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Financing Solution

By Stephen Russell

In this era of creative financing and cost management tools, many employers are looking for new ways to help employees finance their health care expenses.

As an employer, you want to provide good coverage, but the cost increases in recent years have been tough to handle. A typical response to these increases may be to select a high-deductible insurance product that lowers your cost. However, there is a better solution.

Think HMO. That's right - health maintenance organizations. The HMOs of today offer a whole new generation of health care financing tools that every employer should consider.

It's not your father's HMO.

You may have heard bad stories or had a rough experience in the past. However, times have changed. HMO plans today offer extensive provider networks, excellent coverage for preventive care, the ability to frequently change a primary care physician and outstanding prescription drug coverage through broad pharmacy networks.

HMOs take the surprise out of the bill.

With most health insurance plans, an employee is responsible for a percentage of the cost of care, often 20 percent or 25 percent. This can add up very quickly, and employees can't predict what their expense is going to be.

With an HMO structured co-pay plan, an employee knows up front the expenses associated with most covered services. For example, an employee may have a $20 copay for a primary care physician (PCP) visit, which will include all services provided in that visit. Each time employees go to their PCP, they can expect to pay $20 - no surprises there.

Higher co-pays offer savings.

The days of nickel sodas and 25-cent phone calls are long gone - and so are $5 and $10 co-pay plans. It's time to rethink the value of co-pays. New HMO plans have higher co-pays, some as high as $30 for a primary care visit and $50 for a specialist. But that covers all services provided during that visit. That's a valuable cost limit these days.

HMOs offer bold new designs.

New HMO plans have fresh cost-sharing strategies that provide low employee out-ofpocket expenses in some areas while controlling your costs by increasing employee expenses through deductibles in other areas.

In most deductible-based plans, employees have a high deductible that applies to all services. However, with these new focused-deductible HMO plans, the deductible is limited to specific services, such as hospital care or prescription drugs. After the deductible is satisfied, a co-pay also applies to that service.

Furthermore, with these plans, employees continue to have a co-pay instead of a deductible for highly utilized areas such as physician or specialist visits.

HMOs are FSA and HRA compatible.

Many HMO plans can be used with flexible spending and health reimbursement accounts, enabling employees to decide how some of their health care dollars are used. Many carriers are also developing health spending account-compatible HMO plans.

HMOs offer more than health insurance.

Today's HMO plans offer health improvement programs such as discounted fitness club memberships and valueadded options that let employees take charge of their own health.

There are two primary reasons to revisit today's HMO - savings to you and savings to your employees.Rediscover today's HMO - you'll be pleased with what you find.

About The Author

STEPHEN RUSSELL, a health care industry veteran with more than 35 years of experience, joined VISTA in 2002. As vice president of product development, he is responsible for product design and implementation, and contract compliance activities for all lines of business, including Medicare, Medicaid, large and small employer groups and individual. Reach him at stephen.russell@vistahealthplan.com. © 2005 Smart Business Network Inc. Reprinted from the April 2005 issue of Smart Business Broward/Palm Beach.


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