By The Montana Auto Dealers Association
Montana automobile dealers have banded together to provide their employees with health insurance since the 1950s. Over the years, what this means and how it is done has evolved significantly. With the ever-increasing costs of new technologies and medical miracles combined with the for-profit and “fee for service” model adopted by most American hospitals, health care costs have consistently outpaced every other industry’s inflation.
Today, the dealership’s collaborative employee benefits solution is classified as a partially self-funded MEWA (multiple employer welfare arrangement). The official name is the Montana Automobile Dealers Group Benefits Trust. The trust is overseen by a board of dealers — five seats with lifetime appointments and two temporary seats filled by the association’s president and chair. Notably, two families have had three generations serve on the trust’s board: the Olson family of Bison Motor Company and the Aadsen and Anderson families of Don Aadsen Ford.
As a partially self-funded MEWA, the premiums paid by the dealers and their employees are pooled and used to pay the administrative costs and the health care claims experienced by the participants. The risk retention and risk pooling aspect of the trust means the participating dealerships and their employees benefit from the strategic management of administrative partnerships and a healthier population.
The Trust proudly serves 34 dealerships and over 1,100 individuals across the state of Montana.
In the past decade, the board’s primary strategy has been moving away from the broken PPO/carrier model, where the trust has to pay hospitals and health care providers based on a contract they cannot see and negotiate. In 2015, the trust partnered with ELAP to reprice and pay hospital claims around either 120% of Medicare or the hospital’s reported cost for the service. With no contract to lean on, the hospitals’ abilities are limited when inflating their prices and forcing the trust to pay outrageous charges. For many Montana hospitals, this meant negotiating directly with the trust, leading to what has now become a narrow, transparent network. For other hospitals, it means they would balance bill the trust’s participants directly. However, ELAP provides defense and can often force the hospital and debt collectors to stop their actions. The hospitals that chose to provide fair, transparent pricing with the trust are proudly promoted. Members can find them on the MTADA website.
Understanding the strategy mentioned above creates a unique value proposition in the marketplace, the board also chose to develop a strategic partnership with Erin Jimison of Aligned Business Solutions. Jimison has been involved with the trust since 2014 in various roles and capacities. Most notably, she has played an integral role in establishing partnerships with hospitals and negotiating patient-specific contracts to ensure access to health care is possible for all the trust’s participants. Within her duties, Jimison is responsible for working alongside each Montana dealership to educate them on the available employee benefits options.
Scrutinizing charges do not end with hospitals, however. The cost of prescription drugs in the United States has been climbing for decades. We are currently experiencing a considerable spike with the development of high-cost, high-value drugs under the category known as specialty prescriptions. Again, the increasing cost of health care services and treatments directly increases the costs the trust must charge the dealerships and their employees. With this, the trust has partnered with prescription experts at Scrippoint to negotiate the PBM (pharmacy benefit manager) contract and audit the prescription claims.
Attributed to: “HowMuch.net, a financial literacy website”
Last, the health of each participant and their dependents is a top priority for the trust. Healthy individuals are integral in creating and sustaining healthy businesses and communities. The trust provides its members with services and support from two organizations: It Starts With Me and VezaHealth.
- It Starts With Me provides annual comprehensive health screenings with no out of pocket cost to the participants. The screenings include a comprehensive metabolic panel, a lipid panel, complete blood count, TSH, PSA, blood pressure check, body composition, and a personal health report and an easy-to-read lab report for each individual to have for their understanding and records. By participating in the health screening, adult participants avoid a $60 monthly premium penalty.
- VezaHealth provides remote second opinions from elite physicians, nurse coaching and travel support and benefits when clinically necessary. Health care waste comes from unnecessary treatments, less than high-quality providers, ineffective procedures and misdiagnosis. By providing its participants with the wisdom and insight of some of the nation’s leading physicians, the trust hopes to not only improve the health outcomes of the most at-risk participants but also reduce financial waste. Much like the services provided by It Starts With Me, participants have no out-of-pocket expense with the service, and they receive a $100 incentive payment for their diligence in health care decision-making.
Year after year, these programs and strategies have resulted in minimal premium increases. While double-digit increases every year have become standard across the country, participating Montana dealerships have been experiencing increases between 0-9.8% over the past six years. Additionally, the trust retains its financial stability with nearly five months of claims expense in assets.
Yet, there is still more work to be done. To find greater stability and to mitigate risk further, the trust needs to grow. With the addition of a sophisticated underwriting process, the trust could grow beyond car dealerships and serve similar organizations. Adding healthy participants will further the trust’s stability and ensure high-quality, affordable health insurance for dealership employees into the future.
