You Can’t Fix What You Don’t See


By William Rusteberg

Has your company tried, over and over again, to solve ever increasing health care costs?  “Yes, of course we have, but nothing seems to work!” is a common answer. “We bid out our employee health insurance every year through multiple brokers, we reduce benefits to offset rate increases, and we even light a candle 24 hours before year-end renewal!”

Unfortunately we are all in the same boat. We are told that ever increasing health care costs are driven by a multitude of things such as advanced technology, aging population, cost shifting from government payers, etc. All true, but deceptive.

The truth seems elusive at times. Yet the dominant underlying factor for ever increasing health care costs is rooted in partnerships formed between providers and third party intermediaries designed to maximize revenue streams through secretive contracts, and side agreements that you never see.  Costs are a function of what you agree to pay. Unfortunately most plan sponsors have no idea what rates have been negotiated for them through managed care contracts, yet they blindly pay anyway and wonder why their costs go up double digits every year.

The problem is apparent: You can’t fix what you don’t see…………..

Usually, when told you can’t see a contract you are probably paying more than you should. The first step a plan sponsor should take is to find out what terms and conditions are common to most managed care contracts. Now better informed, they will begin to understand one of the primary factors driving health care costs and will be in a position to take corrective action. They will have become empowered with knowledge the health care industry doesn’t want them to know and for the first time, will be in a position of strength in dealing with their broker, TPA, insurance company and the provider community. Thus, the greatest fear of those who now  control health care costs will have been realized.

Once a plan sponsor better understands how health care financing is structured in this country they  will be in a position to fix what they see.   The results may be dramatic.  Lighting candles could well become a fading memory.