Financial Underwriting
Health Benefits Plan Modeling

Any employer must carefully consider the impacts of potential changes to the health benefits plan offered to its workforce, and not just in terms of cost to the business. Businesses must also anticipate how those changes will affect employees and how well changes align with or account for trends in healthcare. Just a matter of decades ago, businesses had to make these decisions without the benefit of the powerful computing technologies available today. At LHD we make use of our sophisticated plan model capabilities and expertise when making our recommendations, predictions, and forecasting related to the impacts potential changes will have. This helps ensure any decision made by the client is one that is as well-informed as possible.


A Model is Like Test Driving Changes to Health Benefits Plan Design

Think of health benefits plan modeling as a kind of test drive. You wouldn’t make the decision to purchase a brand new car without test driving it first, would you? Making changes to your health plan design is a serious undertaking, and one that could have far-reaching impacts on your business and your employees. In spite of the Affordable Care Act (ACA) and its attempt to reign in the cost of care, in the United States cost continues its ever-upward march. Every employer is looking to keep expenses down while still providing healthcare and wellness benefits that satisfy employee needs. Some insurance agencies seem reluctant to help you with this, but you also don’t have to try to figure it out on your own. LHD works with every client using our robust health plan modeling solution for better business decision-making.


Improving How a Health Benefits Plan Performs

The quality of a health plan is hard to define. Almost every employee needs and wants health insurance, and most every employer wants to keep its employees as healthy and productive as possible. But the business also has to operate within its budgetary constraints. There’s a constant interplay between generous benefits and the cost of providing those benefits, as well as the potential cost of not providing them. Finding the optimal situation is a daunting task without the right tool.

Drivers of plan design changes include both employer and employee needs. Businesses understand the value of health benefits that keep workers happy, as well as healthy and productive. After all, absenteeism driven by poor health has a negative impact on the company’s bottom line. But the business also has to be strategic in mitigating risk around claims and expenses related to health insurance. A few of the factors that can be explored through plan modeling include the following:

  • Restructuring deductibles and coinsurance
  • Shifting the mix of office visits and specialist copays
  • Shifting the mix of urgent care and ER copays
  • Exploring an alternative model of health plan (such as an HSA plan)
  • Restructuring prescription drug tiered rates
  • Putting more effort into utilizing preventive care
  • There are many more specific decision points within plan design that can be examined within our modeling capabilities to ensure any changes made help your company achieve its goals.


Prescription Drugs and Pharmacy Expenses

Your company could be missing out on significant savings on its Rx spend, and this is one area you do not want to overlook when considering changes to health benefits. Back in 2019 LHD made a surprisingly simple change to our PBM (prescription benefit managers) approach that resulted in millions of dollars saved across our client base with a 20% reduction in Rx expenses.

Employers also want to know how any change to pharmacy benefits will impact employees. With good data and predictive modeling technologies, LHD can help you identify probable responses to plan changes among participating employees. This can inform your communication strategy about changes so everyone understands what’s happening and why. When a simple change could save substantial sums of money, the last thing you want to do is not make the change simply because some members will have a negative reaction. But if you know about potential resistance ahead of time, you can mitigate it with better communication.


Let LHD Help Your Business with a High-Performing Health Benefits Plan

At LHD we pride ourselves on taking a people-focused, results-oriented, data-driven approach to establish high-performing health benefits plans for our client customers. We’ve been doing this type of work for more than two decades. Using our robust industry datasets combined with data from your company, our health benefits plan modeling is a vital pathway to identifying cost-saving measures. When you see how those costs play out over time, you’re better able to make the right decisions in the here and now. Plan modeling is how to gain truly actionable insights from data for better decision-making that balances value and cost.

Health benefits plan modeling is just one of the many ways LHD helps clients improve plan design in order to better manage their hard-earned money into strategic spending on benefits that get the desired results. We assist clients with benefits strategy and program design, health plan data analytics, pharmacy and PBM analysis, employee communication, vendor management, compliance, and benefits administration technology. You’ll also want to see what we accomplish for our clients through our population health services aimed squarely at keeping your workforce healthy and well for peak performance.

We communicate frequently through every stage of a project in full transparency to keep you informed. We make recommendations based on data combined with our deep industry expertise. In short, we take mediocre health plans and turn them into the high-performing plans that make a difference to your company and your employees.