TAMPA, Fla.--(BUSINESS WIRE)--As it stands today, hospitals, physician groups and outpatient centers (Providers) are still mostly rewarded for the treatment of illness and not for the preservation of health. With this economic structure, there remains a very powerful incentive to initiate treatments and receive their related revenues. This is the primary reason that a group of former healthcare provider CEOs came together under the corporate umbrella of CSuite Solutions to develop and launch a program for Providers to help solve this most challenging problem that is plaguing our broken U.S. healthcare system.
Designed by Providers for Providers, this new program, called “Direct to Employer” (DTE), financially links Providers directly with patients, employee groups and other populations within the communities they serve, making them more effective at managing the health of these populations. In turn, participating Providers are rewarded for producing cost savings through the application of patented population health protocols in addition to working side-by-side with employers and other institutions to reduce costs.
The DTE program initially targets employee groups since research has shown almost 56 percent of the U.S. population has healthcare coverage through their employers.1 However, the program can also be adapted effectively for other population segments.
“In addition to this Program favoring Providers and employers, I am just as excited that the technology behind it can be applied to existing Accountable Care Organization (ACO) and Clinically Integrated Network (CIN) initiatives as well as to the uninsured and underinsured populations which will allow non-profit Providers to better fulfill their community missions,” said Stephen R. Mason, a co-founder and managing partner of CSuite Solutions.
Contrary to other health plans on the market, DTE was developed for Providers by former CEOs of large health systems, not insurance companies, which means it was designed with the Provider in mind, and specifically addresses their unique challenges. This approach removes many of the barriers that often arise when healthcare coverage is managed by insurance companies.
Built upon the concept of self-funded health plans, DTE provides a healthcare delivery platform that allows Providers and employers to share equally in the cost savings. It manages risk with a combination of employer funding and re-insurance for losses above a certain limit. While this approach is used by both insurance and non-insurance company third-party administrators (TPAs), it is new to Provider-branded and marketed health plans.
Although many large Providers have recently implemented their own full insurance model to reduce healthcare costs and achieve population health objectives, most of these initiatives have resulted in massive underwriting losses for these Providers. Learning from the past and looking to the future, CSuite and KBA both believe that Provider resources should focus on reducing healthcare costs through early detection and prevention, and that Providers ought not take on the added risk of underwriting medical claims which is required by the typical insurance model.
The model put forth by this program also differs from other approaches Providers have used in the past by sidestepping the insurance “middle man,” enabling Providers to negotiate in a free market manner directly with the buyer of their services: the employer. Additionally, the financial burden for Providers is cut significantly with start-up costs for the DTE Program ranging from $250,000 to $450,000 versus $2 million and up for a Provider-owned insurance plan. The speed to market for the DTE Program is six to eight months versus 12 to 18 months for an insurance plan.
The DTE offering will be jointly operated by CSuite Solutions and Key Benefit Administrators (KBA). CSuite Solutions brings more than 200 years of combined experience of its partners to this venture, whom have held CEO positions in health systems across the nation leading network development, clinical integration, Accountable Care Organizations and provider-based insurance offerings. KBA is one of the largest independent, non-insurance TPAs in the U.S. with a 30-year track record for reducing healthcare costs.
“Disruption is coming to the employer health plan market,” Mason noted. “Healthcare providers that seize this opportunity will be able to gain first-mover advantage to significantly grow market share, reduce leakage and share real savings directly with area employers.”
“It’s time for healthcare Providers to be directly connected to patients, employee groups and other populations within their communities and to be responsible for the overall health of these populations with tools that have a proven track record for reducing costs,” said Larry Dust, Founder and CEO of KBA. “Under this new model, Providers and employers are ‘at the table’ together. They are equipped with the necessary clinical and financial analysis to understand cost drivers, evaluate clinical treatment protocols, identify areas of improvement and address real plans for reducing costs and increasing quality.”
To learn more about the Direct to Employer Program, go to: https://directtoemployer.com
About CSuite Solutions
CSuite Solutions is a national strategic advisory firm serving health systems across the U.S. The practice is led by accomplished healthcare industry executives who have transformed hospitals and major healthcare systems, physician groups and other Providers into financially robust organizations. These C-level executives are now dedicating their talents and connections to helping their peers successfully navigate these transformative times. To learn more about CSuite Solutions go to: https://csuitesolutions.com or follow us on Twitter @CSuiteSolutions or directly at: https://twitter.com/csuitesolutions
About Key Benefit Administrators
The Key Family was founded in 1979 as a full-service group benefits administration firm specializing in self-funded medical plans. Since that time the Key Family has grown to become one of the country’s largest independently-owned third party administrators, supporting a wide variety of group benefit plans. With its two major locations in Indianapolis, Indiana, and Fort Mill, South Carolina, the Key Family is a commonly held group of benefits-related organizations with over 800 employees, over 4,000 corporate customers and over 2 million members under management. The Key Family is made up of several organizations that work in specialized areas of health plan administration and management. One of these organizations is the Accountable Care Solutions Group which is the contracting entity for the Direct to Employer Program.
1 Census Bureau Health Insurance Coverage in the United States: 2016; web link - https://www.census.gov/content/dam/Census/library/publications/2017/demo/p60-260.pdf