5 Ways Self-Funded Employers Can Change the Cost of Healthcare

As a trusted, objective partner for more than 300 self-funded employers and their consultants, The Alliance is improving access to high-value healthcare for more than 105,000 lives – and we’ve been doing it for more than 30 years.

Our vast experience with healthcare purchasing means we keep a pulse on what’s happening in healthcare and use it to help our employers get more value from their health plans. Here’s how our self-funded employers are changing healthcare – and how you can, too.

Pool Your Purchasing Power

The more employers that join The Alliance, the more money we can save them through contract negotiations. That’s because providers want to serve their community’s best interests, and when we have a large presence (employer groups) in their communities, we can better negotiate with them.

And because we’re a not-for-profit cooperative, we agree to contracts that serve your bottom line – not ours.

(Learn more about how a health-purchasing cooperative works.)

Pay The Alternative Way

Innovative employers don’t play the “discount” game when it comes to paying providers. Here’s an example  of why discounts aren’t indicative of value:

• Provider A charges $12,000 for a surgery at a discount of 50%, and the patient pays $6,000.
• Provider B charges $6,000 at a discount of 20%, and  the patient pays $4,800.

As you can see, higher discounts  don’t necessarily  mean lower overall costs. Reference-Based Contracting by The Alliance uses Medicare as the baseline.  This employers need to pay a fair price for services. Paying providers using Medicare’s methodology means the focus isn’t on a discount off of billed charges but instead on the largest purchaser of healthcare in the US.  So when Medicare’s rates change, so do ours.

This payment method offers a more transparent and appropriate benchmark to measure relative value while also enabling employers to use benefit plan design to incentivize employees to utilize low-cost, high-quality providers and protect their employees from unexpected charges. It’s also why over 85% of the providers in our network agree to this unique contract provisioning.

In addition to our reference-based contracting, we contract differently with certain providers to combine health care into bundles.  Health care bundles mean that employers and employees know the prices in advance and pay a single price for many different services that can be part of a test or surgery, for example.  While not every test or procedure can be delivered in this way, those that can often save a significant amount over  typical fee for service.

(Learn more about why Payment Reform matters.)

Unlock Your Claims Data

Access to data is the biggest difference when it comes to self-funding vs. fully insured plans. The Alliance helps self-funded employers dive into their claims data, where we find savings that others can’t – or won’t – using analytics tools like our Smarter Health analysis.

Smarter Health provides employers with data-driven insights that pinpoint  where their money is being spent – and where they can save.

(Learn how our employers can use a custom Smarter Health analysis.)

Utilize Advanced Primary Care

Smart employers know that primary care is the key to uncovering long-term healthcare savings. By focusing on preventative care, primary care doctors are in the best position to help patients maintain and improve their health, detect and treat problems early on, manage chronic conditions when they occur, and refer patients to the right specialists when necessary.

Advanced Primary Care is an elevated standard of primary care that’s measured by improved health outcomes for patients, lowered total health spend for employers and employees, and achievement of higher levels of patient satisfaction and activation.

• Improved access to high-quality care
• Evidence-based medicine and decision-making
• Risk-stratified care management
• Care coordination
• Built-in care navigation
• Smarter referral management
• Established organizational infrastructure
• Behavioral health integration
• Balanced compensation/payment models

(Read employer case studies on how they use Advanced Primary Care to save as much as 50% on their health care costs.)

Create Custom Provider Networks

OurSmarter Networks^SM produce significant savings for both employers and their employees by custom-tailoring provider networks based on an employers’ unique goals. Through innovative provider network design, The Alliance offers employers three ways to access and customize their network.

• The Comprehensive Network by The Alliance: Serves as a broad choice network for you to offer your employees a wide selection of choices. This default option encompasses over 34,000 health care providers, hospitals, doctors, and clinicians across the Midwest.
• The Alliance & Trilogy Health Networks: This option offers your employees even more choice and covers over 90% of Wisconsin, encompassing over 41,000 total providers. This option gives your employees the most choice possible.
• The Premier Network by The Alliance: Employers who want a fully customizable health plan choose The Premier Network because it allows them to structure their health benefits into a tiered platform, which they can use to offer a set range of provider options to their employees while incentivizing them to use high-value providers.

(Learn which custom provider network is right for you.)

Start Self-Funding Smarter

­­Need help transitioning from fully insured to self-funded insurance (or level-funded insurance)? Want to know how to use your data to unlock better benefit design? Ready to create a custom provider network? Send me a message, and I’ll be happy to walk you through the process!