Employers are switching to self funded health plans quite rapidly, but the swing from fully insured to self funded health plans did not happen overnight. Health care costs have grown steadily for decades, but they have especially ballooned in recent years. 2022 will be the most expensive year ever, and these yearly price hikes have backed employers into a corner, forcing them to innovate and engage with their health plans like never before.

Many large corporations have been offering self funded health plans for decades. In fact, from 1996 to 2018, self funded health plans for employers rose from 28.5% to 38.7%. However, four out of five had 500+ employees, which makes sense because large employers can leverage their sizeable patient population to drive down prices when negotiating with health systems.

However, what is new are smaller businesses learning how to reap the rewards of self funded health plans; what they lack in size and direct contracts they make up for by banding together with other employers to join larger group-purchasing coalitions, who directly negotiate contracts on their behalf.

Here’s how The Alliance, a not-for-profit cooperative helps employers create smarter self funded health plans.

Smarter NetworksSM

Through sophisticated provider network design, The Alliance offers employers three ways to access and customize their network.

  • The Comprehensive Network by The Alliance: This “standard” option serves as a broad choice network for you to offer your employees a wide selection of choices. It encompasses over 34,000 health care providers, hospitals, doctors, and clinicians.
  • The Alliance & Trilogy Health Networks: This option offers your employees even more choice, and covers over 90% of Wisconsin, encompassing over 41,000 health care providers. This option gives your employees the most choice possible.
  • The Premier Network by The Alliance: This option is for employers who want a fully customizable health plan. The Premier Network allows employers 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. This carrots-and-sticks approach lowers both the employer and employees’ health care costs without restricting patients to a particular provider.

Reference-Based Contracting®

The Alliance doesn’t just allow employers to customize their network, but we also guarantee special provisions in our contracts with participating network providers. Reference-Based Contracting provides the baseline employers need to pay a fair price for services by paying providers a percent of Medicare – the single largest purchase of health care in the US – rather than focusing on savings off billed charges.

This driver of payment reform 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.

Lastly, Reference-Based Contracting protects your employees from unexpected charges while also providing the ability to predict future health care costs better. That’s why over 85% of the providers in our network use this unique contracting methodology.

QualityPath®

QualityPath is a program available to self funded health plans that helps patients simplify how they shop and pay for health care. Oftentimes, health care services have multiple charges and bills all related to the same procedure or treatment. This creates confusion for patients when they try to compare costs and after the service when they get their bill in the mail.

QualityPath takes the most popular tests and procedures and offers a single, bundled price at participating providers. We carefully vet these physicians to ensure they are both high-quality and low-cost. Additionally, the provider agrees to a warranty on the service, should complications occur, to ensure quality.

These popular services include things like colonoscopies and hip replacements, which can end up saving you and your employees thousands of dollars in health care costs.

SmarterHealthSM

Access to data is what makes The Alliance different, and by deep-diving into yours, we can find savings for your self funded health plan where others can’t – or won’t – with our Smarter Health analysis.

This healthcare analytics tool provides employers with data-driven insights that can help you understand where your health care dollars are spent, and more importantly, where we think you can save.

After better understanding your patient population, you can find out where to focus your resources for the most impact. For example, if you have a high concentration of employees with a specific health condition, you can steer them to a nearby high-value provider through financial incentives that save you money in the long haul.

Patronage

As a not-for-profit cooperative owned by its employer-members, The Alliance can offer a cooperative shareholder benefit back to our employers each year. When our net proceeds exceed our operation costs and budget, the Board of Directors can approve shareholder benefit distributions in the form of patronage checks.

Each employer’s amount varies based upon how much they use the network, but the more money we save them, the more we give back. For the last five years, the average patronage dividend has been 6.5%.

Smarter Self Funded Health Plans Start Here

Ready to start your self funded health plan? Want to learn more about our services, our provider network, or our mission? Need to register for our next event?

Contact us and let’s discuss how we can help your self funded health plan succeed!

Want More Content Like This?

Subscribe to our newsletter and get our monthly round-up of the latest health policy trends, self-funding events, and more — all delivered directly to your inbox.
This field is for validation purposes and should be left unchanged.
Melina Kambitsi, Ph.D.

Melina Kambitsi, Ph.D.

SVP, Business Development and 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. Dr. Kambitsi currently serves on National CooperativeRx’s Board of Directors.

Dr. Kambitsi received her bachelor’s in international studies and her master’s and doctorate degrees in economic geography at The Ohio State University. She speaks Greek fluently as well as four other languages (Spanish, French, Romanian and Russian).

Read more blog posts by Melina

logo