Bianca Okonkwo· Benefits Analyst, Bellwether Consulting
Asked in Benefits & Wellbeing ·
We are a US manufacturer, about 3,100 employees across four states, self-funded with a PPO and a high-deductible option. Our consultants came in with an 8.5% trend assumption for next year, which is a full point above what they gave us twelve months ago.
Our own claims ran at 6.2% over the last rolling twelve months, so finance is asking why we would budget well above our experience. The explanation we were given is specialty pharmacy, particularly weight-loss drugs, plus provider contract renewals in two of our markets.
What are others using as the starting number, and how much weight do you give your own experience against the consultants' book of business?
4 helpful · 1 insightful · 5 replies · 25 views · 5 following
Accepted answer· by Amara Larsen
The approach that settled it with our CFO was splitting the number into three lines rather than defending one figure: core medical trend, specialty pharmacy, and a named allowance for the weight-loss drug class. We budgeted 6.5%, 12% and a flat amount based on current utilisers plus 40% growth. Once finance could see that the core number was close to our own experience and the excess was two identifiable things, the conversation moved from whether the consultants were padding to what we wanted to do about coverage rules for that drug class. That is the decision that actually changes the budget.
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Victor PereiraCBS, GRS
Sales Compensation Manager, Qasr Holdings
We are at 8% for medical and 11% for pharmacy, blended to about 8.7%. Similar size to you, also self-funded. Last year we budgeted 7% and landed at 9.1%, almost all of it pharmacy, so I have stopped arguing the number down.
Director of Benefits, Bellwether Consulting
At 3,100 lives your experience is credible but not fully so. Ours weighted our own claims at about 70% and the book at 30%, which I thought was reasonable. If yours are effectively ignoring your 6.2% I would ask them to show the credibility weighting explicitly.
Also ask whether the 8.5% is before or after the large claims you had. Two or three claimants above the pooling point can move a group your size by more than a point either way.
Compensation Consultant, Tidewater Utilities
I would push back a little on leaning on a single rolling twelve months. We did that two years ago, budgeted 5.5% on the back of a quiet year, and had to go back to the board in August for another 1.4 million. Never again. Finance forgave the higher budget far more easily than the mid-year ask.
Benefits Analyst, Silverline Media
Accepted answer
The approach that settled it with our CFO was splitting the number into three lines rather than defending one figure: core medical trend, specialty pharmacy, and a named allowance for the weight-loss drug class. We budgeted 6.5%, 12% and a flat amount based on current utilisers plus 40% growth.
Once finance could see that the core number was close to our own experience and the excess was two identifiable things, the conversation moved from whether the consultants were padding to what we wanted to do about coverage rules for that drug class. That is the decision that actually changes the budget.
Bianca OkonkwoCRP, WWP
Benefits Analyst, Bellwether Consulting
Thanks all. I have asked for the three-line split and the credibility weighting. First look suggests core medical is 6.8% and the rest is pharmacy, which is a much easier story to tell. We will take 8.5% forward but with the pharmacy allowance shown separately.
