Provider Sponsored Health Plans Have a Bright Future in US Health Systems

By October 31, 2018

TAMPA, FLORIDA — //MEDIA WIRE TODAY//  CSuite Solutions, headquartered in Tampa Florida, is well-known for its partnership team of qualified C-level practitioners that deliver healthcare management advisory services to health systems and healthcare providers throughout the US. In response to the ever-growing need for a well-constructed Provider-Sponsored Health Plan option, CSuite Solutions has expanded its services to better cater to the growing needs of the provider-sponsored health plan niche with it’s launch of Direct to Employer.

The DTE Provider Sponsored Health Plan program aims to reduce the speed to market for insurance coverage by providing guidance and a pathway to implementation in six to eight months versus a typical twelve to eighteen-month to two-year implementation timeline for a standard self-funded insurance plan. Direct to Employer is a provider-sponsored, non-insurance health plan program that has been designed for healthcare systems and hospitals (Providers) to offer to the provider’s employees along with area employers to offer to their employees as well.

“In the current climate, outpatient centers, hospitals, and physician groups (Healthcare Providers or providers), are rewarded mostly for the treatment of illnesses rather than their dedication to preserving and maintaining healthy individuals. This climate creates a system where administering treatments and receiving the revenue is a powerful incentive for practitioners, undermining the ethos of prevention being better than cure,” says Brian Paradis, Senior Partner with CSuite Solutions and former COO of Florida Hospital’s Center Region.

For quite some time now, Accountable Care Organizations (ACOs)and health providers have lacked the expertise and experience needed to help construct, deploy, grow and manage self funded health plans effectively and in ways that positively affect the bottom line and result in a successful “volume to value” paradigm shift.

Identifying the need for a specialized expertise, CSuite Solutions is now offering Health Providers the assistance they need to power provider-sponsored, self-funded insurance plans for the providers’ own employees along with offering the new PSP health plan to other area employers, especially the smaller employers with 2-50 employees who have significant challenges in offering affordable health care options to their employees.

The new program, called “Direct to Employer” (DTE), was designed by providers for providers. This proprietary self-funded plan allows the healthcare provider direct access to employee groups, patients, and the other populations within their communities, creating a better pathway for managing the health of these individuals. Providers are incentivized with rewards for reducing health care costs and creating savings through the application of patented population health protocols while working alongside area employers and other public and private institutions including local health centers of excellence.

Self-funded health insurance, also referred to as self funded health plans, have long been up for discussion by experienced population health advisors and employers in the United States. While large health systems have expressed their interest in self funded health plans, most remain unaware of the significant upside opportunity for the Healthcare Provider along with the complexities involved in successful deployment and operation of a provider sponsored plan.

In the past, most employers preferred offering their employees fully insured health plans and paid monthly dues to their insurance provider to cover medical claims and costs tied to administering claims filed under the plan. Self funded healthcare plans represent an arrangement where the Health Provider offers employees health and disability benefits using the providers own private funds but also adding a layer of re-insurance or stop loss insurance to minimize and cap potential losses.

With costs for health insurance rising at exponential rates, volume based healthcare and fully-funded insurance plans have made it difficult for health providers and local businesses to offer quality healthcare to their workforce without compromising cost efficiency.

“For ACOs and large health systems in particular, self-funded plans promise a higher level of flexibility, more room for data-driven, population health initiatives and cost-saving benefits,” notes Stewart Schaffer, Managing Partner at CSuite Solutions. Unlike traditional insurance plans, these plans can be designed to address the specific needs of a Healthcare System and the local community employers and its employees. This customization can include focusing more on mental health for companies where employees tend to spend long hours at work and identifying high-risk employees early on in the process to avoid loss of work due to illness and the higher costs of managing an employee (patient) with more serious illnesses.

According to Stephen Mason, Managing Partner at CSuite Solutions and former CEO of BayCare Health System in Tampa, Florida, “The DTE program aims to reduce the speed to market for insurance coverage by providing guidance and a pathway to implementation in six to eight months versus a typical twelve to eighteen-month to two-year implementation timeline for a standard self-funded insurance plan. Speed is not the only benefit, as this program also offers providers the opportunity to negotiate in a ‘free-market’ manner with employers, cutting out the expensive insurance ‘middle man.The cost of entry is as low as $250,000 to $450,000, a huge difference when typical self-funded insurance plans often start at $2 million, sometimes even more.”

Jointly operated by Key Benefit Administrators (KBA) and CSuite Solutions, DTE is managed and administered by some of the top leadership in healthcare systems and third-party administrators (TPAs) in the world. 

CSUITE and KBA are offering Providers the unprecedented ability to disrupt the current payors and market health plans directly to employers without the participation of an insurance company. The combined knowledge, experience and leadership of these companies provides healthcare systems with a comprehensive, inexpensive solution to get to market quickly, manage revenue cycles efficiently and make and sustain profits.

CSuite Solutions, LLC
4830 W Kennedy Blvd # 600
Tampa, FL 33609
(813) 866-5100
Website: https://csuitesolutions.com/

Lane A. Houk

Author Lane A. Houk

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