When assisting clients with plan design and containment matters, Cheiron first seeks to understand clients’ philosophy toward health benefits before developing recommendations. Following are typical goals our consultants work with clients to achieve:
In reviewing the claims and other plan data, we continually look for ways clients can help improve the health of their participants. Examples may include:
We also look for areas where the current utilization of benefits is not as cost-effective as it could be, and recommend plan designs that provide incentives for participants to choose the most cost-effective level care. Some examples where the plan design incentives, such as different copays, are often used include:
We evaluate the effectiveness of networks through predictive modeling and benchmarking, and make sure the incentives provided are appropriate.
Cheiron also seeks to ensure not only that the plan design encourages network use, but also encourages participants to use the most cost-effective providers within the network.
We also help clients assess the degree to which they are able to bear financial responsibility for the healthcare of employees, dependent spouses, dependent children and retirees. We also help clients analyze the balance of the financial burden between sick participants (via copays, deductibles, coinsurance) versus the overall population (via participant contributions).