Is it Finally Time to Think Outside the Box?

Fallon recently announced they are leaving the commercial health insurance market to focus on Medicare plans.  On January 4, Tufts and Harvard Pilgrim announced they have formally combined the two organizations.  https://tuftshealthplan.com/visitor/company-news/2021/tufts-health-plan-and-harvard-pilgrim-health-care

For a number of years, Massachusetts, and Western Mass in particular, have had several excellent local and national health plan options available.  I think it’s unfortunate that the number is now 2 fewer.  Despite the fact that prices have continued to rise, competition is good for employers and their employees.  Less competition doesn’t seem like a win for anyone.

But is there really less competition?  I get calls every week from companies trying to gain market share in Massachusetts, many with some very creative ideas.  The reality is there are plenty of options available for plan sponsors that are willing to think a little outside the box.  Here are a few examples:

  • A local client was getting hammered with increases every year due to an employee’s family using a very expensive specialty medication.  We helped them save over 40% with a change in pricing structure.
  • A small client got a refund check of over $30,000 due to favorable claims experience on a dividend-eligible plan.
  • We have 2 clients considering a new approach that will save more than 20% if they decide to implement the recommended changes.

Other examples include, but are not limited to no-network plans, banding together with a group of other employers to drive down costs, co-employment relationships, and plans that provide incentives to get better quality care at a lower cost.

Losing 2 of our local health plan options is a bummer, but it doesn’t necessarily have to mean there will be a reduction in competition.  Maybe it’s time to think a little outside the box and consider some creative and new alternatives.

If you’d like to discuss creative health plan solutions, give us a call at 866-724-0008 or click the link below to send a message.

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