Benefit Programs: The Right Partners Can Make all the Difference

Reading Time: 4 minutes

A robust, high-quality health benefit program can give employers an edge in today’s competitive hiring market. Beyond attracting and retaining top talent, an employer’s benefit program is a significant percentage of their budget. It is also the foundation of what helps employees, and their families stay healthy and productive.

A well-designed health plan is just the beginning; you cannot create and maintain a holistic benefit program alone. You need the right partners to support your employees in all areas of their health and wellness. But it isn’t easy to pull together all the vendors needed to create an effective benefit program. It takes time and effort to find partners that can support the needs of your business and employees.

Who are Benefit Program Partners?

Benefit partners are vendors that provide a service which allows you to facilitate your benefit program. A few examples of benefit partners include brokers, third party administrators (TPAs), pharmacy benefit managers (PBMs), networks, independent primary care, and care navigation providers.

BROKERS

Brokers provide guidance to employers on benefits options, offering advice about vendors, products and services.

THIRD PARTY ADMINISTRATORS

TPAs manage operational services like claims, processing, and reporting for self-funded health plans. 

PHARMACY BENEFITS MANAGERS

PBMs are third-party vendors that handle pharmacy and prescription drug benefits for insurers and self-funded health plans.

NETWORKS

A network, like The Alliance Smarter Networks^SM, is a curated list of healthcare providers that are contracted to provide care to plan members at negotiated rates.

INDEPENDENT PRIMARY CARE

Independent physicians choose to provide care outside of a major hospital or health system. Direct primary care, in which a self-funded employer or network contracts directly with primary care physicians is one example of independent primary care. Another example is employer-sponsored clinics, where a self-funded employer funds a clinic where their employees can seek care at low-or-no cost.

CARE NAVIGATION PROVIDERS

Care navigation providers help employees and their families through the often difficult and confusing process of care so they can get the most out of their benefits.

While there are many vendors in the market, it is important to choose innovative and supportive partners to help you create and administer the best benefit program for your employees and their families.

What to Look for in a Benefit Program Partner

Choosing the right partner is essential to the success of your benefit program. It’s important to be proactive in your search. Self-funded employers have a fiduciary responsibility to their employees. It is crucial to seek a benefit partner that offers high-value services at affordable costs.

An effective benefit partner will offer a range of customized options tailored to their clients’ needs. Every organization is different. Understand your guiding principles, values and goals, so you can tell when you find partners who align with them. A good benefit partner acts like an extension of your business helping you achieve your strategic goals and supporting your employees. When meeting with potential partners, be clear and upfront about the problem you’re trying to solve. Ask how the potential partner would help you solve it. Make sure your potential partner takes a holistic approach, thinking not only about what is happening today and how to handle it, but also proactively thinking about what issues could arise in the future and how they will be managed.

Ideally, benefit partners should be easy to work with, attentive to their clients’ needs, and willing to challenge the status quo to find new ways to bring more value. A quality partner will help refer your employees to high-value providers because they want patients to get the best care at the lowest price.

Finally, the right benefit partner will be accessible and communicate with you clearly and consistently. They will be transparent about their compensation and will give you access to your claims data. That way you can make the best decisions for your employees and their families. A supportive partner will also help you develop a plan to communicate effectively with your employees about their benefits. A benefit program is only successful if your employees know and understand the full benefits.

What to Watch Out for in a Benefit Program Partner

On the flip side, working with an unresponsive or unethical partner can be detrimental to your benefit program. Your benefit partner should always be working in your best interest and finding innovative ways to improve your benefit program. If your partner is offering one size fits all solutions, it’s time to start looking for other options. You want to look for someone who is willing to challenge the status quo to move healthcare forward for employers and their employees.

Be wary if your benefit your partner is not communicating regularly and transparently. If you ask for your claims data and don’t receive it, that is an issue. It’s also not a good sign if you ask about their compensation structure and they are not transparent with you – or flat out refuse to answer. A great benefit partner will always work in your best interest, offering consistent support and transparent communication.

Employers should also watch out for rising plan costs. Benefit partners should provide independent market data to support benefit plan recommendations and be knowledgeable about industry trends and compliance requirements. If a partner is requiring a significant amount of your time or limiting your ability to be flexible and work with best-in-class vendors, they are not the right fit for you. A benefit partner is there to support you and your employees, not the other way around.

Top Considerations for Choosing a Benefit Program Partner

1. Experience
2. Qualifications
3. Advocacy/wellness
4. Support – who will service your account and to what extent
5. Communication
6. Compliance expertise
7. Day-to-day administration
8. Compensation
9. Length of contract – how to get out of contract if needed
10. Renewal process

The Alliance Can Improve your Benefit Programs

The Alliance can help you put some of these strategies into practice. Using our Smarter Networks, we help employers customize their benefit plan design to tailor benefits to their organizations’ specific needs.

Our Comprehensive Network includes 38,000 healthcare providers and offers the broadest coverage for self-funded employers in the state of Wisconsin. This broad network gives your employees more choice, protects them from surprise bills, and improves their access to high-value healthcare. Our Premier Networks offer a customized option for employers that want to incentivize and guide their employees toward certain providers to maximize their plan savings. You can guide your employees and their families to make smarter healthcare decisions within a broad provider network. We can support up to four provider network tiers.

The Alliance also uses innovative contracting and payment strategies like bundles, direct primary care, steering and tiering and PBM solutions to help our employer-members and their employees manage their healthcare spend.

If you’re considering new benefit partners, it’s important to make sure they are transparent and offer the services your employees need. We’ve created downloadable worksheets with questions you can use to interview potential partners so you can be sure you’re making the best choice for your business and your employees.

Reach out to learn how The Alliance can help you take your benefit program to the next level for your business and your employees.