Analyzing medical claims data is essential to fulfill the fiduciary duty of a self -financed employer, which is to obtain the best medical benefits for the best price for its employees. However, many employers are fighting with this, accusing third -party administrators (TA) or do not give full access to their data.
Some employers have tasks to sue their ta on this, while others have a leg at the recurring end of the demands. For example, a collective lawsuit against JPMorgan was filed in March, claiming that the company’s health benefits and prescriptions and caused employees to pay more for premiums and pocket costs.
However, there are steps that employers can take to ensure that they take advantage of their medical data and fulfill their fiduciary duty, starting with the creation of a benefits committee, according to Sherri Samuels-Fuerst, VP Advisor or Sargto Cheese and Midwest.
“Having an interfunctional team, including its CFO, CHO, legal team, members of the Benefit Team and its consultants, who regularly meet to review financial metrics, governance and even the basic administration issues of the Plan, it is really a meeting,” said Fiducia, Samuels-Fuerst during a Tuesday session at the Midwest Health Business Conference in Chicago.
Once this committee is created, Samuels-Fuerst shared seven additional things that employers should do to fulfill their fiduciary responsibilities:
1. Check your contracts: Employers must review their contracts with T Pass and other partners and review things as terms and definitions entitled in contracts, audit rights, network access rates and more. This will help you identify improvement areas.
“While it is not very exciting, the details are important, and they matter a lot in our contracts … question everything that does not sound good,” said Samuels-Fuerst. “If he says he owns, be careful. It can lead to a lack of transparency in data processes.”
2. Take advantage of your application for proposals (RFP): The best time for employers to obtain what they are because the duration is the RFP process, which is when employers evaluate with which supplier partners want to work, according to Samuels-Fuerst. She said that during the recent process of RFP of Sergeant, one of the Pas T had the language that limited the audit rights of the employer to 200 claims. Sergeant retreated and requested to have access to all claims, and the TPA agreed.
“You have the leverage duration of your RFP, you must use it,” he said.
3. Create a board: Employers must create a board to monitor and compare their medical care data. Sergeant has a board that the benefits committee reviews quarterly and uses to educate the CFO and CEO about medical care trends on time, said Samuels-Fuererst.
4. Claims analysis: Obtaining a more detailed claims analysis can help employers understand trends and find opportunities to improve benefits, according to Samuels-Fuerst. Some things that can review are diagnostic trends, the use of the emergency room, the use and adhesion of RX, high dollar claims and more. Sergeant also has alerts for high -cost claims. For example, with your TPA, you receive alerts for any medical claim of more than $ 25,000.
5. Verify the audit record: A check record is a record maintenance tool to follow all written checks, cash payments and outputs of a bank account. Sergeant checks your check records weekly.
“Our TPA has our checkbook, and although our finance team balances that checkbook, do we really know that what they are paying is legitimate? … A rapid audit can identify possible duplication claims or significant atypical values,” said Samuels-Fuererst.
6. Basic demography: Employers must have a cross table of their basic demographic data, such as the age of employees, gender, race, family size, etc. Benefit leaders should frequently evaluate if demographic data has changed significantly.
7. More data points: Additional data points that employers can look include results of employee surveys, RAND studies, focal groups and more.
“Be sure to get everything possible to inform you and help you boost your decisions,” said Samuels-Fuererst.
Source: Weiyi Zhu, Getty Images