I saw a billboard the other day that caught my attention. It featured a glamorous model, her hands full of gold necklaces and jewelry, coupled with piles of cash. "Go Green — Turn Your Gold Into Cash Now!" the ad screamed.

I thought that was pretty clever. The "green" in the title led me to think of the environment, but then turned my thoughts onto areas of hidden or undiscovered cash. I often think about our self-insured health plan and ways I can be saving money — and yes, I admit it, I'm a health plan nerd.

Health care is a pure gold mine of cash opportunities. According to the Centers for Medicare and Medicaid Services, the United States is projected to spend over $2.5 trillion on health care in 2009, and health care accounts for 17.6% of our gross domestic product.

It's a booming business, and one that has the potential to be great for our economy. But here in my office, just a few miles away from an 800-acre landfill, my view is different.

My trash company has tons of hard-working employees trying to make ends meet. I have a responsibility to them and my company to spend less while still providing awesome benefits. But a plan just can't manage itself. Gold sinks to the bottom, and you have to be willing to dig for it. So let's go panning!

If you're going to pan for gold, it's important to get some good quality boots. Even more importantly, you need to find where the gold is. I frequently like to wade around in the following areas:

>> Claim audits. Most providers or third-party administrators offer their own internal audits. If they haven't done one lately, request it. Every couple of years, follow-up with an outside audit vendor. The advanced technologies many vendors use to catch processing claim problems are incredible. If you pay an auditor based on a percentage of recovery, you know they'll be digging.

>> Plan mining. Data scrubs are a great way to see what's going on in your plan. Contracted experts will take your data and analyze it differently from your standard reports. During one of my reviews, we found an individual who had been using the emergency room monthly, like clockwork. We requested that case management get more involved with this person. This gives me the opportunity to save on utilization, and it saves the patient money, too.

>> Disease and case management. Talk about gold fever, what could be better than to actually avoid costs that could be looming? Hiring the right providers to manage large claims and chronic conditions is key. You should be getting exhaustive details, such as number of cases managed, proactive procedures and reports on cost-savings. If you're not getting these types of reports, I'd start asking or choose a different river.

>> Agreements. Try to get guaranteed pricing for two or three years in writing. Pay close attention to carve-out fees (i.e., if you want to use a different pharmacy or stop-loss vendor), and ask for performance guarantees. Most administrators will offer rebates when their service levels fall below reasonable standards.

>> Prescription rebates. Try to negotiate your prescription rebates. Some offer percentage refunds, other offer per script rebates, even on mail-order drugs. Rebate savings depend upon utilization, and if your group takes lots of medications, that can equal lots of savings.

>> Network discounts. Don't be afraid to ask for details. On the first run, you might get buzzwords like "proprietary" or "confidential contracts." Phooey! You're renting the networks, you're paying the claims and you have a right to know what's going on. Buyers beware: Ask when networks expire. Having a hospital system fall out of your coverage area is no fun. Then you run into 100%, first-dollar emergency room claims that can drain your health plan.

>> Transplant networks. Who would have thought that with today's rising costs, you can actually get a kidney transplant for under $100,000? Hire the right people and you will.

>> Specialty management. Mental health claims gaining? Dialysis out of control? Injectible drug expenses soaring? Solicit the help of specialty management providers that function as gatekeepers. It's not always fun for your workers, but sometimes it's necessary.

>> Plan exclusions. Excluding or limiting coverage removes expense risks, but sometimes good intentions turn sour. I heard of a casino that didn't want to exclude lap-band or bariatric surgery, but wrote specific guidelines for body-mass index so obese members would be approved. Later they discovered a local weight-loss surgery center was telling their plan members who had requests for the surgery denied to gain 15 pounds to meet the plan guidelines. If you give an inch, some people will take a foot.

>> Dependent audits. I know this can be a hassle, but there's no better way to sift through sediment than to remove ineligible folks from your plan. Be sure your plan is managing full-time student status. Continuing education is a great thing, so long as it's actually continuing.

>> Medicare Part D prescription reimbursements. If you have a retiree population, don't forget about the rebates you could be getting from Medicare.

>> Fully insured plans. Make sure your provider touts and follows up with wellness initiatives. Keeping the population healthy results in healthy renewals. Ask for the loss ratios. If a carrier isn't willing to shovel this information out, you may have found some fool's gold.

While my list could go on, these are some of my favorites. Did you know that the term "mother lode" came from the Gold Rush of 1869? Maybe you'll find some nuggets that make your eyes glitter. That sounds good to me — after all, every dollar counts!

Contributing Editor Karrie Andes, SPHR, is the director of human resources for Deffenbaugh Industries, Inc. and Affiliates in Kansas City, Kan. She also is the creator and chairperson for The Savvy Self-Funding Healthcare Conference and Expo. Andes can be reached at karrie@savvyemployerconference.com.