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Gone are the days when one-size-fits-all benefits plans dominated the industry. Today, employers are looking for health plans tailored to their employees' unique needs with more options and flexibility than ever before. But employers also demand plans that deliver high-quality care at cost-effective prices. So how do you help your clients achieve this balance?
The answer lies in leveraging data and key factors to build a customized benefit plan that works hard for employers and employees alike. One critical component for success is the medical network. A well-designed network not only supports employee health but also drives engagement, retention, and cost savings while improving outcomes.
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Here are five factors to consider when determining the most appropriate network solution to deliver a comprehensive health benefit plan for a client’s unique population.
- Geography: Access to in-network providers should be a top priority. Consider where employees are located, and determine if there is adequate coverage in the area. For example, a plan designed for a rural workforce may need to include telehealth options or regional provider networks.
- Demographics: Looking at the health, benefit utilization and priorities of a workforce is crucial. Different generations may prioritize different benefits — like wellness programs or mental health resources — while others may require more robust chronic care management or specialty care access. Look into how benefit plans meet these needs and what the impacts on costs are for both employees and employers. Aligning benefits with these needs ensures employees feel supported and valued.
- Plan goals: Employers’ goals often influence network design. Some prioritize cost containment, while others emphasize comprehensive care access. These goals frequently align with workforce demographics and directly shape plan structure. Ensuring alignment between plan design and organizational objectives is key to a successful benefits strategy.
- Appetite for change: Clients with greater tolerance for innovation may adopt narrower networks or value-based arrangements to reduce costs, while others may prefer the stability of a traditional PPO network. Determine if the client has the resources to support and educate their workforce when making changes to their health plan. Employers more comfortable with making changes to the plan may consider alternatives to traditional networks, like reference-based pricing or direct primary care. These solutions can also be paired with a traditional provider network.
- Access to care: Access to care isn’t just about proximity. It’s also about availability, affordability, and cultural alignment. Benefits professionals should ensure that networks include providers who offer diverse services, flexible hours, and transparent pricing. Addressing barriers like language differences or financial constraints can further enhance care accessibility. Supplemental benefits or case management programs can also bridge gaps, connecting employees to resources that support better health outcomes.
Understanding of these factors will put you on a path to building a benefit plan that aligns with employer and employees’ needs — leading to better outcomes and satisfaction. Benefits professionals and third-party administrators (TPAs) can help bring the plan to life. TPAs are industry experts who can assist in navigating the complex — and confusing — world of employee health benefits plans. TPAs often have access to creative and outside the box solutions that may not be available on the open market and can identify new cost-saving strategies while expanding coverage options. Their expertise and resources make them invaluable partners in designing plans that align with employer and employee needs.
Building a successful health plan requires a strong partnership between benefits professionals and clients. It’s not just about meeting today’s needs but also anticipating future trends and challenges. Data-driven insights, clear communication, and a willingness to adapt ensure that plans remain effective as workforce demographics and health care landscapes evolve. Ultimately, success comes down to balancing cost management with meaningful care access — creating value for both employers and their employees.
Todd Martin is Chief Sales Officer at Nova Healthcare Administrators, Inc. He joined Nova in 2010 as the only sales executive and has helped Nova expand into new markets and grow in membership.
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