Plan Sponsor Reviews 5 Year Plan Performance

By Bill Rusteberg

Five years ago a San Antonio plan sponsor had enough. Self-insured with a BUCA wasn’t working out too well. Three years in a row annual rate increase of 20% and more each year was unsustainable. Drug costs were going through the roof. Something had to be done.

We assisted in developing a five year strategy to bring sanity back to health care for plan members. That was not an easy task. It took an enormous amount of education and buy-in among plan members. How do you change attitudes and mindsets after 40+ years of managed care?

What have been the five year results and has the group met their five year strategy goals. The answer to the second question is 95% of goals were reached (that’s a subject for another blog posting).

Here are the (redacted) minutes of the plan’s risk manager meeting with C-suit executives last month:

  • Presentation was a 5-year road map showing in 2018 (BUCA) premium rates increased 20% and would have continued to increase 10% 15% per year thereafter.
  • 2018 – 2019 we switched to RBP and our premiums decreased 5%. During this year we engaged in direct provider contracting, implemented our DIRECT CASH PAY PROGRAM, and began sending out a regular monthly newsletter to employees
  • 2019 -2020 No premium rate increase. During this time, increased safe harbor providers, had direct agreements with (HOSPITAL A) and (HOSPITAL B). NOTE: Both hospital agreements are straight Medicare based with no outliers, stop loss provisions or escalator clauses.
  • 2020 – 2021 No premium rate increase.  Increased use of Safe Harbor list, increased marketing, implemented dedicated safe harbor website, increased use of DIRECT CASH PAY PROGRAM.
  • 2021 – 2022 No premium rate increase. 1-1 consultation with members and instructing them on how to navigate safe harbor list. During this time, we Increased, marketing with DIRECT CASH PAY PROGRAM.
  • 2022 – 2023 No premium rate increase. We discussed the future of the plan, which includes helping our members establish Primary Care, and use data analytics to find high-quality low-cost providers. Discussed expanding cash pay presence and concierge service. Carved out specialty drugs, with anticipated savings being 1 million. Eliminated PPO plan option (less than 5% of membership were on PPO plan option)  
  • Our Safe Harbor list of over 3,000 providers has improved, giving our employees easier access to find providers who have agreed to not balance bill our members and request providers.

During the past five years benefits have been improved, not reduced. Plan members who “play by the rules” pay nothing for health care access – all financial barriers to health care have been removed.

Meanwhile back in the BUCA world of health care, cost increases continue and benefits erode leaving most Americans essentially functionally uninsured.