Strategy and Analysis: How Alternate Funding and Tools Can Help Control Small Group Health Plans

From ChamberChoice and Smart Business Pittsburgh

Today’s health care environment is riddled with complex plan designs and rigorous government regulations, leaving many employers to feel as though their hands are tied when it comes to finding unique, innovative and cost-saving solutions.

But a new concept is emerging that will enable small employers to identify current and future risk, influence behavior and control costs. 

Smart Business spoke with Aaron Ochs, a consultant at JRG Advisors, about strategic analysis and risk management in the small group health insurance market.

How is the small group health insurance market changing?
Typically, small employers have been unable to maximize the value of their medical benefits due to lack of claims utilization and analysis from their insurance company. In the typical buying arrangement, the small group market is a fully insured contract that does not offer the employer much control over the health plan. Self-funding works differently.

In addition to providing protection against excessive costs in years with high claims and the opportunity to keep the profits from favorable years, the availability of data, including claims utilization, is a significant advantage for the employer. Knowing the health and risk factors of the employee population helps the employer determine the appropriate benefits strategy.

Self-funding is not a new concept; but it is new to the smaller employer — with many insurance companies offering level-funding premium options (a form of self-funding) to groups with as few as 10 insured employees.

With level funding, the employer puts aside enough money to cover anticipated claim expenses and the monthly premium remains level for the entire plan year. If claims are less than the funded amount at the end of the year, a rebate or credit is issued. If claims exceed the funded amount, the employer is protected by stop loss.

How can employers use data as a tool to help?
The ability to anticipate or predict claims costs hasn’t been available in the small group market due to the absence of claims data from the insurance companies — until now.

This is where newly developed risk management and predictive modeling tools come into play, making it possible to take a much ‘deeper dive’ into the composition and risk of the smaller employer, proactively identifying members with markers for chronic illness to predict health risks and determine if self-funding is a viable solution.

The deeper dive begins with employee data that is captured through a custom access portal, scrubbed and reviewed. The portal is an insurance company-accepted, Affordable Care Act and HIPAA compliant online benefits application tool designed to reduce the amount of time, cost and paperwork for employers. Employees are asked to complete an online enrollment interview. The employer receives a confidential de-identified aggregate report with an overall analysis.

This expert analysis guides the business owner through the benefit decision process with the power of knowledge. Gaining insight into the composition and health status of the group means plan design decisions can be strategic rather than an annual game of ‘pinning the tail on the donkey’ to find a tolerable solution.

What kind of results can employers expect?
Often, the same portal technology can reduce or eliminate many administrative burdens by providing the added support of employee enrollment, communication and plan election/waivers. The solution is a faster and more efficient approach to benefits. This means employers can essentially build their own health plan, which can lead to generous cost savings, greater transparency and understanding, and better overall cost control.

Over half of an average employer’s health care budget is spent on members with preventable conditions. It’s time for small employers to take control of their health care plans. Talk to your advisor to learn how these funding arrangements and risk analysis tools can help with your strategic benefits planning needs.

Bloomsburg and Luzerne County Community College Nursing Programs Enter Into Agreement

Two Chamber members, Bloomsburg University and Luzerne County Community College, recently entered into a new agreement that will help facilitate the transfer of LCCC’s nursing program graduates to BU to complete their bachelor’s degree. Nationally, nursing is one of the most in-demand professions and with two of our area’s largest employers — Geisinger and Commonwealth Health-Berwick Hospital Center — both being affected by this national shortage of nurses, the Chamber hopes that this new agreement can, over time, help address this workforce shortage for this profession on a local level. 

Below is the official joint press release from BU and LCCC announcing this new collaboration. 

NANTICOKE–Luzerne County Community College and Bloomsburg University of Pennsylvania have entered into a new agreement which will help LCCC nursing graduates transfer from the community college to Bloomsburg University to complete their bachelor’s degree.

