The Roadmap for a High Performance Employee Health Plan is in the Shape of a Pyramid.

1. Primary Care is the Foundation of a High Performance Employee Health Plan.

There is Virtual Primary Care and Onsite Clinics that provide care management, mental health services and health system navigation support.

Primary Care is Paid Directly by the Employer and is Not run through the insurance carrier.

2. Specialty Care is the Middle Layer and is run through the a TPA or ASO carrier. The key is the plan design steers plan members to the highest quality specialists by offering them at a lower out-of-pocket cost, while the low quality specialists have a higher out-of-pocket cost.

3. Acute Hospital Care is at the Top and Direct Contracting is Used Outside of the insurance carrier for Ortho, Cancer and Cardiovascular care.

This High Performance Employee Health Plan is then Surrounded by a Transparent, Pass-Through PBM.

The Companies Serigraph and QuadMed implemented similar plans over a decade ago with tremendous success and cost savings.

Specifically, Serigraph made an upfront investment of $2 Million for their 1,000 Employees and saved $31 Million over 9 Years.

Sources:
The Company That Solved Healthcare by John Torinus

AHealthcareZ is 200+ Healthcare Finance Educational Videos.

💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: [ Ссылка ]

AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health.

90,000+ Views Per Month Across All Platforms.

Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.

свернуть