The latest attempt to fix the nation’s broken health care system will give providers a financial stake in the outcomes for consumers and plan sponsors.
The Direct to Employer initiative, led by CSuite Solutions and Key Benefit Administrators (KBA), would reward participating providers for their own cost-saving measures as well as efforts to work with employers and other stakeholders to reduce costs. Similar to self-funded plans, cost savings are split between the providers and the consumers and employer group. With no insurance “middleman,” prices would be negotiated between the provider and employer group, according to a press release.
“It’s time for healthcare providers to be directly connected to patients, employee groups and other populations within their communities and to be responsible for the overall health of these populations with tools that have a proven track record for reducing costs,” says Larry Dust, Founder and CEO of KBA. “Under this new model, providers and employers are ‘at the table’ together. They are equipped with the necessary clinical and financial analysis to understand cost drivers, evaluate clinical treatment protocols, identify areas of improvement and address real plans for reducing costs and increasing quality.”
The program will initially target employee groups, which represent about 56 percent of the insured population. Emphasis will be placed on reducing costs through early detection and prevention.
“Disruption is coming to the employer health plan market,” adds Stephen R. Mason, a co-founder and managing partner of CSuite Solutions. “Healthcare providers that seize this opportunity will be able to gain first-mover advantage to significantly grow market share, reduce leakage and share real savings directly with area employers.”
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Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
