The latest attempt to fix the nation’s broken health care system will give providers afinancial stake in the outcomes for consumers and plansponsors.
|The Direct to Employer initiative, led by CSuite Solutions andKey Benefit Administrators (KBA), would reward participatingproviders for their own cost-saving measures as well as efforts towork with employers and other stakeholders to reduce costs. Similarto self-funded plans, cost savings are splitbetween the providers and the consumers and employer group. With noinsurance “middleman,” prices would be negotiated between the providerand employer group, according to a press release.
|Related: Multi-million dollar claims continue torise
|“It’s time for healthcare providers to be directly connected topatients, employee groups and other populations within theircommunities and to be responsible for the overall health of thesepopulations with tools that have a proven track record for reducingcosts,” says Larry Dust, Founder and CEO of KBA. “Under this newmodel, providers and employers are ‘at the table’ together. Theyare equipped with the necessary clinical and financial analysis tounderstand cost drivers, evaluate clinical treatment protocols,identify areas of improvement and address real plans for reducingcosts and increasing quality.”
|The program will initially target employee groups, whichrepresent about 56 percent of the insured population. Emphasis willbe placed on reducing costs through early detection andprevention.
|“Disruption is coming to the employer health plan market,” adds Stephen R. Mason, a co-founder and managing partner ofCSuite Solutions. “Healthcare providers that seize this opportunitywill be able to gain first-mover advantage to significantly growmarket share, reduce leakage and share real savings directly witharea 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.
