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.

To learn more about self insured health plans, check out our Smarter Self-Funded Health Plans page or email me – I’d love to answer your questions!

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Mike Roche

Mike Roche

Director of Business Development at The Alliance

Mike Roche joined The Alliance as member services manager in 2015. He is responsible for working with Alliance employers on health benefit strategies; sharing data-based information to help members manage their health care spend; and serving as a voice of member employers. 
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. 

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