How self-funding and primary care can save even more
Implementing a primary care model into a self-funded plan can help employers build a benefits suite to match their businesses: smart, efficient and with peoples’ best interests at heart.
Increasingly, bottom-line-savvy companies are turning toward a self-funded model to save money and increase financial flexibility while providing high-quality health care to employees. Incorporating a primary care model can help drive costs even further down, all while improving their workforce’s access to the care they need to live and work well.
Here’s some thoughts for employers and their benefits advisors who are considering a primary care model under a self-funded health benefits package.
Self-funded vs. fully insured
If you’re reading this article, chances are you already know what it means to be self-funded. In fact, according to a 2022 survey, 65% of covered workers are under a self-funded plan. But just as a quick review, let’s take a look at the benefits of choosing to self-fund employee health care over opting for a fully insured model.
Under a fully insured model, all health care claims are diverted to an insurance company, which means that the employer must pay premiums to that insurance company. These premiums are paid regardless of how much care is used.
This model can protect employers should one or more of their employees need extremely high levels of care — and often comes without additional administrative costs. Iit also means a lot of money will likely go unused in care costs and wind up as profit for the insurer. That is, after all, how insurance companies stay in business.
Under a self-funded model, employers pay employees’ health care claims directly, usually with the safety net of catastrophic claims protection or stop-loss coverage. The employer is out-of-pocket for the cost of that insurance, as well as any fees collected by third-party administrators (TPAs), who help streamline the process — and, of course, the cost of the claims themselves.
That may sound like a lot of costs, but in many cases, even all these expenses together are significantly less than would have been paid to the insurance company in premiums under a fully insured plan. Plus, the employer has the flexibility to decide what to do with whatever money was saved by this strategy at the end of the fiscal year.
A primary care model can save self-funded employers even more
Most employers who choose a self-funded health care plan do so to save money. And incorporating a primary care model into a benefits offering can help save even more, while increasing employee satisfaction. Here’s how:
1. Give employees better access to quality care
When employees have a primary care provider that they regularly visit, both parties can develop rapport, familiarity and trust — which can translate into better health outcomes (and thus, lower costs).
For instance, if a doctor is highly attuned to a patient’s medical history, they could be more likely to pick up on new symptoms before they become a bigger problem. On the other side of the coin, a patient who trusts their doctor might be willing to seek advice and treatment sooner, catching ailments earlier than they otherwise may have.
In fact, recent studies suggest that developing doctor-patient trust can even help mitigate racial and economic inequities, which means that a primary care model can help your workplace maintain an atmosphere of inclusivity.
2. Reduce the hassle of processing claims
In a self-funded plan without primary care, the various claims from each employee’s health care visits are processed by, you guessed it, the employer or the TPA under the employer’s hire.
While there will always be some administrative expenses associated with providing health care benefits, partnering with a provider network can help reduce the hassle of processing disparate claims from many different providers.
3. Increase employee satisfaction — and retention
Given that nearly a third of Americans don’t have access to primary care, this perk is one that can seriously increase employee satisfaction and help increase employee retention in the long run. That means less time (and money) spent finding the right team members and more time utilizing the great talent already on the team.
How to incorporate a primary care model
If your clients are curious to see how a primary care model could boost health care savings while also making employees happier, there are a couple of ways to go about it.
Some employers partner directly with a local clinic or specific health care network, which can provide a seamless experience for employees while reducing costs even further. (The network or clinic may offer discounted rates in exchange for dedicated business.)
Some employers provide on-site health care in the workplace, which can decrease employee absenteeism along with ensuring employees feel their care provider is accessible. There are health care firms that specialize in this kind of care.
Some employers choose to subsidize direct primary care (DPC), which is essentially a membership model for health care services. Under DPC, patients (or their employer) are contracted directly with a physician or clinic and pay a flat, monthly fee for access to service. Again, this tactic can ensure employees have ready access to high-quality care on their own timeline, while reducing overall costs.
As an advisor, you can help make the connections needed to put a primary care model into action. In fact, according to recent studies by WellNet, some 90% of advisors believe self-funded health care models carry long-term benefits for employers — which is why brokers are increasingly gaining experience in helping companies build these bespoke plans.
No matter which direction you choose, implementing a primary care model into a self-funded plan can help employers build a benefits suite to match their businesses: smart, efficient and with peoples’ best interests at heart.