In the ever-evolving healthcare landscape, benefits brokers, consultants, and TPAs face the daunting task of making critical decisions that impact the client’s financial standing and their members’ well-being. Balancing cost-effectiveness with quality care is no small feat. Incomplete or inaccurate plan data often hinders these decisions.

In this blog post, we explore two challenges brokers face and how they can navigate them to help their self-insured clients make more informed choices regarding pharmacy and medical benefit plans.

Incomplete and Inaccurate Plan Data

One of the most significant hurdles brokers face is data availability and accuracy. Without comprehensive and up-to-date information, making informed decisions becomes an uphill battle. For instance, relying on fill-date spend instead of current spend when comparing market contracts can lead to skewed conclusions.

“The concept of comparing market contracts based on fill-date spend rather than current spend highlights a crucial misstep in decision-making. Fill-date spend might not accurately reflect the ongoing costs of a plan, inflation, new drug releases, or patent expiration,” explains Garret D’Antoni, CFO at Prescription Care Management. “To overcome this challenge, plan sponsors and their brokers should prioritize assessing their plans based on current AWP rates. This approach provides a more accurate representation of the actual financial impact of making a PBM change, enabling better-informed decisions.”

Brokers need access to complete, real-time data that reflects the current state of their clients’ plans, allowing for accurate contract evaluations and market comparisons.

Lack of Benchmarking

Another common pitfall is comparing market contract performance without benchmarking. When completing an annual market check or preparing to submit an RFP, benchmarking plan elements such as spend, PMPM, rebates, and specialty costs against similar-sized groups gives brokers a more accurate understanding of how the plan is performing and how alternative vendors and pricing structures could impact costs and utilization.

Mr. D’Antoni explains, “Benchmarking has long been missing from the benefits management space. Brokers and plan sponsors often make decisions without knowing how the plan stacks up against similar size employers. Benchmarking costs and utilization allows brokers to provide their employer group clients with details necessary to accurately compare their plan to others.”

By considering market averages, brokers derive insight into market trends and use that information to better craft a benefits plan tailored to their client’s unique needs.

Harnessing Data Analytics and Technology with Expert Support

In an era dominated by data, leveraging advanced analytics and technology is necessary. Data analytics tools can help organizations unearth hidden trends, identify cost drivers, and predict future healthcare expenses more accurately. When adopting a data-analytics platform and partner, brokers should consider vendors with the following:

  • Established and proven data collection methods
  • Regular data quality checks
  • Documented investment in systems built to grow with the ever-evolving benefits landscape
  • Independence from other industry stakeholders and no conflicts of interest

Technology-driven analytics solutions transform raw data into actionable insights resulting in well-informed benefit strategies that align with plan goals.

“We’ve seen time after time when brokers have access to simple-to-use technology and easy-to-share cost and benchmark information, their clients are able to understand plan options and make the most informed decision about their benefits strategy,” D’Antoni added. “Our broker partners know every decision about a medical or prescription plan has real-life consequences for employees and plan members. We understand the vital importance of providing integrated data analytics technology to help this process.”

Prescription Care Management is a health tech company dedicated to simplifying pharmacy and medical plan management for brokers and plan sponsors. With plan-specific analytics and insights, PCM’s Performance tool validates contract spend, guarantees, and rebates with a few clicks. To learn more about partnering with PCM, click here.