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Amid Rising Costs, Self-Funded Health Plans Are Getting a Makeover

"[E]mployers have increasingly hiked up deductibles and employees' cost-sharing liability for self-funded plans to avoid steep premium increases ... Enter companies like Centivo ... [which] saves money in part by prioritizing primary care, going so far as to launch a virtual clinic with free appointments for members ... Centivo also contracts directly with healthcare providers, intentionally choosing affordable health systems."

Reasons to Consider Self-Funding Your Company's Healthcare Benefits

"With a self-funded plan: [1] You pay for actual claims. In a fully-insured plan, your costs are fixed regardless of your employees' claim history, and any end-of-plan-year excess remains with the insurer instead of your company. [2] You have access to data to make informed decisions.... [3] You save on state premium taxes and avoid state-mandated benefits. [4] You can customize your benefit plan design to meet employee needs via quality providers and programs while controlling, and even reducing, costs for both you AND your employees."

Why Virtual Primary Care Is Going Viral

"[T]he movement shifts the concept of off-hours or urgent online visits to that of a virtual yet consistent care team that replaces the traditional in-office primary care relationship....Virtual primary care can treat more than people think.... Virtual primary care reduces unnecessary ER and urgent care visits -- and costs.... Virtual primary care doctors work with in-person providers, too."

Health Plans Designed with DEI in Mind

"[1] Reimagine plan design ... [2] Partner with primary care ... [3] Deliver culturally aware care ... [4] Expand virtual care options."

Employers Turn to 'High-Performing' Physicians for Cost Savings

"Higher-performing physicians are defined as those who keep patients healthier at lower cost. Nearly 1,600 physicians, along with 60 hospitals, are contracted for the health program by Centivo."

Survey Reveals Devastating Toll of the Healthcare Affordability Crisis on U.S. Workers

"The most common financial sacrifices made by respondents regarding household necessities included cutting back on groceries (51%) and utilities (22%). Alarmingly, one in ten report a significant medical expense has even caused them and their families to skip meals/go hungry. Significant medical expenses also caused problematic behaviors among those making financial sacrifices, such as taking on credit card debt (60%), completely depleting savings (37%) and borrowing from retirement accounts (23%)."

One in Four Workers Experiencing Significant Medical Expenses Report Major Mental Health Impacts

"The need for employers to reassess overall health plan affordability is further underscored by the ... finding that the less respondents had saved, the more likely they are to report that major medical expenses have impacted their mental health. In fact, only when respondents reported more than $10,000 in savings do they also report low levels of mental health and family well-being issues ... [A] full 20% of respondents who experienced major medical expenses said they skipped or delayed needed mental healthcare/counseling due to cost concerns. "

Four Steps to Your Most Successful Open Enrollment Ever

"[1] Explain the variables they should consider when determining the right plan ... [2] Do the math for them ... [3] Highlight important aspects of coverage, especially for big-ticket items ... [4] Make it easy to include their spouse/partner in the decision."

The New York Times Shines a Bright Light on Healthcare Pricing -- What Should We All See?

"[P]rice transparency alone is not the cure for the disease plaguing U.S. healthcare. Rather, it is a symptom of a larger, far-reaching affliction -- acceptance of the status quo. Payers, particularly employers who provide the majority of coverage in this country, must REFUSE to continue to tolerate high costs overall, uneven quality, and providers whose higher comparative costs do not correlate to better health outcomes. Instead, self-funded employers should work with their advisors to find ways to incent and reward efficient, cost-conscious health systems and practitioners who provide better care at lower costs."