Growing numbers of employers are opting for self-insured health plans. The number of private-sector organizations offering at least one self-insured health plan increased 36.8% from 1996 to 2015, according to the Employee Benefit Research Institute. By 2018, 61% of workers with employer-provided health insurance were enrolled in self-insured plans, according to research from the Kaiser Family Foundation.
Employers that opt for self-insured plans are typically seeking to provide better, more focused healthcare for their employees, as well as opportunities to better control costs. But not every self-insured plan is created equal. In many cases, the self-insured plan is only as effective as the third-party administrator (TPA) that is managing it.
The most effective self-insured health plans rely on TPAs that focus on patient care first. That focus is based on an understanding that with superior care management, integrated into cutting-edge health benefit plan design, cost savings will follow.
How Care Management Drives Savings
Without an active care management team, plan participants are essentially on their own, making their own healthcare decisions in a vacuum or even on a whim. A plan participant with no access to a care management team may be more likely to simply stop taking his medication when he experiences an unwanted side effect. A care manager could inform him about alternative medications and recommend discussing the issue with his provider.
When no care management team is easily accessible, a plan participant who needs an MRI may simply schedule the procedure at the hospital her doctor recommends. But an in-touch care manager could explain that an MRI center much closer to the patient’s home can provide the same service with no need to drive downtown or use public transit, and at a much lower cost.
A superior care management team is always available to answer questions for plan participants. Also, by keeping up with real-time health data for participants, the care management team can reach out to a participant anytime they see a red flag, such as a missed behavioral health appointment, a new diagnosis or an unfilled prescription refill.
Superior care management can keep plan participants on track with medication compliance and other goals, as well as provide decision support and guidance for those who need to take the next steps in their healthcare journey. Having those care managers can help plan participants achieve better health outcomes, which results in lower costs overall.
Levels of Care Management
Such intensive, cost-saving care management may sound expensive, but it doesn’t have to be. The right TPA will offer various levels of service depending on the needs of employees and family members.
For instance, employees who are relatively healthy and mostly use preventive care services need only the most basic level of service, or concierge care. This level usually involves getting questions answered about benefits or accessing human resources-related information.
However, employees who have conditions such as pregnancy, diabetes or cancer, or who require chronic behavioral health management, need the most advanced level of service, or complex care management. These plan participants have conditions that are costlier than those of others in the group, and they need more attention.
As plan participants’ healthcare needs change, they may seamlessly move between the different levels of care, with dedicated care managers meeting their needs throughout their healthcare journeys. By integrating various levels of care and pulling continuous, real-time health data on plan participants, the right TPA can always be prepared to provide the care management that employees need, when they need it. And self-insured employers can rest assured knowing their plan is taking good care of their employees, with the happy result of controlling costs.
Learn more about Lucent Health’s superior care management here.