Business

Private Employer Onsite Health Clinic

How To Tansition Health & RX Claims

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USPA NEWS - There never seems to be a logical way of turning your company health plan into a revenue producing stream. If anything, it's always the opposite.
Source: Edwards Strategy Group, LLC
There never seems to be a logical way of turning your company health plan into a revenue producing stream. If anything, it's always the opposite. But there is a way to transition claims experience away from your health plan. By doing so it will help create a significant reduction in your plans usage and claims experience for primary care and prescription drugs. This will definitely two things, 1. Provide better healthcare for employees. 2. Help drive your rates lower. Usually the first question is, 1. What will it cost me? 2. Is there a way to calculate my ROI? Cost will vary depending on the number of employees and how many hours will the health center would be open. To make it viable and cost effective for the employer, there should be a minimum group of about 400 employees and the center would need to be open for 25 hours a week to accommodate the group size. There are other ways this may be accomplished if one location may not have that many employees. As an example in an industrial park setting you could have several different groups of employers go together and cost share based on their group size helping all to reduce their healthcare cost. Remember this is a private employer healthcare center, only for employees and their dependents. Not for the general public! Very important distinction when dealing health clinic compliance regulations. Here is a sample model for a group of 400 employees with 2.5 average dependents, representing 1,000 total lives. The analysis shows three 3 levels of participation from your employees. If 20% of your employees use the center vs. 35% & 50%. Normally its break even the first year for employer. Mostly due to setup cost. In years 2 & 3 and there after you can recognize the transitions. Obviously numbers can and will vary from region to region. But the idea is to see how you can transition both health and RX claims via through your health center. Your buying power for RX drugs now changes from paying retail through your health plan RX, to buying whole sale because you are now a health clinic pharmacy. This can drive your RX cost down by thirty precent 30%. In summary when you combine a health center with the Benefit Science Technologies & Robust Optimization as discussed in previous article you will see substantial savings.
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