For a small or mid-sized business, it doesn’t take dozens of expensive claims to affect a health plan. Sometimes one or two employees or covered family members dealing with serious medical conditions, specialty medications, or ongoing treatment can significantly influence overall healthcare spending.
For employers, that can create a frustrating situation. You want employees to receive the care they need, but you also need a health plan that remains financially sustainable for everyone.
The answer is not simply cutting benefits, but rather understanding what is driving the cost and whether there are better ways to manage it to ensure everyone has affordable healthcare provided by the business.
A large company may be able to spread significant claims across thousands of covered employees.
However, a business with 25, 50, or 100 employees has a much smaller population, meaning a handful of major claims can have a much larger effect on plan performance. These claims may come from serious diagnoses, surgeries, chronic conditions, specialty medications, or other ongoing healthcare needs. These conditions often increase costs overall despite only being from a small percentage of employees.
When employers understand where those costs are coming from, they are in a better position to evaluate possible solutions and work to design a plan that benefits everyone in the best way possible.
High-cost claim management should never be about preventing employees from receiving necessary treatment.
Instead, the goal is to make sure employees have access to appropriate care while identifying opportunities to manage costs more effectively. That may include care coordination, clinical support, pharmacy management, or helping employees navigate complex treatment plans. It isn’t always easy for employees to navigate these conditions alone.
Palmetto One Health includes proactive care management resources designed to help identify members who may benefit from additional support and connect them with the appropriate healthcare resources.
Not every large claim can be prevented, and some employees may have significant medical or prescription expenses that are expected to continue. There is not a way around most of the time.
In those situations, employers may benefit from exploring more targeted strategies rather than allowing one major expense to repeatedly affect the broader health plan.
Palmetto One Health also includes additional solutions for certain members facing significant anticipated medical or prescription costs, giving employers another option to consider when high-cost claims are creating ongoing challenges.
The right approach depends on the individual situation, which is why reviewing the details of the plan and its cost drivers is so important. This can ensure the most important things are addressed when making decisions regarding healthcare.
One of the biggest challenges employers face is knowing that healthcare costs are rising without understanding exactly why.
A proactive benefits strategy looks beyond the renewal premium and examines claims trends, prescription utilization, chronic conditions, and other factors affecting the plan. Rather than being reactive, employers can get in front of issues and make the necessary changes before they become major problems.
That information can help employers make more informed decisions about plan design, funding strategies, and available cost-management resources.
At Palmetto Insurance Group, we help employers in North Carolina, South Carolina, Georgia and Tennessee understand what is driving their employee health insurance costs and evaluate strategies designed to address those challenges.
Through solutions such as Palmetto One Health, businesses may have access to care management, pharmacy support, targeted high-cost claim strategies, and other resources focused on creating a more sustainable health plan. This can create more affordable healthcare costs while still making sure employees are cared for properly.
If a small number of claims are having a large impact on your healthcare costs, it may be time to look beyond the renewal and understand what options are available.
Learn more about Palmetto Insurance Group and the employee health insurance solutions available for your business at https://palmettoinsurancegroup.com/