Three Things Small Businesses Should Look for in a Health Plan

In this article published in the Sacramento Business Journal, Silicon Valley Business Journal, and San Francisco Business Times, Rob Carnaroli, Sutter Health Plus Vice President of Sales, discusses trends in the health plan marketplace and how employers should shop around.

As we head into the last quarter of the year, many small business owners are planning for open enrollment and shopping for health insurance options for their employees. A competitive and compelling health benefits package may help attract the best talent around and also retain high-performing employees.

The good news for small business owners in Northern California is there are several insurance carriers with multiple options for you to consider. While premiums are usually the first thing consumers look at when reviewing health plan options, the comprehensive value of what you are purchasing is also important. Here are three things to consider before making a final decision at open enrollment.

A network of respected and high-quality providers
An important thing to look at before selecting an insurance plan for your employees is the quality of care available through the provider network—the doctors, specialists, hospitals, and care centers your employees can access for their health care needs. Here are questions to consider about the providers in the insurance plan’s network:

• Do they deliver high-quality care?
• Is their quality and service highly rated by third-party quality rating groups, such as U.S. News & World Report, the Integrated Healthcare Association, and America’s Physician Groups, among others?
• Do the providers, hospitals, and facilities deliver integrated care, making it easy for a patient to navigate the healthcare landscape?
• Do the providers offer virtual alternatives to care such as expanded telehealth options and virtual-first primary care providers?

The desire and ability to adapt and innovate
Employers should also assess a health plan’s desire and ability to be adaptable. You may find it worthwhile to investigate how well they served their customers and members at the onset of the pandemic and how well they continue to serve their members today. Here are some questions to consider about the health plan’s ability to adapt and innovate:

• Were they at the forefront of assisting their customers and members or did they take a passive or reactive role?
• Were they quick to embrace new innovations, such as the rapid expansion and adoption of telehealth services?
• Did they remove barriers to accessing care, such as by promoting home delivery for prescription drugs, expanding access to mental health services, or reducing or eliminating certain cost-sharing?
• How did they keep their customers and members informed throughout the changes in processes?
• What do they promote beyond the “table stakes” (standard benefits, portals, ID cards, call center, etc.)?
• In addition to insurance portals with accumulators and plan details, do members have access to a provider portal where they can navigate and manage their care virtually?

Ability to simplify health care
Finally, it is important to understand how the health plan you select will help you and your employees navigate the complexity of health care. Many people find it challenging to understand what services are covered or not covered, what is in the network and what is not, and what they will have to pay out-of-pocket each year.

This is where provider-sponsored health plans have an advantage over traditional payers. Provider-sponsored health plans are health plans owned and operated by provider systems that bring together the best of both worlds—care and coverage. Provider-sponsored health plans are designed to place the member in the center of all they do by focusing on:

• Providing access to the right care at the right time in the right place.
• Eliminating the duplication of services.
• Engaging early before conditions worsen with a focus on quality outcomes.
• Encouraging routine care with a focus on prevention.
• Delivering a seamless experience, such as providing one number to call for assistance with care and coverage.

In closing
As you consider health plan options for your small business, it’s important to look beyond the monthly premium. Your employees may find value in an insurance plan that gives them access to a reputable, high-quality network of providers and may benefit from one that can deliver innovation and health care beyond the traditional brick-and-mortar provider office. And, they will appreciate coverage and care that’s simplified and easy to navigate.

Rob Carnaroli
Vice President of Sales, Sutter Health Plus LinkedIn