Leveraging cost-sharing waivers strategically in an employer-sponsored health plan can drive better health outcomes and reduce overall plan costs while making it easier to hire and retain the best talent.  

Here’s a multi-faceted approach to maximize the value of these waivers: 

1. Focus on Preventive Care

• • Encourage preventive screenings and vaccinations: Waive cost-sharing for preventive services like annual physicals, cancer screenings, and immunizations. This can help identify and address health issues early, avoiding more costly treatments later. 

• • Promote wellness programs: Integrate waivers for wellness initiatives such as smoking cessation, weight management, or mental health programs. 

2. Target High-Value Services

• • Eliminate cost-sharing for chronic condition management: Conditions like diabetes, hypertension, and asthma drive significant costs. Waiving costs for medications, regular check-ups, and necessary tests for these conditions can improve adherence and reduce complications. 

• • Highlight high-value medications and therapies: Partner with PBMs to identify cost-effective medications and therapies and remove financial barriers to access them. 

3. Direct Members to High-Quality Providers

• • Encourage use of Centers of Excellence (COEs): Waive cost-sharing for surgeries or treatments performed at COEs to ensure high-quality outcomes and reduce complications. 

• • Promote in-network utilization: Reduce or eliminate costs for services within a high-performance network to incentivize members to use preferred providers. 

4. Incorporate Behavioral Health Benefits

• • Remove cost-sharing for mental health services: Offering no-cost therapy, counseling, and psychiatric care can address a critical need, especially given increasing demand for mental health support. 

• • Expand telehealth options: Waive costs for telehealth visits, making it more convenient for employees to seek mental and physical health care. 

5. Leverage Data Analytics for Strategic Implementation

• • Analyze claims data: Identify high-cost areas where cost-sharing waivers can drive the most value, such as conditions with frequent ER visits or expensive procedures. 

• • Track outcomes: Measure the impact of waivers on employee health, utilization patterns, and overall plan costs to refine strategies over time. 

6. Educate Employees

• • Communicate the value: Make sure employees understand the cost-sharing waivers and how to take advantage of them. Use clear, accessible materials and highlight success stories. 

• • Personalize outreach: Tailor communications to specific employee groups, emphasizing benefits that are most relevant to them (e.g., promoting maternity care waivers to younger employees).