If We Ran Your Health Plan, Here's What We'd Do

Very few people get hired at a company to run a health plan. It lands on a CFO's desk because it's the second or third largest line on the P&L and somebody has to own it, usually with no background and no obvious first step. In this episode of Own Your Benefits, Steve Gingrich and Brandon Ernstes take the seat instead of advising it. The setup is a 250 person company, fully insured, just starting to look at self-funding. What would they actually do, and in what order? Steve starts with awareness, because it's hard to get pitched a shiny new program when you already know exactly where you stand. That means benchmarking per employee per year spend nationally and against peers of similar size, industry, and geography. It also means asking how the carrier and the broker get paid, whether contingencies exist, and whether anyone's incentives are pointed the same direction as yours. Brandon starts with the leadership team. What's the culture, how engaged are the mid-level managers, how would a sharp change be received, and what does the demographic makeup look like. Higher tenure and lower turnover push you toward investing in a plan rather than buying insurance. Then the mechanics: what a captive actually is underneath the buzzword, how to vet a TPA, a PBM, a network, and a concierge, and why reference based pricing lives or dies on how easy the plan is to use. Anyone can adopt it and save money. Doing it without fixing access buys you frustration you'll pay for later. Chapters:00:00:00 - If We Were Running Your Health Plan00:01:11 - Step One: Know Exactly Where You Stand00:03:48 - Buying Insurance or Running a Plan?00:06:28 - Captives, TPAs, PBMs, and What to Vet00:10:56 - Why Access Decides Whether RBP Works00:15:38 - Prevention and the 90% Exam Benchmark