5 Reasons to Move to a

Self-Funded Health Plan

Let’s level set: healthcare is a frustrating experience for everyone, especially employers who have to deal with rising costs and little control over the plan. The past year has only brightened the spotlight on the challenges many face when it comes to their health plan.

But better benefits do exist and a self-funded health plan might be just the change employers are looking for to improve the benefits experience and preserve their bottom line.

Our latest webinar, “Better Benefits Exist: 5 reasons to self-fund,” digs into the benefits of self-funding. You can find the recording here if you missed the live event:

Watch the Webinar

Self-funding is the best way for employers to regain control over their healthcare costs, have better transparency into cost drivers and plan utilization and have true flexibility when it comes their health plan. Our speakers talked about how breaking out of the fully insured one-size-fits-all model can help you truly take control of your health plan.

Here’s the highlights reel:

Customization and control over your plan design.

While a fully insured model might look comfortable and reliable, it’s not designed around the needs of the employer or the member. The one-size-fits-all model often leaves employers stuck with too much of what they don’t need and not enough of what they do.

Self-funding gives employers of any group size the control to truly have ownership in the plan design, from tailoring it to their members to plugging in with their preferred vendors. In short, a self-funded plan is the employer’s plan, not the carrier’s plan.

Financial control and transparency.

Healthcare costs are one of the biggest issues facing employers and members today. A self-funded plan puts employers in control of their costs with more transparency and insights.

Here’s a look at what employers pay for a fully insured plan versus a self-funded model:

How a fully insured premium compares to self-funding expenses

How a fully insured premium compares to self-funding expenses.

Instead of paying into profit margins, fixed fees and “anticipated” claims, a self-funded plan enables employers to budget into specific pools, forecast claim spend with data and get true transparency into what plan costs actually look like for their group.

Access to your data.

One of the more critical components of a self-funded health plan is that you get complete access to the plan data. This gives you a whole new level of transparency and can help inform cost management strategies and drive better member health outcomes.

Here are a few of the ways we help our clients derive better insights with customized reporting:

  • High-cost claimants, like ER frequent-fliers or members struggling to manage a chronic condition
  • ER visit analysis, including admissions, avoidable visits and cost
  • Chronic conditions impacting the group
  • Billed charges, discounts and non-covered items
  • Medications and mark-ups

Ability to mitigate and understand risk.

According to our webinar poll, over 30% said that risk was their biggest hesitancy about moving to a self-funded health plan.

To put it plainly, every plan type comes with a level of risk; self-funding gives you more insight into and control over those risks.

Our partner Claros Analytics™ has proprietary software that models what a typical claim year should look like and what a really bad year can look like, giving you the insight into the risks you’re faced with and how to set up strategies to plan ahead.

Having these insights upfront empowers employers to truly understand their risks and implement the right strategies and find the best partners for their needs, like stop loss and building reserves.

Implementing better service and support resources for HR and health plan members.

When we say “healthcare is difficult to navigate,” we know that’s not a ground-breaking assessment of the industry at large. Yet many fully insured plan designs don’t offer the support members need in order to truly understand or use their plan.

Our partner TouchCare™ spoke about how concierge-style member support for plan navigation and advocacy is a crucial part of a successful benefits experience. Having a high-touch service model in place means HR and members have the resources and support they need to truly understand and use their plan and can truly benefit from the plan design, including the cost saving and transparency tools available to them.

Here’s a look at the benefits of a high-touch service model:

  • Proactive decisions instead of reactive clean-up
  • Cost evaluation, education and navigation support to direct members to the right care
  • Supplemental benefit support, like understanding bills and claims, finding in-network providers and choosing the right plan options
  • High-quality care and provider searches and appointment scheduling
At the end of the day, the benefits of a self-funded plan far outweigh the risks of taking on the responsibility of the claims. With the right partners in place, employers can leverage the control and transparency of a self-funded plan to create a better benefits experience.

Enough talk. Let us show you the benefits of a self-funded plan. Contact us to learn more about how we’re putting employers in control with better benefits options.

The Latest From Maestro Health

How Maestro Health Does Clinical Care Management Better.

How Maestro Health Does Clinical Care Management Better.

Blog Post How Maestro Health Does Clinical Care Management Better. Going self-funded has big benefits for many employers which can result in serious cost savings and better health outcomes. Our in-house clinical care management program leverages a data-driven approach...

Better Benefits Exist With Maestro Health.

Better Benefits Exist With Maestro Health.

We’re putting employers in control of their healthcare costs with a sustainable, scalable self-funded solution. Our approach to self-funded benefits is designed to arm you with more flexibility, transparency, cost management strategies and plan insights. There are a...

Breaking Down the “No Surprises Act”

Breaking Down the “No Surprises Act”

In December 2020, Congress signed the Consolidated Appropriations Act (“CAA”) into law. Among other provisions, the CAA includes the No Surprises Act. The No Surprises Act requires all group health plans, including grandfathered plans, to apply in-network cost sharing...

Build healthcare that works for everyone.

Don’t let insurance companies control your healthcare. Build a plan that puts people first.

Contact Us