August 29, 2022


Have you looked at your health plan data lately? Do you understand the story it’s telling you?

Careful preparation can make your health plan renewals more effective and less painful. Being prepared means knowing the projected risk of your current situation and identifying alternative solutions now — so you can mitigate year-end cost increases.

To realize the greatest value in your company’s benefits plan, consider these 5 tips:

Analyze medical and Rx claims to find cost-savings opportunities

  • Look at data proactively throughout the year
  • Review claims from financial and clinical perspectives
  • Maintain a rolling 24 months of information and a history of all plan changes
  • Compare actual experience to prior renewal projections
  • Request renewal projections from your carrier
  • Analyze claims data monthly to find cost-savings opportunities for your plan

Benchmark your plan to see where you stand competitively

  • Ask your broker for benchmark data to compare your plan to other organizations and ensure you’re as competitive as possible
  • Utilize local, regional and national benchmarks to review:
    • Average annual cost for employees
    • Average monthly employee contributions
    • Deductibles, copayments, coinsurance, out-of-pocket maximums, etc.

Leverage new pharmacy benefit savings opportunities to reduce costs

  • Consider a tiered formulary design to help prevent unexpected expenses and reduce overall prescription costs for you and your plan members
  • Find out the strength and transparency of your PBM contract by requesting an assessment from your broker
  • Curb specialty drug prices by implementing a patient assistance program (PAP) that offers copay assistance and/or financial-based assistance for your plan members
  • Educate your plan members on where to find rebates and coupons for the most cost-effective prescriptions and services

Implement disease management strategies to impact high-risk plan members who are at greatest risk

  • Review claims as often as possible to identify the 20% of your population who account for 80% of your costs
  • Implement a biometric testing program to improve health outcomes
  • Utilize nurses to communicate peer-to-peer with your insurer’s case management staff for timely high-cost claims identification and intervention
  • If you have a wellness program, revisit your strategy and make sure the program meets your goals for ROI, true employee engagement and positive outcomes

Explore alternative stop loss vendors

  • If your current stop loss vendor is already predicting delays in your renewal data, explore additional vendors in your RFP process
  • If your company is on a self-funded plan, determine the financial stability of your stop loss coverage provider and make sure the carrier is vetted, stable and financially sound
  • Review the carrier’s contract terms, coverage definitions, lasering and rate caps to make sure they fit with your company’s needs

Not sure where to begin with analyzing your health plan? Now is the best time for you to schedule a Peer Review – a no-obligation review of your organization’s medical and pharmacy costs. To learn more, visit so you can confidently head into renewal season fully equipped with all the information you need.

Download “5 Questions to Answer for an Effective Renewal” and learn how a Peer Review can help your organization identify hidden savings and control costs at