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Money, Time and Performance: 3 Critical Health Plan Audit Statistics

Published Date

Money, Time & Performance:
3 Critical Health Plan
Audit Statistics

 
Amid the myriad types of data a health plan audit can examine and uncover, three measurements stand out. If you’re responsible for any part of your company’s employee health plan, you should know what these are and why they matter.

THE FISCALLY RESPONSIBLE THING TO DO

Financial Accuracy

The right audit shows whether your carrier is correctly spending your money. If you put millions of dollars every year into your health plans, why wouldn’t you audit the carrier to ensure they’re doing a good job for you?

 

99%  vs  99.3%

 

What’s the difference?

For an employer spending the U.S. average of $14,800 per year per employee on health benefits, the difference between 99% and 99.3% accuracy is $1,376.40 per employee.

 
 

ENSURE EFFICIENT DELIVERY OF ACCURATE PAYMENTS

Turnaround Time

This is the time from the date an insurer receives all the information necessary to process a claim to the date the claim is processed.

For insurers, claim handling time is critical to getting provider discounts (which save you and the insurer money).

You need to know your vendor is not only paying claims accurately, but paying them timely.

 

99%

 

Aon’s minimum satisfactory goal is 92% in 14 calendar days and 99% in 30 calendar days.

 
 

DON’T TRUST THE FOX WITH THE HENHOUSE

Performance Guarantees

Most vendors agree to performance guarantees, and failing to meet them can affect their fees. Too often, performance guarantees are self-measured and self-reported by the carrier.

You don’t go through life completing your own report card. Why wouldn’t you get someone to verify your carrier’s self-reported results?

 

Three Examples

 

First Call Resolution

90% on first contact

Average Speed to Answer

30 seconds or less

Call Abandonment Rate

3% or less

 
As an employer sponsoring a group health plan,
getting the right plan audits from the right partner will give you three powerful tools for fulfilling your fiduciary responsibilities:

Trust but verify
Know how well your vendors are doing, beyond self-reporting.

Meet fiduciary due diligence
Know and demand appropriate responses to all Department of Labor suggestions.

Validate vendor performance metrics
Find problems early and ensure there’s an action plan for resolution and to prevent future occurrences.