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There are rapid changes evolving in plan design, and C.M. Smith can help sort out the range of options now touted by health plans.
Faced with double-digit increases in health care costs year after year, employers are constantly looking for ways to mitigate those increases for themselves and their employees. Changing contribution strategy to cost-shift to all employees is one way to achieve that. However, some employers only want to shift plan costs to those that are the primary drivers of their costs. For those employers, plan design changes can be an effective cost management tool.
For example, did you know that a visit to a specialty care physician can cost up to 70% more than a visit to a Primary Care Physician (PCP)? To address that differential, many employers are moving away from the traditional "flat" co-pay, to a "split" co-pay. In this scenario, the co-pay to see a specialist is $10, $15, or even $20 higher than the PCP co-pay.
Let's not forget about prescription drugs. They remain a prominent target for the use of cost management tools among employers. In today's environment, the majority of employers are implementing or are considering implementing changes to their prescription drug programs. For these and other employers, the most frequently utilized design changes include:
- Implementing or making changes to a formulary
- Increasing co-pays
- Introducing co-insurance and/or a separate deductible
- Adding "mandatory generic"
- Instituting a plan maximum.
There are positive and negative implications to all of the strategies mentioned above. Call us so we can help you work though your plan design decisions.
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