Cost Management: Strategies for Self-Funded Health Plans

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August 3rd, 2012

self-funded cost management strategiesWith the demands of the PPACA and the rising cost of medical care driving fully-insured premiums higher, more employers both large and small have been choosing to self-fund. Control of health plan design, management of plan costs and increased quality of care for their employees are seen as some of the main advantages of self-funding.  For many employers, the cost management component is seen as one as one of the main incentives with a variety of strategies that can be implemented.

Self-Funded Health Plan Cost Management Strategies

  1. Managing provider network reimbursement increases more effectively to achieve deeper discounts.
  2. Investing in wellness and disease management, and exploring ways to encourage plan participants to make healthier lifestyle choices.
  3. Building value-based plans that encourage greater use of clinics and other alternatives for minor illnesses and injuries. Promote the use of generic drugs and step therapy
  4. Managing imaging/diagnostic technologies more tightly.
  5. Using data mining to make effective plan design decisions that focus on high-cost conditions and atypical utilization patterns
  6. Using more aggressive hospital-admission management strategies that pay for quality outcomes, reduce readmission rates and channel patients to high-quality/high-value providers by specialty.
  7. Conducting aggressive, data-driven renewal negotiations.

By utilizing these strategies employers can begin to address some of the main drivers of cost such as consumer health habits, waste in the health care system, poor quality care and poor preventive care. It’s important for employers to act as a guide for plan participants as they navigate the healthcare system. By providing participants with information about high-quality providers, access to appropriate care and offering assistance to improve participant health habits, employers can have a positive impact on employee health as well as their bottom line. PayerFusion is a Health Plan Administrator offering solutions to help design and manage self-funded health plans.  We offer complete health plan administration solutions customized to meet self-funded payer needs such as provider network design/support, policy design, full-service TPA, technology solutions/support and informatics.  Contact us for more information and to learn more about our services. 


One Comment

  • By identifying each of the costs associated with a business, you can identify the business your organization is actually in. once you have identified and isolated each of these business, you can then manage each section by evaluating the costs of that section.