BMI-HealthPlans designs self-insured benefits packages

As health care costs continue to rise, employers are looking for ways to provide employees the best possible benefit packages and still manage the bottom line.

BMI-HealthPlans, as a claims administrator for employee health plans, manages health programs for employers in the self-insured market, said Jeff Rogers, operations manager for the company's Springfield office at 3116 S. Pickwick Place. A self-insurance, or self-funded plan is one in which the employer establishes a fund from which day-to-day claims are paid. The fund is paired with reinsurance policies to cover catastrophic claims.

The office is one of three regional BMI-HealthPlans locations, said Dave Sigmon, BMI president and chief executive officer. Regional offices, he said, make it possible to be closer to the medical community and also provide better quality of service. "We try to have be-tween 20 and 30 employees in an office."

BMI often works with employer groups that have from 50 to several hundred employees. "We have one client with 8,000 employees, but for the most part we're mid-range," Sigmon said.

Changing market

The health care market has changed considerably over the years, according to Sigmon. In the early '80s, the government began to change laws in ways that encouraged employers to become self-insured. As more employers began to understand the processes and legal issues involved, they found they could save money and have more flexibility by designing their own benefit plans. As a result, 60 percent of employers with more than 100 employees today are self-funded or partially self-funded.

BMI's job is to help self-insured em-ployers design, administer and manage their benefit plans. Rogers said, "When we sit down with a client, what we're trying to do is just give them all the options of how to manage their bottom line. It's our job to go out and find them the best rates and the best coverage."

State and federal regulations can make creating a health plan a complicated matter. Along with an in-house legal counsel, BMI works with clients to make sure their plans are set up properly from the legal standpoint. "Our goal is twofold," he said. "We are providing the service, actually processing the claims, but then we're also bringing a lot of other expertise to the table."

Role of prevention

Rogers, who joined BMI Oct. 1, brings his own expertise to the area of prevention. After 10 years of being in charge of St. John's Hospital's marketing of wellness and preventive programs and workers' compensation programs, he started his own health care consulting company, Corporate Health Coaching. Through that company he became familiar with BMI. "I was really impressed with what they were doing," he said.

Rogers said that his approach has always centered on wellness and prevention. Now he explains to clients that rate increases are due in large part to preventable illnesses. "Prevention is a tough sale," he said. "We all know that we need to eat properly and exercise, but it's just finding the commitment level from the employer to say, We're going to put these programs in place, and we might not see the return in the first quarter or the first year.' In the long term, however, a healthier group of employees will help reduce health care costs."

Rogers noted that most companies have safety programs in place to prevent employee injury and that Springfield has several companies with excellent prevention and wellness programs. He added, however, that with the tightening economy and increasing health care rates, it is often difficult for employers to spend money in the short term to try to save on future health care costs.

Rogers described health care as "just a tough marketplace" right now. "It's our job to help our clients negotiate discounts with provider networks. We try to approach it from every angle we can."

He noted that employers are faced with rising costs each year at renewal time and have to look at the benefits they're giving employees and try to find ways to either cut some of those benefits or ask employees for a greater contribution to the plan. "It puts then in a tough situation," he said.

The future of health care is uncertain, Rogers said. "It is possible that in the next three to five years the government might try to step in and dictate how things will be done."

Many companies are looking at ways to reward employees for a healthy lifestyle through incentive programs. Rogers said that instead of just doing away with benefits, employers are really trying to work with employees.

Small employers

Small employers are in an especially tight spot, he said, when it comes to providing benefits. "It's really a tough market for the small employer. I think a lot of times people just don't understand how expensive health care is."

The days of $5 office visits and $3 prescriptions are over, Rogers said. "Everybody's feeling the cost of health care. So, it's just trying to figure out what is the best plan."

Sigmon said that last year, a 15 percent to 20 percent increase in health care costs was common for large employers, and several factors seem to be driving up costs.

"Prescription costs are going up 20 percent or more," he said, "and through better education and advertisement, people tend to go to the doctor more than they ever have in the past." He added, "It's going to be very important for employers, health care providers, and the government to work together and decide what kinds of health care products we really need."

Sigmon, a Springfield native, is a graduate of Drury College. With degrees in economics and business administration, he traveled for 20 years as a corporate labor negotiator, working on employee relations issues.

The employee benefits industry fits his background, he said, because "we're actually there to service both employers and employees, working on problems and helping to get programs to work."

BMI-HealthPlans is doing well in the competitive market, according to Rogers, which he attributes to Sigmon's business philosophy. "His approach with clients is, We'll find a way to help you,' and I think that's been the success of the organization."