One More Thing to Add to the Benefits Manager’s Job Description

If you go to any job search site and look at open positions for a Director of Benefits, you’ll likely see common themes: the ideal candidate will develop and implement the organization’s benefits strategy, manage a budget as well as an internal team and a cadre of external vendors and consultants; the candidate will be responsible for ensuring compliance with federal regulations, overseeing employee communications…the list goes on. One job requirement that you won’t find on Indeed.com or LinkedIn is that the ideal candidate will align with health care benefits peers in other companies or organizations with shared expectations of third party administrators to do their part in improving the quality and affordability of health care.

You – as a benefits director – are probably thinking to yourself right now – “Wait, what?!  That’s not in my job description!  And I’m already working 60 hours some weeks!”  But consider the following:

1. It’s highly likely your employee base is located in a market that lacks any meaningful provider competition. After all, according to the Health Care Cost Institute, 74% of metro areas are highly or very highly concentrated. 
2. Your health care spend is therefore at the whim of your third-party administrator’s (TPA’s) success at negotiating affordable rates with dominant providers, and there aren’t many alternatives to your TPA.
3. About 75% of Americans who are not covered by Medicare or Medicaid receive health care coverage through their employer; so while any one employer-purchaser may not have much sway, purchasers that align their expectations with those of other purchasers will send a stronger signal to the market. 

So, how might this purchaser alignment exercise work? 

It could involve bringing your peers together, for example, to meet with a key health care provider to understand why purchasers are paying so much more than Medicare for the same services, or with a TPA to push for a high-performance network option in a specific geography.

Or it could involve taking a page from the same playbook during a Request for Information/Proposal, Request for Renewal, or when renegotiating your administrative services contract.  CPR’s flagship Aligned Sourcing & Contracting Toolkit is intended to help purchasers align their expectations with those of other purchasers using these tools, sending a strong signal to TPAs, and through them, health care providers.  It comprises three resources – a Request for Information Questionnaire for when the purchaser is seeking bids from multiple TPAs, a Renewal Questionnaire for incumbent TPAs, and Model Contract Language that a purchaser can include as an addendum to its administrative services contract.  All three tools address important marketplace issues, like health care price inflation, provider market power, price and quality transparency, payment and delivery reform, and benefit and network design.  This year’s iteration also gives purchasers tangible questions and contract language for working with their TPA to analyze race and ethnicity data and address care inequities and outcomes disparities.

So, what are you waiting for?  CPR’s updated toolkit will help you crush it!  By addressing critical marketplace challenges, with the added influence of your peers, you are ultimately helping your organization and plan members manage their health care spending and get better value for it.