Why Managing Employee Benefits Requires the Assistance of an On-Staff Medical Director

To fulfill the demands of employees and ensure that they are in compliance with all state and federal regulations, businesses that closely collaborate with an employee benefits broker to build their benefits packages significantly rely on the knowledge of employee benefits consultants. Additionally, companies rely on these benefit consultants to maximize the return on their benefits investment and, whenever feasible, bend the expense curve lower.

However, not every broker can provide the same services to their clients in this area. Selecting a benefits broker with a Medical Director on staff is recommended among other things to think about when choosing a broker.

Special Requirements for Medical Directors

Strong clinical backgrounds make medical directors particularly well-suited to navigating the current healthcare landscape. They are clinicians, thus they are aware of the difficulties in patient care. They get the value of reducing financial risks while delivering that care since they are administrators. A Medical Director has a thorough awareness of both financial and commercial difficulties in addition to medical ones.

Gregory Preston, MD, the chief medical officer at Cook Children’s Health Plan in Fort Worth, makes the following observations about how Medical Directors combine medical knowledge with the management of strategic and operational responsibilities:

“To handle the ongoing influx of new technologies and the conversion from clinical efficacy evidence to strategic medical policy, Medical Directors need to stay current with the standards of practice and stay in contact with the physician community.”

A Source of Creative Change

Medical Directors work as “creative change agents who promote continuous improvement” for benefits brokers, employers and plan members with whom they contact, bridging the gap between corporate accountability and high-quality patient care.

Medical directors have practical sales and marketing experience and a thorough grasp of health care delivery systems. Medical Directors maintain a careful eye on delivery system developments, changes in health care law, and regulatory and accrediting criteria in order to do their roles successfully.

What Does It Mean to You?

A benefits broker can uncover efficient solutions to combat rising medical expenditure trends by having a Medical Director on staff. A Medical Director frequently performs the following activities to keep your benefits plan affordable and useful for its members.

Analysis Driven

A Medical Director analyses claim histories and rates hypotheses for underwriters and actuaries using his or her clinical expertise. If you conduct this kind of in-depth investigation and have a practical grasp of clinical issues, your renewal rates may drop dramatically.

According to research, 40–50% of all healthcare costs are incurred by one percent of the insured population. A medical director searches for strategies to encourage efficient case management for expensive cases, which would lower total costs. A Medical Director can also assist in negotiations for more effective results in both group and individual instances.

A medical director assists in developing effective wellness programs. He or she can recommend effective wellness program ideas based on his or her examination of health results about program expenses.

Facilitates Communication

When participants in a plan require assistance managing a specific health condition, a Medical Director makes themselves accessible as a resource. He or she can handle difficult circumstances to facilitate communication amongst all parties if they have a thorough understanding of the healthcare environment.

A medical director collaborates with employer organizations and health plans to guarantee that all members receive the finest treatment possible in the most suitable clinical environment. It is simple to understand how picking a benefits broker with an experienced Medical Director on staff would deliver the most value for your business when you consider the unique talent and insight these individuals can provide.