Health insurance has lost its way. As a result of bureaucracy and corporate greed, the healthcare system is broken, and is costing employers and employees alike.
Company health insurance should give employees peace of mind — assurance that care is available whenever needed. It should provide companies a way to keep employees healthy and show that every individual’s best interest is a priority. In these areas and more, full-coverage health insurance falls short.
According to a recent study from the Employee Benefits Research Institute, high deductibles continue to increase among company health insurance plans. Shifting trends within healthcare put added pressure on individuals to cover costs, while insurance companies profit from mediocre coverage.
Many people have lost faith in insurance as a helpful benefit and a necessary safety net for themselves and their families. Instead, health insurance is begrudgingly offered by employers and unenthusiastically accepted by employees. Companies pay insurance providers to deliver benefits to workers that are usually not ideal, and many employees treat healthcare plan selection as a chore.
The true purpose of health insurance should be to provide care for people; however limited options or exorbitant costs get in the way. Here are two ways health insurance can be resuscitated from the cold machine it has become.
Move away from traditional health insurance models
Worst of all, this number is predicted to rise well into 2025. The US has one of the best healthcare delivery systems in world, but many employers are forced to shift the financial burden to employees in the form of high deductible health plans and benefit reductions to compensate for rising healthcare costs.
Unfortunately, high cost is not yielding high results. US citizens, on average, spend double on health insurance compared to other developed countries, yet the country ranks worst in chronic disease prevention and obesity rates. This dilemma raises the question, “Why aren’t high costs making us all more healthy?”
In pursuit of an option that better aligns with the intent of health coverage, some employers are turning to self-funded insurance. The self-funded model is a break from the fragmented, impersonal full-coverage system, and drives down costs by offering financial independence.
In traditional healthcare models, employers have little choice for which benefits are offered. Also, they have minimal control over how funds are invested and little insight into rising premiums along the way. An overall lack of transparency within traditional insurance plans, which do not share information on the collective health of employees, leads to unnecessary costs.
Adopting the self-funded healthcare model puts control back in the hands of business owners. It enables companies to set aside funds for healthcare — and choose how that cash is spent — rather than relinquishing power to an insurance company. By paying for claims on an individual basis instead of prepaying for coverage, self-funding companies see more control of their cash flow.
The increased employer power that comes with self-funding opens the door for companies to provide health insurance that is customized to an employee group. This means employers can reduce costs and avoid shifting the financial burden to employees.
incorporate care coordination and Navigation
Traditional healthcare plans typically refer patients to a call center, and this reactive model does not yield patient satisfaction. The nuisance of reactive support causes employees to avoid “dealing” with doctors and healthcare providers, which can ultimately delay treatment and increase healthcare costs in the long-term. Within the traditional healthcare delivery process, evaluations, specialty care, drug delivery, and rehabilitation are understandably handled by different practitioners, but meaningful coordination rarely occurs among everyone involved.
Healthcare plans that offer care coordination and navigation are changing the paradigm of health insurance support. Care coordination provides a central service center with dedicated care coordinators to guide members through the confusing, disjointed healthcare system. Care coordinators are available to discuss claims, provide referrals, and act as member advocates. Care coordinators are members’ healthcare warriors, and any question about healthcare is fair game.
Care coordination and navigation reworks the member experience to meet members when and where they need help. This compassionate approach to patient support makes healthcare more efficient and enjoyable.The care coordination model keeps stakeholders informed and ensures the delivery of the best possible care for a patient.
Care Coordination closes the gap between high cost and quality care by making healthcare more transparent. Care coordinators facilitate this savings by intercepting treatment and claims in real-time and eliminating any redundant or unnecessary services. On average, care coordination and navigations cuts healthcare costs 12.5% in the first three years after adoption — that number grows to 17.9% over the first five years.
Traditional healthcare insurance providers have lost sight of what it means to help people affordably maximize quality of life. It’s time to ditch this trend, and return to the true intent of healthcare through the more compassionate, proactive model of self-funding with care coordination.
Contact Apta Health to learn more about saving on group-healthcare plans, and providing a more personalized healthcare option for employees. Companies with over 100 employees can partner with Apta Health to manage the care delivery process, eliminate waste, reduce overhead and avoid extra costs typically associated with delivering healthcare to employees.