Leverage Provider Partnerships to Reduce Costs and Improve Employee Health

As healthcare costs continue to rise, employers are looking for better ways to manage expenses while making sure employees can get the care they need. Incorporating independent providers into the benefit plan is one strategy employers can use to increase access to high-value healthcare.  

The Alliance recently hosted a webinar featuring a panel of independent providers who each play a vital role at different stages of the care journey. Anthony Brown, CEO at OrthoIllinois, Julie Lombardo, PT, DPT, OCS, WCS, CEO at Capitol Physical Therapy, Angela Marchant, DO, Principal/Provider at Tall Grass Osteopathic Family Medicine, and Christina Wipperfurth Pepper, Co-owner and COO of MH Imaging. These expert panelists shared how employers can partner with independent providers to better guide their employees to high-value, cost-effective care to improve outcomes while reducing overall spend. 

Keep reading to get the key takeaways from the discussion. You can also watch the full webinar on-demand.    

The Importance of Primary Care

A smart healthcare strategy starts with primary care. Primary care providers are in the best position to help patients maintain and improve their health by detecting and treating problems early and managing chronic conditions. These providers act as a quarterback, coordinating care, and referring patients to the right specialists when needed.   

Guiding Employees to High-Value Care

Think about the last time you took a road trip. Before GPS, most of us relied on paper maps or our own memory to get from point A to point B. Sometimes that worked, but more often than not, it led to wrong turns, wasted time, and frustration. 

After GPS, we have access to real-time directions that help us avoid traffic, choose the fastest route, and know exactly when we’ll arrive. It was a game changer and now, we wouldn’t dream of traveling without it. 

When it comes to navigating healthcare, employees face a similar challenge. Without guidance, they can easily get lost in a maze of costly emergency room visits, unnecessary specialist appointments, and delayed care. This confusion not only impacts their health but also drives up costs for self-funded employers. 

But it doesn’t have to be this way. By implementing a strong primary care strategy, employers can provide their workforce with a “healthcare GPS,” helping employees make smarter decisions that lead to better outcomes and lower costs.  

Avoiding Costly Detours

Let’s consider a common scenario, you’re out for a walk and twist your ankle. In a traditional system, you might go to the ER, wait hours, and walk away with a hefty bill and referrals to multiple specialists. 

With a strong primary care strategy, a primary care provider evaluates the injury, refers you to a cost-effective imaging provider if needed, and guides you to trusted partners for necessary follow-up care like orthopedics or physical therapy. 

The result? Faster treatment, lower costs, and a smoother experience for both the employee and the employer.  

Benefit Plan Design: Steering to High-Value Care

Providing access to high-value care is important, but it’s not enough on its own. Employers must design benefit plans that encourage employees to make smarter choices. 

Employers can use a tiered network to encourage employees to seek care from cost-effective providers.  

For example: 

Tier 1:

Services from these providers (including Preferred-Value Providers) can be offered at low or $0 out-of-pocket costs for employees. Once employees enter the system through a Tier 1 provider, that provider can continue guiding them to other Preferred-Value Providers for follow-up care, creating a continuous cycle of accessibility and savings. 

Tier 2:

Services from these providers can be offered at a moderate out-of-pocket cost for employees.

Tier 3 and 4:

Providers in tier 3 or out-of-network care come with higher costs for the employee. This empowers employees to choose but financially incentivizes them to select high-value options, saving themselves and the health plan money. 

Incentives:

Employers can also use cash rewards or incentives outside the benefit plan to encourage the use of specific providers. 

Education is The Key to Success

No matter how well-designed a plan is, it won’t be effective without employee education. Many employees think they have to go wherever their doctor sends them. But patients can choose where and when they receive care.  

Educating employees on this is crucial and this education shouldn’t be limited to open enrollment. Use creative methods like breakroom posters, bathroom flyers, or digital screens to keep messaging visible year-round. Employers can also hold regular educational sessions, health fairs, or lunch and learn events where providers introduce themselves and explain their services. Putting a face to a name reduces fear and uncertainty. 

When employees understand their options and the value behind them, they’re more likely to make informed choices that benefit their health and your bottom line. 

The Alliance partners with a wide range of providers, including independent providers, and helps employers build smarter, more effective benefit plans. Connect with us to learn how we can support your organization.