April 30, 2024

As healthcare insurance costs continue to escalate, an increasing number of companies are contemplating the shift to self-funding their employee health insurance plans. Self-funding presents an attractive opportunity for businesses to mitigate healthcare expenses. By opting for self-funding, employers gain access to valuable data that aids in assessing plan performance and pinpointing areas for potential cost savings. While the idea of navigating the complexities of a self-funded plan can be daunting, advancements over the years have made the process of risk management and goal prioritization more manageable. Here are some things to consider when evaluating a claims payor, prescription vendor, and strategies for cost control in the self-funding realm:

·       Third-Party Administrator (TPA) Partner – The TPA serves as the quarterback of your benefits plan, offering administrative services, claims management, and acting as the interface between the health plan and your employees. When assessing a potential TPA partner, inquire about the network, alignment with your business profile and carrier partners, commitment to innovative solutions, flexibility in plan design, and availability of managed care options (e.g., PPOs) for employees.

·       Pharmacy Benefit Manager (PBM) – Navigating the pharmacy landscape can be intricate. When evaluating PBMs, inquire about their rebate-sharing practices, availability of innovative patient assistance programs, and service support.

·       Cost Containment – This area presents ample flexibility for employers assuming liability for claims. It’s crucial to explore programs that enhance quality while reducing costs. Start by examining the vendors integrated with the TPA, considering recent successes with transparency tools aiding provider cost and quality assessment, virtual care alternatives, and participant education initiatives.

Transitioning to a self-funded plan may seem more dauting than a fully insured arrangement, but it doesn’t have to be with the right support. The extra effort in making the move can produce significant cost savings and a long-term solution.

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February 29, 2024

At Watko, a focus on growth is a basic characteristic of our work culture. Having a growth mindset allows us to serve our customers better by learning new ways to improve practices, impact vendor performance, and make a measurable difference in a momentous way year in and year out in every relationship. Below are some examples of how we focus on this in our business:

• Growth by deepening the relationships with our existing customers, while recognizing that every customer is unique. Understanding objectives over time with a focus on listening and staying in touch is fundamental within our practice.
• Growth by keeping an open mind toward new solutions that meet typical challenges in a refreshing and new way.
• Growth by always seeking ways to introduce our services to new opportunities available in the market.
• Growth through proactive education and communication – Educating during open enrollment is the norm but sometimes not enough. There are tools to communicate benefits year round.
• Growth in benefits offerings – Millennials and Gen Z are now the majority of workers in today’s workforce, so plan designs and employee offerings should be updated and reviewed on a regular basis. Offering voluntary benefits can also help bridge the coverage gap and allow flexibility for employees to decide how to spend their discretionary income on products that may fit their needs.
• Growth by leveraging vendor capabilities – Vendors are always updating their plans and offering new features. Growing within your existing plan is fundamental and something many planholders forget to consider.

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February 1, 2024

I watched the last night. If you haven’t watched it, there’s much to learn and it is very entertaining. His Yogi-isms and story in general are epic.  Makes me think a lot about the way we run our business. How many times are you advocating for your customer and it just seems to take much longer than it should to get the right answer?  “It ain’t over ’til it’s over” is a classic. The “always do the right thing” and “never give up” paradigms are timeless.

Which yogi-ism is your favorite?  Check out the link below.

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October 26, 2023

While it’s true that most self-funded health plans have over 200 employees, there are more creative self-funded plan options for smaller groups, including groups that have fewer than 10 employees.

In fact, we have experienced an enhanced level of stability for those employers that decide to implement a benefits captive strategy.  Being self-funded through a benefits captive provides greater stability on large claims experience, along with the advantage of participating in lower-than-expected claims experience.  Being able to leverage the marketplace based on Captive size also provides great advantages for smaller employers.  In addition, gaining transparency with Prescription rebates and financial assistance with Specialty drugs are other advantages of being self-funded vs staying fully insured.

There are various components of a self-funded plan.  Employers who are self-funded usually select an Insurance Carrier or Third-Party Administrator (TPA), a Pharmacy Benefit Manager (PBM), and a Reinsurance carrier (Stop Loss coverage).  There are pros and cons associated with every vendor in the market.

Remember that being fully insured does not mean less long-term risk for small to medium sized employers.

