By Rachael Pfenninger and Susan Denzio, AMBA

As healthcare costs continue to rise, and no relief appears to be on the horizon, research shows that there is a growing movement to minimize premium costs by designing a healthcare program that is carefully cultivated to meet the particular needs of an organization1.

In many cases, there are opportunities for mold manufacturers to follow suit. However, it is important that business owners and HR professionals understand what questions are most important to ask in order to assess the condition of their current healthcare plans and better manage those plans moving forward.

Ask Your Broker

  1. What is our Per Employee Per Year cost? More specifically, what is our Per Employee Per Month (PEPM) cost?

Understanding the per employee cost per year – and, more importantly, the cost per employee per month – is necessary for benchmarking and managing your healthcare costs from year to year.

2.     Can that cost be broken down in the following categories?

  • Claims PEPM
    • Medical
    • Rx
  • Administrative costs PEPM
  • For Self-funded organizations: Premium PEPM

Understanding the cost breakdown between claims (medical and drugs) and the administrative costs provides a better overall view of the plan. By identifying and reviewing these buckets of spend, a business has a better view of the plan utilization. Higher utilization results in lower healthcare costs, because to a healthcare provider, this signifies better preventive maintenance. By asking for the data, employers have a vehicle through which to locate possible improvements or changes to the spend, which can impact the performance of their plan in a positive manner.

3.     How did age demographics affect our health insurance risk rating and costs?

Both population growth and an aging population are drivers of health insurance prices. As people get older, insurance becomes more expensive, and an aging demographic typically requires more care than a younger one. Diving deeper into employee demographics will allow a business to identify how and/or if these factors are impacting the renewal rate.

4.     What are the three primary drivers of our health benefit costs?

Knowledge is power. Identifying what items are driving the costs provides insight to better manage those areas and make decisions based on that data.

Dig Deeper with Your Broker: More Questions to Ask

The following questions will bring additional clarity to better manage your healthcare plan:

1.     Do we have any data on the price of our most common services utilized?

               How can we affect this?

2.     Can you break down the pricing for our three highest cost claimants?

               What can we do to affect this?

3.     What is our Rx PEPM?

4.     What is our average cost per script?

5.     Can you identify our top three prescription spend categories?

6.     Can you identify our top three high-cost prescriptions?

Tracking prescription data provides the knowledge needed to better manage resources for the best pricing.

One Solution – A Healthcare Strategy Based on Data

Healthcare ranks among the top three concerns of every business owner and yet, few apply a businesslike strategy (five-year plan) to their healthcare plan. There is no easy, one-size-fits-all solution for health benefits. The challenges, pitfalls and options are broad and diverse. Therefore, the AMBA, under the First Resource umbrella, has been working diligently on a healthcare solution that affords the ability to leverage the size of an aggregate group while maintaining individual choice.

First Resource has created a solution that is based on the same principles used to successfully run members’ businesses – it understands how and where bottom-line dollars are being spent and makes those expenditure decisions based on data. This healthcare solution is simple: Control the money, engage employees and attack high-cost medical and prescription services, while allowing members the flexibility to implement a risk-management strategy that best meets their needs. For more information on this healthcare strategy, email


  1. Collins, Michael. (2019, Jan 28). Manufacturers Face Rising Healthcare Costs. Manufacturing.Net. Retrieved from