inefficiencies, it is necessary to concentrate on improving “consumerism” among your members. Consumer driven healthcare plan designs such as HRA’s and HSA’s put the consumer in charge by providing the incentive and information necessary to best purchase healthcare. Those employers who elect not to establish an HRA or HSA can still benefit from plan designs that promote smart consumer choices. Education and access to the tools necessary to be a “good” consumer allow individuals to get the best care at the best price.

C. Cost Driver Management

Cost driver management entails aggressively managing the 27% of your population generating 85% of your costs. Establishing programs in the areas of predictive modeling, large case management, disease management and health promotion are keys to controlling the skyrocketing cost of healthcare.

D. Health and Wellness Promotion

The best way to reduce the cost of healthcare for your organization is to dramatically reduce the need for healthcare services. Health insurance costs are a direct result of general inflation, advances in drugs and other medical devices, rising hospital and doctor expenses, government mandates, increased utilization, cost shifting, litigation and fraud. We have seen estimates that almost 40% of all healthcare expenses result from preventable conditions. These preventable conditions are caused by lifestyle choices such as tobacco, obesity, stress, lack of exercise and poor diet. Realistically, we are never going to eliminate all lifestyle related healthcare costs. However, a reduction in demand associated with improved lifestyle choices will result in a corresponding reduction in the cost of healthcare. Your return on investment in effective health and wellness programs will be as high as 2:1 in the first year.

E. Technology

The proper use of technology is essential to having an efficient plan. Our investment in technology and information systems allows us to provide “best practice” assistance to our clients in the following areas:

Plan evaluation
Communication
Employer web technology
Employee web access
COBRA administration
HIPAA compliance
FSA administration
HRA and HSA administration
Benefit statement creation
Employee self service opportunities