Director of Business Development
Mike Roche joined The Alliance in 2015. He is responsible for working with prospective employers, their broker/consultant and their TPA partners to introduce them to self-funded health benefit strategies; sharing data-based information to manage their health care spend; and serving as a voice of The Alliance to expand our membership.
Mike has a strong background in health benefits and self-funding. He previously served as a regional sales advisor for Digital Benefits Advisors in Madison, Wis., where he managed the health benefits for more than 160 credit union clients across 14 states. Prior to that position, Mike worked at CUNA Mutual Group in their employee benefits division for almost 10 years as an employee benefits sales specialist.
Mike has a bachelor’s degree with a double major in marketing and business administration and is licensed in both health and life insurance in Wisconsin, Illinois, Iowa, Minnesota, Nebraska and Montana.
If you want to design a health benefits plan that saves your business money but don’t know where to start, begin by creating a corporate culture that educates employees on the plan and encourages them to use it. Why? Because you want to influence your employees to make behavioral health changes before they develop medical conditions that require costly, specialty care.
Whether due to lack of knowledge, motivation, or education, some employees may choose to ignore what they consider to be minor health symptoms. Things like hypertension, high cholesterol, and obesity are often minimized by the patient, but if these health risks continue to go unchecked, they can lead to more dangerous – and costly – medical conditions.
Beyond creating a wholistic company culture focused on leading a healthy lifestyle through education and empowerment, you can use Benefit Plan Design to influence where your employees seek treatment to care for their health – and your bottom line.
Health Benefits Plan Design in Action
By providing employees with financial incentives for utilizing high-quality, low-cost providers, employees are more likely to utilize care that saves them and the health benefits plan money. For example, you can design your plan to feature a multi-level network structure using our Premier Network. Multi-level networks (also known as tiered networks,) incentivize employees to go to doctors that are high value – good quality at a fair price – while still offering a broad network to give employees and families choice.
Here’s how it works – let’s say your company gives employees three options based on quality and cost.
Level 1: High-Value providers from a particular health system that has zero out-of-pocket costs for the employee but is located 25 miles from your workplace.
Level 2: High-Value providers from a different health system located 5 miles from your workplace that require $150 in out-of-pocket costs for the employee.
Level 3: The rest of the providers in the network that require $300 in out-of-pocket costs for the employee.
Based on these options, your employees are financially incentivized to choose Level 1, which saves both them and your health benefits plan money. However, they could pay more to choose Level 2 if the provider’s location is important to them, or pay even more to choose Level 3, which is possibly a provider they trust and may have chosen in the past.
This design structure gives employees more transparent options when making a decision and over time, saves money without limiting the health care options for your workforce.
What Makes Benefit Plan Design at The Alliance Different?
The Alliance has developed contracts with high-value provider systems that are based on a percentage of Medicare – what we call Reference-Based Contracting. Combining this strategy to produce transparency in pricing along with our membership’s purchasing power, The Alliance is able to negotiate deeper discounts with large providers than what would traditionally be possible – as long as they are added to the plan’s top tier of benefits. This results in savings for both employers and their employees.
Ready to Get Started?
Learn more about Benefit Plan Design.
If you want to incentivize your employees to use low-cost, high-value providers while still offering them the flexibility to choose within a broad network of providers, our Premier Network offers customized provider levels – all of which are within our Smarter NetworksSM.
If you want to learn more about how The Alliance can help you with your benefit plan design, including how to offer leveled tiering, contact Business Development or your Account Executive.
Details matter when you’re comparing captive models, analyzing stop-loss costs and seeking to understand captive value. Alex Gloeckner, senior vice president at Moreton & Company, recently dived into those details for Alliance employers. Moreton works with The Alliance to manage ShareCap™, a medical stop-loss captive.
Joining a captive is a little like deciding whether to try a new entrée for the first time. No matter how many times you’ve been told it will be delicious, you’ll never enjoy the taste unless you’re willing to take the risk of ordering it. And if you’re not interested in taking that risk, you’ll likely settle for never learning just how tasty it could be.
The Alliance is taking the next step toward helping members capture stop-loss savings by creating a medical stop-loss captive. In 2017, The Alliance held a feasibility study to examine whether Alliance members were interested in forming a captive. The answer was clearly “yes.”
Every bidder for your health plan’s business claims their network of hospitals, doctors and health services will save you money. But how do you know whether that’s true or just marketing hype?
When the annual physical exam identifies a significant health problem, that’s definitely a plus. But what if it leads to a “false positive” test result that results in more tests and possibly even treatment that the patient didn’t need in the first place?