Whether you are a small team in a relatively new business or an established company with thousands of employees, navigating employee health insurance can be a major headache. Healthcare plans traditionally provided to employees by insurance firms are simultaneously expensive while still often failing to meet the needs of the participants. Additionally, companies are expected to pay a considerable amount toward premiums (for most companies, healthcare is the second largest expense after payroll) regardless of whether team members are utilizing the provided medical services or not.
It is obvious who benefits most in these scenarios, and as a result plan providers are expectedly resistant to making changes to their services to address these issues. However, as long as consumers have problems they will always search for solutions, and in recent years a number of organizations have emerged who are seeking to solve this pain point. One such company is HAUSER Insurance, which recently launched its transparent health benefits program (Hauser THB) aimed at providing the healthcare solutions that best serve both employers and employees.
HAUSER Insurance, a national, full-service brokerage singularly focused on the needs of private equity firms and their portfolio companies, has utilized their tenured team of risk advisors, M&A experts, and brokerage professionals to build unique insurance solutions for organizations of all sizes from multinational enterprises to founder-led businesses. Purchased as a small local insurance company by Mark Hauser of Hauser Private Equity, over the past two decades the firm has grown to become a nationally-recognized organization, making it uniquely-positioned to understand the needs of businesses large and small when it comes to health insurance.
To combat the disconnect between companies’ needs and what is offered by health insurance providers, HAUSER Insurance created Hauser THB. Building a team of employee benefit advisors, companies who utilize the program gain access to these experts who serve as consultants guiding employers in establishing their own self-funded benefits programs. While most major insurers are proactive in their efforts to direct employers away from self-funding, HAUSER Insurance touts the strategy as a practical approach built on what the most successful purchasers of health insurance are already doing, ensuring enhanced access to higher quality care for employees and lower costs for employers.
Employers offering quality care at the best possible price is a mutually beneficial practice. A healthy workforce is essential to productivity, but it shouldn’t be at the cost of an organization’s limited resources. HAUSER Insurance employs utilization management in their Hauser THB methods to give employers the tools to bring these two elements of health insurance together. Through this system, models are used to help businesses identify the needs specific to their companies, and individually select healthcare locations that meet at the intersection of the best care at the best price. Through an advocacy program, outcomes can be optimized to reduce confusion and expenses.
With alternative reimbursement strategies, control of plans, costs, and reimbursements for services provided is taken from health insurance companies and placed back in the hands of the employers. While insurers disproportionately have the most to gain from increasing healthcare costs, through Hauser THB the relationship becomes equilaterally beneficial, with employees gaining better access to higher quality care, employers reducing their expenses, and providers getting paid faster as a result. HAUSER Insurance achieves this through reference-based pricing, moving away from the opaque bill-charge discounts and establishing a reimbursement model that utilizes a transparent reference point instead. They also create a direct relationship between employers and healthcare providers and work to form bundled payments for services.
Additionally, prescription drugs typically account for 20 to 25 percent of an employer’s total healthcare spend, but through Hauser THB’s strategies that cost has the ability to be reduced by a significant amount. Tools implemented in prescription drug optimization include helping employers understand the cost differences between national and local pharmacies, sourcing medications outside of pharmacy benefit managers through strategies such as medical tourism, and identifying employee-specific needs and reducing costs through employing assistance program options.
The biggest roadblock to having access to quality care is the complicated nature in which insurance providers offer their information. As it currently stands, health insurance companies take control of deciding which procedures, doctors, and facilities are covered for their members, meaning that the best-quality care such as top surgeons or well-rated hospitals is out of reach. The long-term and broader implications of employees not having access to these are numerous, but Hauser THB provides each plan member with a dedicated care advocate to provide guidance on how to get the best care while maintaining cost transparency. By eliminating the traditional network, the best providers become universally available.
HAUSER Insurance’s transparent health benefits business model has a number of proven success stories across a wide range of businesses. One such example of this was in North America’s leading marine equipment manufacturer, whose existing PPO and Rx plans were together presenting a significant expense. Being a large multi-state enterprise, a self-funded model had previously seemed too complicated when navigating the various compliances across the nation, not to mention also having a diverse range of employees across the socio-economic scale. However, it was these challenges that also made self-funding the ideal solution. Through Hauser THB, the company was able to move into a more flexible model, allowing them to maximize cost reduction.
Similarly, a business communications technology solutions company in the Midwest had been experiencing a year-over-year cost increase of 10 percent, with prescription drug prices soaring particularly high. The company wanted more support and advocacy from the plan, and through Hauser THB found the solution in a national PPO with custom wrap to fill any gaps in coverage. Through utilizing an open network for facility-based claims, reimbursements based on Medicare, and a transparent prescription program eliminating both member and plan costs, the company was able to create a service that was collaborative, non-litigious, and increased member engagement.
Insurance providers may seem like monoliths, but with attention and care their offerings can be tailored to the best advantage of both employers and employees. However, many companies lack the ability to dedicate the time, or simply don’t have the knowledge to make these changes. As one of the largest expenses for a business large or small, it makes infinite sense to try and find a happy medium in which high-quality healthcare is provided to employees at the lowest cost possible, and thanks to HAUSER Insurance and programs like their transparent health benefits offerings a solution is that much closer.