Finding the Right Fit

Over the last 20 years or so, we’ve seen a lot of changes in the open enrollment process. We’ve gone from filling out stacks of paperwork to going online to read about our coverage options and then making our choices with a few clicks of a mouse. Another big change is in the number of different types of health plans we’re being offered. Many employers are offering four or more plans that may include choices like a traditional PPO, an HMO plan and a couple of high deductible options. How much time do you spend on selecting the plan that is the perfect fit? Is it more or less than you spend trying on jeans to find the perfect pair? Chances are that it is less; and while finding the perfect pair of jeans is important, it doesn’t usually have the long-term impact on your physical and financial health that choosing the right health plan can have.

When you go to buy a new pair of jeans, you bring several facts with you that help make sure you pick the right pair: you know your size, what color you need and the cut you prefer. At Benefitfocus, we think of approaching the purchase of health coverage in the same way - armed with information. For example, if you knew what health care services you used last year, you could make an informed decision about the type of coverage that is right for you – paying more up front with less out of pocket at the time of service (PPO or HMO), or paying smaller amounts in premium and only paying out of pocket when and if you use services (high deductible plan). Taking that a step further, what if you also knew what your predicted risk was for the coming year based on factors like your age, gender and the healthcare services you received during the last 12 months? You would then be able to select the coverage that not only fit the healthcare needs you had last year, but is a better fit for what may happen next year.

While making data-based decisions is important for the consumer, we think it is imperative that plan administrators also have access to the same information so that they can be sure they’re offering the type of plans that their members need. Much like a store would keep track of inventory and sales trends to ensure they stock the right types of jeans, plan administrators should be able to see not only what types of coverage their members chose last year but also the types of care most commonly needed and the providers most often visited. Additionally, knowing the average predicted risk for their population in the coming year, based on demographics and utilization patterns, would help them ensure that they ‘stock’ the right types of health plans for next year.

Having ongoing access to cost and risk data helps administrators make the best offerings available to their members and helps the consumers make the smartest purchasing decisions during open enrollment. This is important because, unlike a bad choice in a pair of jeans, you cannot return to the store and exchange your healthcare plan for a better fit.

Our team will be in Las Vegas next week attending the 17th Annual HR Technology Conference. Stop by booth #2403 to learn more about the data analytics applications available through our Portfolio of Products & Services.