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How Higher-Value Healthcare Achieves Savings for Self-Funded Health Plans

The key elements self-funded employers need to put high-value healthcare into action and deliver noticeable results.

“Business as usual” is no longer an option for the healthcare industry. The US healthcare system struggles with rising costs and inconsistent quality despite its world-class reputation. Healthcare spending in the US increased by 9.7% in 2019 compared to the average annual growth rate of 4.2%. Moreover, 30% of those costs are wasted on low-value care. Considering that employers pay roughly 29% of healthcare spending in the country, this has not gone unnoticed. With the known importance of strong employee benefits (especially during the tightest labor market in decades) and the endless growth of healthcare costs, employers are embracing high-value healthcare in their health plan strategy. Since 2015, high-value healthcare has seen a 10x increase in savings compared to the typical standard of care, and employers are looking to capitalize on this growing trend.

The Institute of Medicine defines high-value healthcare as “the best care for the patient, with the optimal result for the circumstances, delivered at the right price.” In its simplest form, it’s high-quality, fair-priced care. However, high-value healthcare is not an easy single-step solution but an all-embracing, comprehensive strategy. It requires rethinking and restructuring the delivery of healthcare to your employees.

Independent and forward-thinking organizations, like Healthgram, leverage high-value healthcare principles to give employers the control and financial outcomes needed for their businesses and employees. To help put this into perspective, we’ve outlined the elements that help self-funded employers put high-value healthcare into action and deliver noticeable results:

1) Customizable Plan Design

A customizable benefits plan design can be a driving force behind incentivizing high-value healthcare utilization, offering choice and flexibility to help meet businesses’ ever-evolving needs and circumstances. Flexible plan designs enhance cost savings for employers and employees because they aren’t paying upfront for unnecessary low-value treatments in a given plan year. Additionally, with personalized benefits, your employees know they are in control of their healthcare and want quality, affordable options.

2) High-touch Clinical Support

Employers continue to see positive trends in employees using high-value services and treatments through high-touch clinical support. By reducing overall health risks, preventing unnecessary claims, and promoting qualified providers, clinical teams play the quarterback role in high-value healthcare. The collaborative process of assessment, coordination, evaluation, and advocacy makes it possible for employees to identify the best options for themselves before receiving care. Employees can search for health needs and see the range of treatment options available to them, along with information and incentives to choose the highest-value care.

3) Price Transparency

If you can’t measure it, you can’t manage it. The success of high-value healthcare hinges on having complete and easy access to all relevant information on prices and quality. This information empowers patients to avoid low-quality, expensive, and often unnecessary care. Furthermore, integrating transparency data with clinical support services is equally as important so that patients are not alone in finding quality providers. Best-in-class self-funded plans provide employees with the tools needed to evaluate healthcare consumption before, during, and after they receive care.

4) Member Advocacy

High-value healthcare is the perfect balance between cost and quality, which can be challenging to find in a cluttered healthcare system. With Member Advocacy, employees and their families are assigned a dedicated advocate to help them navigate care and coverage. Overall, Member Advocacy programs work to assist employees when they need help, but more importantly, to educate and ensure optimal healthcare quality and cost.

Having the right strategies in place tailored to your unique business can result in the significant savings opportunities seen with high-value healthcare. To learn more about how Healthgram can help you bring high-value health care to you and your employees, download our self-funding guide, or connect with our team.

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