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September 6, 2023

Every company is concerned about increasing costs across their business. Providing competitive benefits plans becomes more complicated as health costs increase. Many companies are spending as much as 50 percent of their health claims on prescription claims and in some instances have no awareness of this. In the next year, outpatient prescription drug costs are projected to grow 16%. A large portion of this growth is due to an increase in specialty drug utilization and prices. This growth is expected to be in behavioral health, cardiovascular, neuroscience, and oncology related services. Offsetting this growth is the continued uptake of biosimilars, which has increased over the last few years. 

Having a proactive approach to introducing biosimilars with patient incentives and patient advocacy can help stem this growth in costs. These strategies are difficult to implement or even consider in a fully insured health plan.  Having a strategy to address these challenges can help enhance quality and costs in plan sponsor benefit plans.

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July 13, 2023

More of our customers are engaging in ways to enhance provider access while improving patient care and potentially lowering health costs.  This is the foundation of Direct Primary Care (DPC).  Provider access is a real issue as witnessed by the amount of time it takes to get an appointment with your primary care physician.  When a DPC Clinic has a provider to patient ratio of 1 to 500, same day visits are attainable and patients experience an enhanced relationship with their provider.  We have also seen chronic condition health management be managed in an orchestrated and “as needed” strategy through DPC.  This has significant potential in improving care while lowering costs.  Last, integrating a DPC solution can be done in a variety of plan settings whether fully insured, self funded with a carrier or through a benefits captive.  For more information, contact us at info@watkobenefit.com.

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June 28, 2023

On June 28th every year, National Insurance Awareness Day reminds us to review our insurance policies.  The observance offers an opportunity to review current levels of coverage and look into other types of policies available.  Below are a few things you should consider:

• Make sure you understand your policy – Did you know that 86% of people can’t define the terms “deductible,” “copay,” “coinsurance,” and “out-of-pocket maximum”?  Today is a great day to make sure you understand your health plan so you can properly use your benefits.
• Family changes – Has your family changed?  Do you need to update your life insurance policy?  Nobody wants to think about what might go wrong in your life, but the reality is that good and bad things happen and you need to be prepared.
• Insurance is Evolving – Yes, life is constantly changing, but the benefit market is also changing too.  There are new products, services and solutions being introduced every day.  If your policy isn’t reviewed until it’s time to renew, you could be missing out on some added savings.

If we can help you improve your benefits and costs, please don’t hesitate to call us: 913-685-0000.

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April 27, 2023

American employers are facing challenges due to the developing cannabis legalization and the increased use among employees.

It may not be surprising to hear that more people are smoking marijuana than cigarettes according to a recent Gallup poll. In July of last year, 11% of Americans confirmed they smoke cigarettes compared to 45% in the mid-1950s. 16% of Americans say they smoke marijuana, with 48% saying they tried it at some point in their lives. The perception around both substances have changed dramatically in the past 50 years.

Although marijuana use violates federal law, many states have passed laws legalizing marijuana. State laws that legalize medical or recreational marijuana do not affect employers’ rights to retain zero-tolerance drug and alcohol policies. Marijuana use in the workplace can be a serious safety and health concern for a variety of reasons. Recent studies have suggested that cannabis users can have disorientation, impaired judgement, lack of concentration, and slowed fine motor skills. This can also depend upon the THC concentration, user’s experience, and route of administering.

The recent research on marijuana use and health risks have been mixed. However, there are some health risks involved with marijuana smoking. The smoke from marijuana combustion can contain many of the same toxins and carcinogens as in tobacco smoke. This can be even more harmful to immune-compromised individuals who are more susceptible to lung infections.

This is an evolving topic that we will continue to monitor.

Sources:

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March 21, 2023

How many times do you hear an insurance producer tout the number of years they’ve been in the business as a basis of doing business with them?  As my first boss used to say, “It’s not how many years you have been working that matters; it’s how many calls you have made and how you learn from those calls that matters.”  Or, experience is important, but not near as important as how you utilize your experience to help.  Our business is complicated. It takes a lot of time to learn it, understand how to maximize results and employ strategies that are impactful.

We value experience, and we treasure the opportunity to learn every day.  In every opportunity, based on our experience, we can assess a situation and identify multiple ways to address the recurring yet unfortunate theme of higher than expected employee benefit costs.  Our experience and the way we use it helps us produce better results for our customers; that’s what the Watko Way is all about.

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November 2, 2022

As I mentioned in a prior blog, the pandemic made employers focus on the health and well-being of their employees.  How do employers continue to accomplish this?

• Employee Awareness – understanding utilization of benefit options
• Ensuring equitable care and support across all employee populations
• Recognizing the value of whole person care for the organization
• Creating a successful enrollment and engagement strategy

This is The Watko Way.

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