Six Steps to Uncover and Address Pain Points in Your Health Benefits Plan

By Melina Kambitsi, Ph.D.

Do you have costly pain points hidden in your health plan data?

It’s important to know the trends of your organization’s health claims data. By examining your data, you can identify pain points. Pain points are the problems hidden within your data that are causing you pain by pushing up your costs without increasing the value of health care for your enrollees.

Now is the perfect time to talk to your health care partners and analyze your healthcare data to see what you can learn. And if you don’t have data on hand, ask your broker or your third-party administrator (TPA) for it.

This list can help guide you through the process of identifying pain points and then creating a plan to address them.

  1. Get to know your health claims data. Working with your trusted advisor, search for trends to uncover where your money is being spent.
  2. Discuss your trends and identify specific pain points. Examples of pain points could be the rising use of imaging tests such as MRIs in highcost settings, wild variations in costs for inpatient hospital care or an increasing number of enrollees who have health conditions, such as diabetes, that are tied to higher overall health care costs. As part of this process, you should identify the health benefits vendors who play a key role in serving enrollees. This might be your provider network, TPA, pharmacy benefit manager (PBM) or another vendor.
  3. Working with your broker and vendors, find options for addressing these pain points. For example, if costs vary wildly for common surgeries, one solution can be providing incentives for enrollees to opt for care from a “bundle” provider such as NOVO Health. A bundle means that a single price, which is known in advance, covers most or all elements of a surgery or test.
  4. Define goals to measure health outcome quality and costs. Repeat for each of the targeted pain points so that you can measure the value you are getting from your health benefit costs.
  5. Evaluate the progress of your plan design changes annually. Adjust the plan as needed.
  6. And finally, consider how you can benefit from direct contracting. Utilizing the right network providers that uniquely serve the needs of your population can greatly assist you in managing your health care costs.

Knowing your pain points can empower you to design a more effective health benefits strategy. Self-funding can play a critical role by giving you access to data and flexibility in plan design.

Melina Kambitsi is senior vice president, business development and strategic marketing, for the Alliance. To learn more, contact Melina at 800.223.4139 x6643 or [email protected]

The Alliance ( is an employer- owned, not-for-profit cooperative that moves health care forward by controlling costs, improving quality and engaging individuals in their health. Its more than 240 employer members provide health benefit coverage to more than 85,000 people in Wisconsin, Illinois and Iowa.