Health plans today are feeling more pressure than ever before to do more with less. This is especially true now that health plans have to operate within the federal minimum medical-loss ratio (MLR) requirement. The minimum MLR requirements leaves health plans with only 15 percent of their Medical revenue to spend on administration, marketing, and, often the most expensive line item, employee salaries.

For health plans looking to bring on more resources to handle growth – for instance, moving from a small health plan to a medium-to-large health plan – the obvious course of action may be to hire more full-time equivalent employees (FTEs). However, adding FTEs comes with great expense. Salaries, benefits, workstations, equipment and other expenditures associated with FTEs add up quickly. In short, hiring more FTEs is not necessarily the most efficient or cost-effective next step for a growing health plan looking for scalable solutions.

Instead, health plans should consider solutions to help automate and streamline tasks that will eliminate the need for additional FTEs and keep the plan running smoothly in the long-term. Below are three ways growing health plans can accomplish this.

1. Use Technology to Your Advantage

Regardless of the size of the health plan, the right software programs can do the job of multiple FTEs, at a fraction of the cost. Health plans using non-industry-specific solutions like SharePoint, Excel spreadsheets and email to manage their policies and procedures, HMPS Memos, investigations and collateral material development can especially benefit from upgrading technology to increase efficiency and productivity, and reduce overall compliance risk.

Keep in mind, taking a generic software program and trying to force it to work for the specialized needs of a health plan can be a waste of time, effort and money. To truly maximize the benefits of technology, health plans should implement software created for the managed care space. That’s why our CodySoft® suite of compliance modules was designed specifically for health plans by a team of experts in the industry. These programs help health plans effectively leverage technology and prevent them from proliferating expensive FTEs, while reducing compliance risk.

2. Outsource Wisely

In instances where technology can’t replace a person, consider whether it’s possible to outsource tasks or functions rather than hiring FTEs by leveraging a flex-staffing arrangement with an industry expert. Paying business process outsourcing (BPO) fees can often be more cost-effective than bringing on a new FTE with salary, benefits and other overhead.

Again, it’s critical to find vendors with deep experience working with health plans and in the managed care space. Your BPO partners should be experts in regulatory compliance and industry best practices. For example, health plans often contact us when they have received a regulatory deficiency or can no longer effectively produce required member marketing materials using their internal resources. In these engagements, we prepare their materials on an outsourced basis for a limited period or for the long term.

3. Maximize Existing Resources

It’s good practice for growing health plans to regularly assess their organizational design, processes and personnel. If the existing infrastructure and team aren’t operating at maximum efficiency, adding more FTEs to the mix will likely only compound problems.

For example, when our team evaluates health plans’ marketing communications departments, we often recommend workflow improvements, develop proper job descriptions, reassign current staff and provide on-the-job training. This level of assessment and subsequent adjustments help ensure all existing personnel resources are maximized, and can potentially alleviate or even eliminate the need to hire more FTEs.

While it’s true health plans are having to do more with less than ever before, health plan leaders who think strategically can scale the organization while effectively managing expenses, including costly FTEs. If your health plan is at a critical juncture in its growth trajectory, contact us today to see how we can help.