Working with an employee health insurance broker or consultant

Navigating the complexities of today’s health insurance marketplace can get overwhelming for employers. The landscape is constantly evolving with legislative changes, technology advancements, and group policy options.

Employers must consider the value of different plans, balancing fixed and variable costs while ensuring comprehensive coverage for their workforce. Health insurance brokers and consultants can add valuable expertise.

What to expect from an insurance broker or consultant

Employee health insurance brokers and consultants serve as intermediaries, offering specialized knowledge about an intricate system of options. They:

• Analyze employee insurance utilization for health care trends using third-party data modeling tools and/or payer-provided data.
• Compare employer group health plans to find the best fit for current needs, based on data analysis.
• Respond to employee benefits surveys with programs tailored to needs and expectations (e.g., mental health care, virtual visits).
• Identify underused benefits to reduce cost, while also looking for opportunities to improve preventive care and chronic condition management.
• Negotiate favorable terms that deliver both high value and competitive costs.
• Provide updates about new employee health care solutions entering the market.
• Offer year-round guidance on regulatory changes and industry trends, not just at open enrollment time.

“Ten years ago, companies would offer multiyear arrangements,” says Amanda Rose, Director, Producer Strategy at Highmark, Inc. “Now, companies reassess their needs and costs every year. Their broker or consultant should explore and understand every option. Especially when it comes to pharmacy benefits, which is the biggest cost in health care coverage.” 

At a health care insurance company like Highmark, the vast majority of business runs through brokers or consultants. They are an essential partner to employers and benefits administrators. Brokers either work on commission or for a negotiated fee, often depending on the size of their clients.

Adding value to employee health

Value in health care means keeping people healthy through preventive care and timely interventions for chronic conditions. Value is also about making the most of available health care dollars and facilitating whole-person wellness. Other aspects of value include quality, health equity, engagement, and outcomes.

“At Highmark, we ask brokers and consultants for their feedback on the potential for new solutions,” says Rose. “Is there an appetite for this solution? Is this something that can add tangible value? If we can continue to launch comprehensive solutions into the market, we will expand and increase access to care. Increasing access will bring Highmark one step closer to our Living Health mission of reinventing health care,” she continues. “The industry cannot continue to drive the market with fragmented solutions. By doing so, we give health plan members a disjointed experience.”

Highmark solutions no longer require as special “opt in” for condition-specific programs. “Everything gets included up front. We are launching solutions that integrate clinical outcomes and pharmacy benefits — creating a cost-controlled experience with improved accessibility,” adds Rose.

She used Highmark’s virtual diabetes care management program as an example. “We chose a clinician-led diabetes management program that includes access to certified endocrinologists,” she explains. “Members can get virtual care within a matter of days versus waiting months to see a specialist in person.” Companies with high employee claims rates for diabetes care can find value in such a solution.

The same applies to other Highmark programs for mental health, musculoskeletal health, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). The solutions are built in, making easier it for employers to provide comprehensive health plan coverage.

Controlling pharmacy benefit plan costs

Health care costs continue to rise, with pharmacy benefits leading the way. An educated broker will ensure accurate comparisons among insurance companies and pharmacy benefit managers (PBMs). PBMs are entities owned by pharmacies or that are separate operating units of large insurance companies.

Integrated pharmacy benefits are part of the employer group health plan. Third-party PBM agreements — called pharmacy carveouts — are separate from the larger health plan. Rose wants employers to understand the contrast. 

“Our integrated pharmacy solution is a differentiator at Highmark,” says Rose. “It’s part of our Living Health approach and vision for 360-degree, whole-person care.” An integrated pharmacy solution can also deliver savings.

Savings come from improved efficiency under one payer umbrella and better overall member health management. A combination of preventive care, wellness programs, and chronic condition management may reduce reliance on medications.

Making the right group health insurance decisions

Employee health insurance is complex, with costs that can easily escalate. Choosing a trusted broker or consultant is a key decision. They should be someone who is not just chasing business but serving as a true partner.

This person is essential to finding solutions your employees want and need, based on rigorous data analysis. It’s important to know where your health care dollars are going in order to eliminate waste and add value. For example, if employees are overspending on medications, it’s time to investigate an alternative pharmacy solution. 

Intangibles also matter. Accessible care, convenience from options such as phone apps, customer service, and community resources are essential in serving the whole person. “We have a greater mission at Highmark,” Rose stresses. “We are trying to make a fragmented health care delivery system easier for our millions of members.” 

Talk to your employee health insurance broker or consultant to see what’s new at Highmark. Use our Broker/Consultant Checklist to ensure that you’re maximizing your relationship and employee health care dollars.

_{All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.}