It's the Details That Matter

by Tim Wyman
The Wyman Group


Look beyond the quarterly summary reports to ensure that your investment is paying off.

Standing upon many a precipice, its doom ever inches away—and with more lives than the Road Runner—the Patient Protection and Affordable Care Act, aka Obamacare, has survived what was most likely its last hurdle. Barring an unforeseen happenstance, the legislation will take its place upon the mantle alongside two other landmark social laws, Medicare and Medicaid.

Immediately upon the re-election of President Obama, House Speaker John Boehner, leader of the only governing body that can impede the law’s full implementation to any degree, declared that “Obamacare is the law of the land,” indicating that Republicans will no longer devote political capital to repealing it.

However, Speaker Boehner did state that there “may be parts of it that we believe need to be changed.” Shortly thereafter, he recanted those statements in a tweet and said Republicans remain fully committed to repealing the law in its entirety. And yet, in politics, we know that the first statement is almost always the most truthful, no matter how it is spun later. Moreover, without the Senate majority, House Republicans are exceedingly limited in what they can do—as we have seen the last two years.

The Finer Points
So, in 13 short months, everything that we have said is coming is coming—Medicaid expansion, the individual mandate, health exchanges, and the employer requirement—all of it. As soon as the federal government finishes writing the regulations and details, we will happily tell you all about it.

In the meantime, if you, as an employer, are interested in controlling your costs and meeting the goal of not only attracting and retaining your employees, but maximizing their productivity, you must continue (and in some cases, start) looking at the finer points of your plan.

We’ve all heard the expression, “It’s the details that matter.” Your mother most likely said something similar when you were a kid, learning to color inside the lines. And if you’ve spent any time in the working world, you know these sage words of wisdom to be true.

A story about a security clerk at a high-end office building in Manhattan provides us with a perfect example. It seems this particular individual was not only very good at his job, he was also extraordinarily nice to anyone who checked into his desk with any degree of regularity. He learned people’s names and greeted everyone with a quick, enthusiastic smile every day. Without fail, he made everyone’s day a glimmer brighter.

When it came time to renew the building’s four largest tenants, all of them quickly re-upped for an extended term, despite a sizable rate increase. When asked why all four tenants signed up again so eagerly, without much resistance to the increased cost, all four pointed to the security guard as the reason.

Little Things Mean a Lot
And just like this one person in the multi-million-dollar leasin g company, so too are the little things in your plan important. For example, there is a fairly new weight-loss drug on the marketplace, Qsymia, that clinically shows significant loss of body fat when taken. But this pill, as you would expect, is rather expensive, at around $200 per month.

Currently, there are only three pharmacies in the United States allowed to dispense this medication. Of course, you need a doctor’s prescription, and there are some significant prerequisites that must be met in order to get that prescription. But given this country’s innate desire to deal with every medical affliction with a pill instead of diet and exercise, this is a new area of healthcare that’s ripe for abuse.

Most health plans, especially those partially self-funded, pay for some sort of weight-loss regiment, from counseling to lap-band procedures. As a new weight-loss initiative, Qsymia would naturally fit into that element of the plan, and it’s entirely possible it could do so without notice to the plan administrator. Obviously, problems like these are much easier to address early on, before the massive expenses and precedents have been established.

Understand Your Plan
So what to do? Go beyond looking at the summary reports each quarter, and start looking at detailed reports with more frequency. Understand how your plan document is written, and know how all types of claims are to be paid before you have that $10,000 claim that you cannot take back.

In addition, look at the intimate details of the ancillary plans that include the obvious things, such as dental and vision insurance, but also your wellness programs and health savings accounts. Ask if your employees are utilizing the dental insurance to its fullest benefit, for example. We now know there is a direct link between good oral health/hygiene and coronary artery disease (CAD). Make certain that you pay for those checkups twice a year at $100 a pop, versus CAD care of $30,000 per year. Beyond that, make certain people are using it. I have seen some companies require annual checkups in order to be eligible for the health insurance package.

Employers are spending tens or hundreds of thousands of dollars on employee benefit packages. I have never understood the “I just wanna write a check” mentality, when they should be making certain that their investment is paying off by ensuring that everyone is not only engaged, but that employees are using it as it is intended, without waste and abuse.

Mom was right. It’s the details that matter. iBi