What is this about?
A major challenge for all employers is how to align their health plan design so that it supports wise personal health care choices and wellness behaviors. Historically health plan design has been either agnostic with regard to wellness or in the worst situations, actively in conflict. We know that rich or generous health plan design leads to higher cost and can undercut wellness and wise plan use choices of employees and their family members. Issues such as plan type, out-of-pocket cost-sharing levels and forms, utilization incentives, health cost management requirements, provider panels, and preventive benefit design all have a significant impact on the health effects and cost of health benefits coverage.
The various health plan design features that are addressed in this Solution Set include:
- Core health plan functions
- Plan Type
- Employee Premium Contribution Level
- Employee Share of Future Plan Increases
- Size of Individual Deductible
- Number of Family Deductibles/year
- Co-insurance rate
- Annual Maximum Out-of-Pocket (Individual) MIOP
- Annual Maximum Out-of-Pocket (Family) MFOP
- Emergency Room Co-pay
- Prescription Drug Cost Sharing (All drugs must be included in a formulary and unusually high-cost drugs must be used under case management oversight.)
- Preventive Medical Benefit Coverage
- Separate Employee Premium Contribution for Wellness Incentive
- Case Management Requirement
- Management and operating principles
Why is this important?
This document is important because it addresses the major elements of health plan design that lead to efficient and effective health care utilization and provide the strongest support for individual employees to engage in wise health consumer and personal wellness behavior. My experience with more than a thousand employer wellness programs and benefit re-design projects underscores that the best worksite wellness programs will only produce mediocre results if the health plan(s) involved is not fully aligned and compatible with the wellness behaviors (and attitudes) that the employer wants to promulgate among employees and their family members. This document is an important resource because it can help you get the most out of your worksite wellness efforts.
What can you do with this document?
- First, familiarize yourself with the issues that are addressed in this Solution Set document.
- Next, assess for all these issues the current status of each recommendation for each health plan offered to employees.
- Then, provide a set of recommendations on how each health plan involved can be modified to enhance its alignment with overall wellness goals and objectives.
- Then, conduct after the modifications are in place for a minimum of 12 months, conduct an evaluation of the effects of the recommendations.
In summary, this Solution Set document can help bring greater effectiveness to employee wellness programming efforts by modifying and aligning health plan design to support the behaviors and attitudes that are embodied in our wellness programming efforts.