Melina Kambitsi, Ph.D.
SVP, Business Development & Strategic Marketing at The Alliance
Melina Kambitsi Ph.D. joined The Alliance in 2017 and leads the teams responsible for business development, client development, and strategic marketing. Dr. Kambitsi came from Network Health in Milwaukee and Menasha, Wis. where she was chief sales and strategy officer. In this role, she was responsible for sales and underwriting, strategic planning, product development and risk-based contract analytics. Earlier she was senior vice president of sales at Blue Cross Blue Shield in Honolulu, Hawaii and the vice president of sales, marketing, and product development at Blue Cross of Northeastern Pennsylvania.
The Alliance Annual Meeting served as the launchpad for our Roadmap to High-Value Health Care, featuring real-life examples from employers that use the flexibility and data The Alliance provides to move the needle on quality and cost.
Brakebush Brothers Inc., headquartered in Westfield, Wis., uses self-funding to look for opportunities to lower the cost and increase the value of their employee health benefits. Many of these opportunities arise because Brakebush is willing to challenge the status quo in employee health benefits, according to Dan Ludwig, director of benefits and safety.
The status quo for employers typically means that insurance plans own the employer’s health benefits data; providers set their own prices and increase them regularly; and patients have limited ability to judge where to go for care based on cost and quality.
Instead, Brakebush utilized their claims data (a perk of self-funding their health benefits) to find opportunities where they could modify their health benefits plan to lower costs and promote better health outcomes. Employees and vendor partners were included in this process.
The result of Brakebush’s collaborative efforts provided employee health care options that were more easily accessible, less costly and provided high-value specialty referrals.
Support from The Top
Ludwig praises open-minded executives at Brakebush for their support for changing the company’s approach to health benefit costs.
“Employers have to get rid of the status quo,” Ludwig said. “That means employers can’t do it the way they’ve always done it. At Brakebush, we’re given the freedom to explore opportunities. We have to justify every one of these changes, but we’re given the ability to go and explore.”
Ludwig believes that only companies who realize health care can be controlled will be able to achieve flat or lower benefit costs. Employers who are unwilling to challenge the status quo, learn about health care pricing or embrace innovative approaches are unlikely to gain the full benefits of self-funding.
“The lack of understanding in the world of how health care is paid and what impact it has on business has really led us to this problem,” Ludwig said. “Employers have to look at health care and say, ‘We’re done with this.’
“As employers, we control everything else that is on our budget and we hold vendors accountable for giving us high-value products and services. Why are we not holding health care to the same standards?”
Are you an employer searching for self-funded health benefit solutions? If so, Ludwig offers the following tips for you to consider.
Brakebush Brothers’ Top Tips for Self-Funding Results
Get ready to self-fund. Looking back, Ludwig thinks Brakebush should have had new solutions ready to introduce when self-funding started in 2014, so employees immediately noticed the difference.
Be willing to change. Employers get the best results by combining self-funding with data-driven changes in their health plan.
Develop a team of collaborators, internally and externally. Internally, create a team of employees who take responsibility for changing the health plan to focus on high-value health care. Externally, network with peers at other companies and then find vendor partners who are interested in working with you on innovative solutions. Your relationships will make a difference in what you achieve.
Make sure partners have aligned incentives. They should “win” financially when your company wins and lose when it loses.
Tell employees how self-funding makes a difference to their out-of-pocket costs. Explaining the relationship between the company’s costs and their health benefit premiums is a great place to start.
Remind employees of ways to save, again and again. Sharing information at open enrollment is critical, but employees also need reminders throughout the year. If you have an onsite clinic, make sure clinic providers know all the current options for employees to use programs such as Centers of Excellence.
Use employers’ combined power. Employers’ ability to change how they purchase health care grows when they work together.
Read the case study on Brakebush Brothers for details about their award-winning approach to changing employer-sponsored health benefits.
There are two things people often mention when they talk about health care frustrations. They want:
A bill they can actually understand.
A price they can compare in advance.
Of course, that’s not the way that most health care is purchased. In our current “fee-for-service” health care system, each separate item or service carries a separate fee, which usually makes it impossible to know what a surgery or test will cost in advance.
Health care bundles are the exception. Health care bundles are now available for many surgeries and tests.
What’s a Bundle?
When you buy health care in a bundle, it means you:
Pay a single price for many different services that are part of a surgery or test.
Know the price in advance.
Typically save a significant amount when compared to buying the services one-by-one and fee-plus-fee.
Unfortunately, not every surgery or test can be easily turned into a bundle of care. Surgeries and tests typically work well as a bundle when they:
Are not emergencies. That means that patients have time to “shop” for care and compare prices.
Can be delivered in an outpatient setting. Bundled prices can sometimes be used for “inpatient” care, where the patient stays in the facility overnight. For example, The Alliance QualityPath program offers bundled prices for some inpatient joint replacements, as well as outpatient colonoscopies and MRI and CT scans. But most surgeries and tests with bundled prices are available only for outpatient care. These outpatient options usually have the greatest savings for employers.
Are available from many different providers. That means patients have an opportunity to compare their options for where to have care. At The Alliance, for example, patients can choose between multiple bundled providers as well as traditional fee-for-service care for many surgeries and tests. Well-known providers who offer “bundles” for care and are part of The Alliance network include NOVO Health, Twin Cities Orthopedics, Marshfield Clinic Health System and Smart Choice MRI.
An Employer Opportunity
Knowing the price in advance gives employers the opportunity to decide whether to offer incentives for using bundled care. If you can know you can save hundreds or even thousands of dollars on a surgery or test by using a specific bundled provider, for example, you may decide to share a portion of the savings with employees as a way to increase participation.
Encouraging employees to choose a bundled provider also helps employers begin to move away from buying health care on a fee-for-service basis. We all know that fee-for-service health care prices vary wildly from provider to provider and from service to service, even when a provider network provides discounts on the cost of care. Bundled pricing provides a framework that lets you fairly compare these prices and make clear decisions.
The health care marketplace has a long way to go before we can all make sense of bills and pricing. In the meantime, buying care in a bundle is one way to gain savings while helping the market find better approaches to paying for care.
Many employers are intrigued by the opportunities and savings that come with self-funding your health benefit plan. Learn how you can move from being fully-insured to taking control through self-funding.
Self-funded employers take employee well-being seriously. That’s because they know that every dollar saved by improving employee well-being — whether it’s from spending less on health care for chronic conditions or gaining more from higher productivity — has a direct impact on the bottom line.