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Assisting Clients With Plan Design

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:

  • Improving participant health
  • Promoting cost-effective use of benefits, and
  • Creating tools that allow Trustees to understand and determine optimum cost sharing between the plan sponsor, participants and other parties

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:

  • Helping participants better manage their chronic conditions. This might involve providing incentives for participating in disease management or removing copays for cost-effective medications (such as statins or insulin)
  • Identifying barriers to cost-effective care in plan design
  • Promoting wellness benefits that are cost-effective
  • Helping clients provide on-site clinics (if feasible)
  • Helping the Plan (via vendors) maintain electronic health records
  • Using therapeutic-based prescription drug formularies

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:

  • Prescription drugs (generic vs. brand drugs, retail vs. mail order)
  • Primary care providers (PCPs) versus medical specialists
  • Urgent care versus emergency room services
  • Use of cost-effective providers
  • Use of centers of excellence

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).

 
OUR MISSION: To empower benefit plan sponsors to understand and better manage their benefit programs and their resulting financial risks through innovative technological applications and unsurpassed professional expertise.
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