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Human Resources CAN take control of their Medical Plan Spending

/ October 4, 2019 October 4, 2019

The days of “there is nothing we can do about our healthcare costs” are over for many organizations.   However, not all Human Resource Managers, CFO’s and Benefit Managers realize this. Historically, the philosophy was:

Health care inflation and insurance carrier profit are a given. We have to provide competitive benefits to attract and retain talent. As a result, there is nothing we can do to affect our ever increasing Medical plan spend.

This does not ring true anymore.

The competition between carriers and market share is fierce which works in favor of employers.   In addition, traditional insurance carriers are losing more and more organizations to the world of self-insured medical plan funding.  This has two benefits for employers:

  • Insurance carriers will fight harder to win or keep your business on a fully insured basis
  • Self-Insured is now, more than ever, a very viable option for a large portion of employers


For Example:

Perhaps you have a high diabetic population and there are a number of high claimants. The data shows over time these claimants are not all adherent to medications, doctors’ visits, etc.  With this information, you can make informed design and care management decisions.  You may decide to make all diabetic testing and insulin prescriptions free of charge to members of the plan that stay in adherence. This will not only help those members, but also keep the plan’s hospital charges down. Again, with this transparency, you own the data and can design a plan based on your needs which you would not be able to do in a fully-insured model. Net results include:

  • Creating a pathway to healthier employees
  • Managing plan costs


In the past, this method of funding was really only available to the larger employers who have several hundred employees or more. However, today, self-Insured funding is available to almost all employers regardless of employee size.

It is important to understand your own medical plan experience and work with an industry expert to ensure your plans are properly utilized. You’re able to manage costs, and you’re able to offer plans that are the right fit for your organization.