Plan Integration
Employers are strongly encouraged to systematically coordinate their health plan design and
administration activities with other benefit and human resource programs. The Business Group
believes this type of integrated approach will lead to decreased healthcare costs. Examples of
integration opportunities include:
• Team with workforce scheduling staff to develop alternatives for pregnant and postpartum
women and parents of children with special healthcare needs (e.g., compressed workweeks,
telecommuting, flex-time, alternative start and end times, and partial workloads).
• Collaborate with disability plan administrators regarding return-to-work strategies for
postpartum women.
• Coordinate plan benefit administration activities with employee assistance program (EAP)
managers regarding the availability and use of mental health prevention and treatment
benefits.
• Include information on the value of preventive services in work/life manager and employee
training sessions.
• Include well-child care and prenatal care resources in health promotion materials.
• Incorporate maternal and child health needs into existing worksite-based health promotion
programs and policies (e.g., healthy cafeteria, on-site immunizations, campus-wide smoking ban).
Actuarial Analysis
Purpose
Benefit managers charged with administering employer-sponsored health benefits are often forced to
make difficult resource allocation decisions. Typically, an employer’s benefits budget determines the
selection and continuation of health benefits. However, increasing healthcare costs and stagnating
quality have led many employers to shift their focus from budget-based allocation decisions to value-
based purchasing strategies. Value-based purchasing brings together information on the quality of
healthcare, including health outcomes and health status, with data on the dollar outlays going towards
health.^15 It aligns financial incentives for beneficiaries and providers to encourage the use of high-
value care while discouraging the use of low-value
or unproven services.^16 Employers have also begun
to evaluate the medical evidence for benefits, as
described in the previous section.
Concepts of evidence and value have helped
balance health benefit decisions in recent years.
However, the cost impact of benefit modification
remains a critical factor in employers’ resource
allocation decisions. To help employers understand
the cost of adopting the Plan Benefit Model
recommendations, the Business Group sponsored
an actuarial meta-analysis of the model. This
analysis estimated the cost impact of the model’s
recommendations on typical large-employer health
Because preventive services can
prevent or reduce the need for
treatment they provide a cost-
offset. Employers who invest
their healthcare dollars in screen-
ing, counseling, and preventive
medications may be able to avoid
spending healthcare dollars on
treatment. In some cases, where
the cost of screening is less than
the cost of treatment, employers
may be able to save healthcare
dollars by investing in preventive
services. For more information on
cost-offsets, refer to page 77.