Situation and Complication
Self-insured employers are increasingly relying on additional services, e.g., telehealth, care navigation, to remedy the failings of the standard health plan. Unfortunately, due to the industry’s notorious lack of transparency, employers cannot measure ROI. Instead, they are left to measure “engagement” and assume that engagement is beneficial. And yet, there is rarely any visible impact on trend, leaving employers to wonder if engagement is sufficient.
Solution
Get your claim data and calculate the ROI. Under ERISA law, a health plan is expected to manage health plan performance. Therefore, employers with ERISA plans can obtain THEIR data from the carrier / Third-Party Administrator (TPA) to optimize the performance. The carriers do not make that process easy (surprise!), but it can be done, with knowledge and diligence. Add in your vendor’s engagement data and you can evaluate whether the engagement is on-target (i.e., with most applicable members) and calculate ROI.
Wellnecity Example
