Understand the External Market

• Check your plan’s financial strength by consulting resources that publish strength ratings for HMOs and health insurance carriers, such as Fitch Ratings, Moody’s Investors Service, and Standard & Poor’s.
• Check external quality of care reviews performed by independent organizations such as the NCQA (ncqa.org) or The Joint Commission (www.jointcommission.org).
• Evaluate the impact of your plan’s diversified portfolio, multiple product lines, or lack thereof.
• Determine your plan’s level of knowledge, experience, underwriting expertise, and plan design options.

Maintain, Understand and Use Your Data

• Review claims quarterly if you are experience-rated.
• Maintain a rolling 24 months of information and a history of all plan changes.
• Compare actual experience to prior renewal projections.
• Request renewal projections from your carrier.
• Analyze claims data to find cost-saving opportunities for your plan.

Benchmark Your Plans

• Ask your broker for benchmark data to compare your plan to other companies, based on several factors:
• Demographics
• Average annual cost for employees
• Average monthly employee contributions
• Deductibles, copayments, coinsurance, out-of-pocket maximums, etc.

Evaluate Your Current Carrier

• Evaluate the following factors about your carrier and what they can offer:
• Financial – including discounts delivered, return on investment on disease management and wellness programs, and ability to offer new products
• Service – including employee surveys, online services to assist in plan administration, and communication pieces for employees
• Network – including in-network access and usage level, quality and tools for measurement, key additions and deletions, and disruption study

Consider New Ways to Leverage Costs

• Consider plan design changes such as raising deductibles or copays for out-of-network providers, implementing a tiered prescription drug plan design, offering a consumer-driven plan or increasing employee cost-sharing in other ways.

• Explore alternative stop-loss vendors.
• Complete a dependent eligibility audit.
• Implement disease management or wellness initiatives, or expand upon existing programs.
• Offer additional employee education regarding healthcare consumerism and making informed healthcare decisions.