There are many distinct differences between fully insured and self-funded plans, and one of the biggest is access to data. In a fully insured plan, employers typically receive some basic summary data at year’s end right before renewal time. The problem? This data shows overall costs accumulated for the year, but it doesn’t give employers a chance to act on any troublesome trends or other issues as they’re happening.
With self-funding, employers have access to more health plan data and receive more frequent reports – often monthly or quarterly – that break down the numbers. Plus, a variety of reports can be generated, including:
- Total claim charges billed
- Total claim charges paid
- Diagnosis reporting with payments by service code or diagnosis
- Payments by provider/place of service
- Network utilization
Why is it so helpful to receive all of this data on a regular basis? First off, it helps with planning and benchmarking. Seeing actual costs gives employers a better idea of what to expect for the future, and it also helps them identify – and proactively respond to – any cost hikes over time. On top of that, this data helps employers adjust their plan benefits based on medical trends. Let’s say there’s a large increase in the number of claims coming through for a certain medical condition. Based on this data, employers can implement a targeted wellness effort, education program or benefit solution.
If your company has a self-funded plan in place, take advantage of the data! Ask your third party administrator for reports and watch the trends. This information is available to you so go ahead and make the most of it!