As the health care industry continues to be refined by the complexities of the Affordable Care Act (ACA), trends toward narrow networks and accountable care organizations (ACOs), and the pressures of the ever-increasing costs of specialty drugs, there may be a simple solution to streamlining administrative services and reducing costs. The solution lies in the integration and consolidation of benefits with a single administrative partner.
While many employers have already transitioned to a service platform in which one administrator serves as the strategic partner and single point of contact for benefits administration, it is a trend that is escalating, with the potential to grow exponentially over the next several years.
For organizations that adopt a single administrative partner model, the tangible and intangible benefits include:
- A single point of contact for client-level questions and requests
- Integrated reporting to demonstrate all factors impacting experience costs
- The convenience of a single member service call center
- Integrated member communications, such as plan documents, member identification cards, and other notifications
- Global compliance review of all plan elements
- A single online/mobile member resource with convenient access to information on all plan elements (medical, dental, prescription drug, consumer-driven health plans, eligibility, population health management, workers’ compensation, and ancillary insured lines of service)
- Integrated medical management and case management services that incorporate all medical, prescription drug, and wellness data to provide each patient with a comprehensive treatment plan across the wellness continuum
- Streamlined administrative service billing
In addition to such optimized patient care, member service, and administrative efficiencies, employers that integrate the administration of their medical, dental, vision, prescription drug, and workers’ compensation plans under one administrator can realize significant overall cost savings both as the result of administrative efficiencies, and enhanced quality of integrated patient care.
For example, according to the U.S. Centers for Disease Control and Prevention, the cost of diabetic treatment alone in the United States cost more than $245 billion in 2012. Diabetes can be detected early, however, through a routine eye exam. Through early detection of risk factors, a prediabetic patient can be put on a treatment plan that improves health outcomes and reduces health care claim costs. With an integrated medical plan, medical management program, and vision plan, the most efficient sharing of the prediabetic patient’s health data can be integrated, interpreted, and acted upon in order to address risk factors before they escalate.
Closing gaps in care, encouraging compliance with a prescription drug treatment plan, and monitoring identified risk factors are aspects of an integrated benefit administration model that can support improved health outcomes and lower the overall cost of care. This type of synchronicity can not be as seamlessly or quickly accomplished, however, under an administrative arrangement that utilizes disparate partners for each plan element.
An integrated benefits administration platform also allows for a global analysis of the disease states and risk factors that are most impactful to plan members. An analysis of the global plan populations across the care continuum can lead to the strategic implementation of targeted programs to address those diagnoses with the most potential for adverse and costly health consequences.
By adopting an integrated administrative service model with an expert benefits administration partner, organizations can provide valued employees with a total care solution model as well as reduce overall plan costs, so that available funds can be reinvested back into the organization to further benefit its employees.
For information on POMCO’s integrated service solutions, visit our Benefits Administration Page.