We are not healthcare “Business as Usual.” We do not want to “quote” your insurance solutions.
We assist CFO’s, employers in crafting healthcare solutions that identify the “Root of the Problem.” Our strategies identify healthcare need per covered member, the specific individual behavior that is creating this need and then work one on one with the member, coaching and incentivizing them to a better “state of health,” both clinically and financially. We deliver on demand reporting, daily if desired, that measures from your healthcare data problems, actions, successes and more. Johns Hopkins University is our data “crunching” partner, number one vendor in this arena in the country with over 91 million lives in their ACG management system.
- How would the perfect group healthcare solution be configured?
- What would the needed insurance coverage and contract look like?
- How would you control healthcare cost and save money?
- What would it take to be very well received by all plan participants?
- Is it possible to lower cost, manage risk and have a financially safe solution?
Consumer Directed Health Plans and Value-Based Insurance Designs are the current strategy. These ideas are only single pieces of our solutions.
There is only one way for every employer to control the cost of healthcare increase - reduce the frequency, size and amount of claims. Even if you achieve claim reductions, you will not financially benefit through your current insurance relationships. What are you doing to control the frequency, size and amount of claims and benefit financially?
In order for an employer to benefit financially, new insurance contracts have to be crafted. Contracts that first remove insurance company and shareholder profits; reduce insurance plan tax liabilities; deliver plan design flexibility between the employer and insurance contract and then benefit design flexibility between the employer and all of the covered members. Benefit satisfaction is critical if you want to retain and attract talent.
In order to reduce the frequency, size and amount of claims, strategies and tactics have to be developed that will first engage with enthusiasm all covered members; motivate all members to improve their lives and state of health by improving medical literacy. These strategies must be fully administrated, managed and delivered through technology and “live” coaches. All healthcare data sources must be connected, verified for accuracy and updated daily. All data must be 100% actionable, driven by the technology with health rules, automated messaging triggers and live credentialed people to communicate directly and timely with each member of concern.
The new solution will be comprised of fixed cost; administration, network, service and insurance cost and then a variable cost that is used to pay claims. These costs will be identified, fully funded by the employer at the guaranteed highest plan year cost and deliver 100% refunds of the unspent variable cost funding at the end of the contract.
The solution cannot contain unknown financial and clinical liability for the employer or covered members, regardless of circumstances or decisions to terminate the relationship for any reason.
Facts About Healthcare Costs
- 75% of claims arise from Chronic Care, not Acute Care.
- 71% of claims are attributed to Behavioral Choices (Lifestyle).
- Obesity medical costs total over $12 Billion annually.
- Diabetics cost 5-6 times more each year than a non-diabetic and a “non-compliant” diabetic costs twice as much as the compliant.
- The Affordable Care Act has increased access to healthcare but imposed new costs to fully insured group plans.
- Rising plan costs continue to be a major problem.
Hope Is Not A Strategy
Why pay the ever-increasing costs of allowing your group medical benefits to be held hostage by expanding government regulations and insurance company inefficiencies?…Hope Is Not A Strategy.
How Can You Manage What You Don’t Understand?
For many employers, the costs of group medical are 2nd only to payroll. It’s not that you don’t know your costs for healthcare continue to rise, it’s just that you don’t have the data when you need it to make a difference. If you receive any data at all, is it what they show you to justify your latest rate increase? That’s no way to manage your company’s 2nd highest expense.
Doesn’t it seem logical that you need a way to help your people reduce the frequency, size and number of claims? If you’re like most employers, less than 20% of your people account for more than 80% of the claims. And since that information is private and protected, how can you be involved at any level?
Contact Mr. Hettesheimer today to learn more about this new and innovative small group health insurance solution available in all 50 states. “The perfect small group healthcare solution.”