In 10 years, the most prestigious business schools will be educating the next generation about how we changed healthcare and health insurance in the United States.
Obviously, Health Insurance is a massive expense. Having the privilege to now be in the mix to help manage the member experience and cost, I am getting some inside baseball to this phenomenon of ‘decision making’
We just lost an RFP. Why?-
- The executive was behind us
- The price was right: We were the best quoted plan by 7% to our nearest competitor- Max cost was $1m less than the nearest Fully Insured plan (at least 10 jobs)
- We were dedicating 4 PCP clinicians to the school district- those school district lives were there only patient responsibility- with 12 onsite visits per year, including virtual access and 2 new facilities nearsite (no other RFP was offering this)
- Labs were free, RX were free, sleep studies were free, CGMs for all members were free and members had no out-of-pocket costs when care was coordinated through the DPC (Free means no copay for the member and no claim for the plan)
- A network option for those that want to do their own thing with copays, deductibles and coinsurance enforced
- – Self Funded with an A+ rated carrier
Based on our projected spend and our history of performance, the group would be looking at a $2m surplus+ (20+ jobs).
Then, it went to the school board (the reason why). They said, nope, for 1500 EEs, self funding is too risky…………..let’s remain fully insured.
Unbelievable. This is one major reason why your school’s are closing. Stupid decisions around how their health plans are being funded. It is their second largest expense and the people in charge are making uninformed decisions to the detriment of the local community.
Not “Unbelievable.” Decisions like this are more common than not in public sector bidding. We’ve seen poor decisions like this repeated time and time again. Decisions are often made before the bidding begins, a formality designed to foster the illusion of competitive procurement.
HOMEWORK READING ASSIGNMENT:
San Benito School District Awards TPA Services to Highest Bidder
Why Consultants Should Just Say “No” To RFP’s
Public Entity RFP Scoring Revealed – Risk Managers
Hoax RFP From The Past – Risk Managers
