Self-insured plans are able to cut costs mainly because they allow the employer direct access to the way that healthcare is managed.
With most fully insured plans, the employer and the insurance carrier sit back and simply pay the bills, allowing providers and patients to make all healthcare decisions on their own. (And those bills continue to rise: Annual premiums for employer-sponsored family health coverage reached $20,576 in 2019, up 5% from 2018, according to Kaiser Family Foundation.)
With a traditional fully insured plan, a provider might recommend a diagnostic test or procedure and direct the patient to his or her partner facility, and the patient may have the procedure done at that facility before the insurance company ever knows about it. There’s no opportunity to discuss the various options for getting that procedure or the differences in price; the carrier—and eventually, the employer—simply pays the bill.
But effective self-insured plans offer the opportunity to deliver exceptional care management, which allows employers to not only cut costs, but also help improve their employees’ health. In fact, if you aren’t laser focused on delivering exceptional care management, including complex care management, you simply aren’t delivering healthcare.
Care management is a broad term that includes all the innovations that are designed to impact the way care is delivered, minimize care that is avoidable, and select the right provider to provide care at the right time. It’s a process that includes disease management, complex case management, pre-certification, discharge planning and utilization review. A self-insured plan that has structures in place for providers, the insurance carrier, the employer and the patient to work together with aligned incentives is capable of improving both health outcomes and financial outcomes.
For example, programs like Lucent Health’s One Call Care can bridge the gap between providers and health plan leaders, helping provide better patient care and cutting costs. One Call Care focuses on helping patients get diagnostic images at independent outpatient facilities. The program provides cards to physicians that say: “If your patient needs a CAT scan, PET scan or MRI, please call this number.”
Most doctors will usually recommend the center at their hospitals, but if they’ll call the number on the card, Lucent Health professionals can let them know about other options. In many cases, Lucent Health can make the patient a same-day appointment at a facility that’s closer to his or her home, with no potential of being around sick people, at a cost that is a fraction of the hospital center’s. Making that choice can help save money for employers, as well as for employees who have high-deductible health plans.
Every employer says it cares about its people, but exceptional care management can show employees that you really do care. Lucent Health makes it easy for its clients to implement top-notch care management by providing employee services such as:
- Mobile technology. People are accustomed to using mobile apps and other technology tools to manage their everyday lives, with the ability to pay bills, book appointments, read books and even watch TV on their mobile phones. Your health plan should also provide the tools and technology they need and expect to manage their healthcare quickly, easily and on the go.
- Customer service. Healthcare and health insurance are complicated. Many educated people simply don’t understand deductibles, copays and how to navigate a complex health system. Managing care effectively means providing real people on the phone for employees to talk to when they have questions.
To learn more about TPAs and how Lucent Health can help you evaluate costs, visit https://lucenthealth.com.