The January Checklist for HR: Setting Up a Health Plan That Works All Year

January isn’t just the start of a new benefits year—it’s the best time for HR teams to get ahead of cost, engagement, and member experience before problems show up at renewal. A well-managed health plan doesn’t happen by accident. It’s built with intentional steps taken early in the year.

Here’s your practical January checklist to ensure your health plan performs all year long:

1. Review Your Claims & Utilization Data Early

Don’t wait until renewal to find out what’s driving your costs.

• Analyze high-cost claim categories

• Identify prescription spend trends

• Review ER vs. urgent care usage

• Flag chronic conditions that may need proactive support

When you have visibility early in the year, you can intervene before costs snowball.

2. Strengthen Your Rx Strategy

Pharmacy is often the fastest-growing portion of employer healthcare spend—especially specialty drugs. Consider evaluating:

• Alternative sourcing options

• Carved-out pharmacy benefits

• High-cost specialty medication programs

• Prior authorization effectiveness

A smarter pharmacy strategy can save the plan thousands while improving access for employees.

3. Launch (or Refresh) Chronic Care Initiatives

A small number of chronic conditions typically drive the majority of claims. January is ideal for rolling out programs that support members with:

• Diabetes

• Thyroid and autoimmune disorders

• Hypertension

• Mental health needs

• Obesity and metabolic conditions

Targeted support leads to healthier employees and lower long-term costs.

4. Improve Member Engagement Early

Employees won’t use the plan well if they don’t understand how it works. In the first 60–90 days, make sure employees get:

• Clear communication on benefits

• Guidance on how to find in-network providers

• Education on telehealth, urgent care, or imaging options

• Information about free or low-cost services your plan offers

Strong engagement now reduces frustration and prevents unnecessary, expensive claims later.

5. Evaluate High-Value, Low-Cost Benefits

Benefits like free imaging, free prescriptions, direct primary care, or mental health support are surprisingly affordable—especially for employers exploring self-funding. These enhancements:

• Improve employee experience

• Reduce out-of-pocket costs

• Lower overall claims spend

They’re the rare “win-win” that drive better outcomes without inflating budgets.

6. Confirm Your Vendor & Partner Alignment

Your TPA, stop-loss carrier, pharmacy partner, and wellness vendors should all be aligned on your goals for the year.

• Set expectations

• Review reporting schedules

• Establish communication channels

• Ensure everyone is working toward cost control and member satisfaction

A coordinated team keeps your plan running smoothly.

Start Strong, Save All Year

A proactive January sets the tone for the entire benefits year. With better data, stronger engagement, and smarter strategies—especially around pharmacy—HR can drive meaningful results for both employees and the company’s bottom line.

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