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Providing Healthcare Coverage for Your Medical Practice Employees


Providing healthcare insurance for your employees can sometimes seem impossible. But don't despair. There are new options to help your practice afford coverage.

I won't claim that this article will be a popular one, because when it comes to employers saving money on healthcare benefits, it is often a contentious subject for employees. However, there are realistic and not-so-unpleasant steps that can be taken to lower overall costs for everyone.

First, understand how the new reform laws may help you. Small businesses with fewer than 25 employees and annual average wages of $50,000 or less may qualify for special tax credits if they choose to provide group health insurance coverage and pay at least 50 percent of employee premiums. In a small medical practice, you may find that this credit applies to you.

Look to healthcare exchanges, starting in 2014, which allow small businesses with up to 100 employees to purchase group coverage. These are state-based and will be known as Small Business Health Option Program (SHOP) exchanges.

The concept is that small employers will be pooling their resources and risk factors into larger groups which will allow them to qualify for less expensive insurance rates. Small businesses of fewer than 25 full-time employees who qualify for the tax credits and who also purchase their coverage through the SHOP exchanges after 2014 will continue to receive special tax credits for an additional two years.

Next, really assess the needs of your workforce and audit your claims from the previous year to identify trends and patterns. Do you need to pay for a top-tier drug plan if only one employee is utilizing it? Do you have add-ons such as dental and vision that may be more affordable when purchased separately from other companies, or vice versa? Think about narrowing options. Are you offering both PPO- and HMO-type plans? It may be cheaper to restrict coverage options to just an HMO plan, but first make sure that it can meet your needs. Have the plan demonstrate that it is contracted with top specialists and facilities in your area before signing up.

Then determine what your employees are comfortable with in terms of high deductibles, copays, and cost sharing by surveying them. You may find that many prefer a lower monthly premium even if it comes with a high deductible, or that the opportunity for setting up health savings accounts is desirable to them. But you won't know unless you ask. The results will help you to determine which types of plans you should ask for quotes.

Once you have nailed down your needs and options, get as many quotes as possible. The range and variation between plans can be staggering. Use an agent or broker, as they can help you make sense of offers and help to negotiate best pricing. And do this annually! Also look into any groups or associations that may help you lower costs - for example, local chambers of commerce may have local businesses in one pool (or group), which helps to lower costs for everyone.

Go the wellness route. Offering a wellness plan - any type of plan, whether it is subsidized gym membership, onsite blood pressure checks, or reminders for annual physicals - will help secure you a discount from your next insurer. And if you have smokers on your team, offer smoking cessation support.

Lastly, take advantage of insurers' patient support programs. For example, United Healthcare offers comprehensive diabetes management for its members, working one-on-one with its employed nursing staff. Most large insurers offer similar programs, so take advantage of them, see your employees' health improve, and avoid rate hikes the following year.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She is also COO, National Breastfeeding Center, and cofounder, Patient Centered Solutions. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.

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