What tools or partners can help us model different plan design scenarios (financially and clinically)?

Designing the right health plan requires more than adjusting premiums or deductibles. It means understanding how each change affects cost, compliance, and employee health outcomes. A mix of actuarial tools, analytics platforms, and care partners can help you model these impacts before making decisions.

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Use actuarial and benefits modeling tools for financial forecasting
These tools project how plan design changes—such as deductible, copay, or contribution adjustments—affect premiums, total spend, and employee cost-sharing.

Examples include:

• Carrier or TPA tools: Most major insurers and TPAs (UnitedHealthcare, Cigna, Aetna, Blue Cross, and others) provide plan design modeling and renewal impact projections.
• Actuarial firms: Partners such as Milliman, Mercer, Aon, or Lockton can model claims savings, utilization trends, and ACA compliance.
• Benefits administration platforms: HR systems like Ease, Employee Navigator, or Rippling can run contribution and affordability scenarios based on payroll data.

Best practice: Use these tools annually to test how small design changes impact both total cost and ACA affordability.

Use population health and claims analytics for clinical modeling
Financial models forecast cost, while clinical models explain what drives it. Population health analytics reveal where high costs originate (such as chronic conditions, emergency room overuse, or prescription patterns) and how plan design influences outcomes.

Examples include:

• Carrier or TPA dashboards: Show utilization trends, preventive care gaps, and chronic condition prevalence.
• Health analytics platforms: Vendors such as Springbuk, Artemis Health, and Health Catalyst model how preventive care affects outcomes and spending.
• Vitable insights: Employers using Vitable can track engagement, primary care utilization, and early intervention data to measure how access affects claims and overall health.

Why it matters: Understanding where spending originates helps you target plan improvements, such as adding $0 primary care or mental health access to reduce long-term costs.

Leverage benefit consultants and brokers as strategic partners
Experienced brokers combine financial modeling, network analysis, and benchmarking to help employers compare strategies such as:

• Fully insured versus self-funded or level-funded models.
• MEC plus primary care or ICHRA structures for flexibility.
• Integrating value-based primary care to reduce volatility.

Tip: Choose a partner who understands both financial forecasting and care delivery design to ensure balanced, data-driven decisions.

Engage primary care and value-based care partners for outcome modeling
Innovative care partners like Vitable can model the real-world impact of improving care access. Predictive models can show:

• Fewer avoidable ER visits.
• Better chronic condition management.
• Lower absenteeism and turnover.
• Year-over-year cost stability.

Impact: Employers can measure the ROI of preventive care and engagement before finalizing plan design changes.

Combine financial and clinical data into one scorecard
The best plan decisions come from combining cost, utilization, and health outcome data in a single view.

Your scorecard should track:

• Premium and contribution impact.
• Projected utilization and engagement.
• Long-term claims reduction potential.
• ACA affordability and compliance.

Best practice: Review your scorecard quarterly or annually to stay proactive about adjustments.

Vitable partners with employers and consultants to model both the financial and clinical impact of plan design decisions. By integrating with claims or utilization data, Vitable can show how $0 primary care, mental health, and preventive care improve engagement and reduce high-cost events. This helps employers build a data-backed case for smarter, value-based plan design.

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Use multiple data sources and expert partners to model plan changes holistically:

• Actuarial tools forecast cost.
• Clinical analytics measure health outcomes.
• Vitable and value-based partners model real-world engagement and ROI.

When financial and clinical insights work together, you can design benefits that are cost-efficient, compliant, and proven to improve employee health.

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