Proactive Measures to Avoid Employee Health Plan Pitfalls

Apr 24, 2024

In the intricate world of employee health plan management, staying ahead of the curve isn’t just a strategic move; it’s a necessity. 

As the responsible party for your organization’s health plan, you are tasked with a crucial role in safeguarding both the well-being of your employees and the financial health of your organization. 

What is the best way to ensure you’re avoiding any health plan pitfalls?

To leverage proactive health plan management and understand how it can mitigate legal and financial risks while optimizing outcomes. 

Proactive Measures to Implement 

Risk Identification and Assessment

To effectively manage your employee health plan, it’s essential to start by identifying potential risks. Constant threats include:

  • High-cost claims
  • Compliance pitfalls
  • Regulatory changes

Work with your HR Team to establish a robust risk identification and assessment framework. This will ensure you stay ahead of these challenges and enable swift and informed decision-making.

Strategic Negotiation with Providers

Negotiating with healthcare providers and pharmacy benefit managers (PBMs) requires a strategic and direct approach. Stepping into a negotiation equipped with data and benchmarking insights empowers you to secure favorable terms. 

Whether negotiating rates, implementing value-based contracts or optimizing formularies, strategic negotiation is critical to controlling costs while maintaining quality care.

Effective Vendor Management

Your relationship with vendors is pivotal in shaping the success of your health plan. From insurers to third-party administrators, effective vendor management is comprised of the following: 

  • Setting clear expectations
  • Monitoring performance metrics 
  • Clear and effective communication
  • Conducting regular reviews
  • Building long-term relationships
  • Partnering with vendors with expert knowledge

By fostering transparency and accountability, you can ensure alignment between vendors and your organization’s goals and objectives.

Creating a Culture of Health

Promoting employee health and wellness isn’t just generous; it’s a strategic imperative. A proactive approach to employee well-being can reduce healthcare costs, increase productivity and improve morale. 

Here’s how you can create a thriving culture of health with employees:

  • Implement wellness programs
  • Provide access to preventive care
  • Foster a supportive work environment
  • Offer incentives for wellness initiatives

Focusing organizationally on the importance of wellness for all employees not only better cares for your team but also raises awareness of the health resources they have at their fingertips. This is likely to lead to an increase in health plan utilization and overall employee satisfaction. 

Take the Next Step to Avoid Health Plan Pitfalls

Navigating the complex healthcare landscape is tricky, especially for health plan fiduciaries. Taking a proactive approach to your health plan management is more than just a best practice. It’s a competitive advantage. 

Completing the actions outlined above will likely safeguard your organization’s financial stability while better caring for employees. To learn more about what Totem recommends to avoid severe implications due to health plan failures, connect with one of our team members today.


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