The Guaranteed Admissions Agreement is designed to facilitate the transfer of LCCC nursing graduates from The Mary Gill Carrozza, R.N. School of Nursing and Health Sciences to the BU online nursing program. LCCC graduates will be guaranteed admission into BU’s Bachelor of Science in Nursing (B.S.N.) online degree program with third year (junior) status.

In order to take advantage of the program-to-program agreement, students must graduate from LCCC with an Associate in Applied Science (A.A.S.) degree in nursing with a minimum grade point average of 2.0. LCCC nursing graduates are also required to successfully pass the National Council Licensure Examination for Registered Nurses (NCLEX) prior to beginning courses at BU. The application fee to Bloomsburg will be waived.

“We’re pleased to continue our valuable partnership with Bloomsburg University, which has consistently ranked among the most popular choices for our students to continue their education,” says Thomas P. Leary, president, LCCC. “The College has many nursing graduates who are employed in the region and this cooperative agreement allows them to continue their education online and obtain a bachelor’s degree while working in their field.”

“This is another fine example of the strong, collaborative efforts BU maintains with its significant community college partners in Pennsylvania, with the ultimate goal of student success,” says Dr. Bashar Hanna, president, Bloomsburg University.

For more information about the new partnership, contact Jim Domzalski, director of enrollment management at LCCC at 570-740-7342 or email, or Tom Fletcher, vice president of enrollment management at BU at 570-389-5161 or email.

Executive Order Supports Broadband Infrastructure Expansion With Focus on Rural America

In an effort to support the expansion of broadband internet service in rural America, President Trump signed an executive order on Jan. 8 that streamlines the application process for locating wireless facilities on Federal property. The order sets guidelines and timelines for processing applications from private entities. It is hoped that other benefits will be realized from this policy “to use all viable tools to accelerate the deployment and adoption of affordable, reliable, modern high-speed broadband connectivity in rural America.” (Read the full executive order)

The Columbia Montour Chamber continues to advocate for the expansion of broadband in rural areas to support economic growth. In November, the Chamber sent a letter to the Federal Communications Commission supporting a petition by the Pennsylvania Public Utility Commission (PUC) to keep $140 million for broadband expansion in Pennsylvania. While federal funds have traditionally only been available to regulated telecommunications companies such as Verizon, the PUC and Chamber are seeking greater flexibility to work with other potential providers.

New Legislation Makes $30 Million Available in Grants for Businesses in Solar Energy Field

From Chambers for Innovation and Clean Energy

In an effort to help develop and maintain solar jobs and manufacturing in Pennsylvania, new bipartisan legislation was recently passed and signed into law to do just that. Act 40 is designed to keep solar energy jobs within the Keystone State instead of sourcing them to neighboring states, as has been practice in recent years.

Additionally, $30 million in grants and loans is now available through the Solar Energy Program (SEP) to businesses that manufacture solar equipment, or generate or distribute solar power. The goal is to support Pennsylvania’s efforts to strengthen its position in the clean energy space.

“The Solar Energy Program is vital in our efforts to make Pennsylvania a leader in clean energy,” Governor Tom Wolf said. “Developing new renewable energy sources including solar is critical to ensuring Pennsylvania has a balanced and diverse energy mix that maintains our position as a major energy producing state.”

Many local Pennsylvania chamber member businesses can benefit from the SEP as it provides financial assistance in the form of grant and loan funds to promote the use of solar energy in Pennsylvania.

If your organization is interested in applying for a SEP loan or grant, please visit the PA Dept. of Community and Economic Development page.

PA Department of Labor Offers Free Workplace Safety Webinars During January

The Pennsylvania Department of Labor & Industry’s Bureau of Workers’ Compensation Health & Safety Division will offer a series of free webinars on workplace safety throughout the month of January.  Titled PATHS (PA Training for Health and Safety), these webinars will cover subjects such as safe driving in inclement weather, dealing with angry people, snowblower safety, safety incentive programs, mold awareness, ADA compliance, social media safety and much more. Each webinar lasts approximately one hour depending on course material and viewer participation. 

For more information, to register, and for a complete listing of each webinar, visit the PATHS training calendar