The Status Quo Dilemma
Over 30% of U.S. health care spending is wasted due to poor care management and accountability. This results in avoidable health ailments, unaffordable insurance and health care being the 2nd largest employer cost.
The health plan provided by employers is often their second largest company expense with this cost growing over 5% every year. Employers and employees struggle with this rising cost and mediocre health outcomes of status quo insurance carrier plans and networks.
The core of the problem is the current fee-for-service (FFS) health system paying providers for care volume rather than successful care results. This system is designed to take care of the sick rather than maintain good health and prevent sickness and unnecessary cost. This leads to more than 30% of health care spend being wasted with no accountability for quality and ever escalating prices.
Traditional status quo health plans are also confusing and take a one size fits all approach that isn’t personalized to member needs. This results in poor member utilization, health outcomes and satisfaction.
The Solution
20-40% Lower Cost for Superior Care
Value-Based Care (VBC) is an alternative to FFS that pays health providers for achieving optimal health outcomes and patient experience at affordable prices. VBC rewards high quality care and the elimination of unnecessary care and cost. An employer plan can provide its members superior health care at 20-40% lower cost by evolving to value-based health benefits that embody VBC.
Add Anytime with No Plan Disruption
Enable Health’s solution suite enables employer plans to gradually transition to value-based health benefits either on or off cycle. They can overlay current benefits to achieve more value and choice with no disruption in plan design. Our solutions can also stand-alone if an employer prefers.
Members Can Save 50% OOP
Employers, members and high-quality providers all win. Members benefit from having access to the best providers in a high performing network with fair and transparent prices. Personalized navigation services guide them in best utilizing their plan and managing their health. Our solutions can save members up to 50% on their out of pocket (OOP) expense and increase an employer’s bottom line by 10% or more.
Our Care and Benefit Models
Our care model delivers VBC by combining advanced primary care (APC), high quality specialty care and personalized navigation to deliver a comprehensive value-based health benefit.
APC centers on keeping members healthy by preventing disease/illness and coordinating all care for a member. This subscription program pays for itself by eliminating unnecessary care including reducing emergency care by over 50% and hospital stays and outpatient procedures by over 20%. APC has no co-pays or deductibles and treats 80% of patient health issues with 24/7 access, unlimited clinician visits and wellness coaching.
A curated, high performance specialty care network is customized for each market. We navigate members to top quality providers resulting in the best care and often the most savings. Members are incentivized and coached to make smart, well informed decisions to seek appropriate care and best manage their care and health.
Our goal is to direct contract with significant health providers, maintain provider choice and fairly price out-of-network providers. Population health management facilitates the efficient allocation of resources to achieve most favorable health results for overall plan membership.
Employers Must Drive Evolution
Evolve beyond traditional plans and invest in the innovation that will significantly improve the health, financial security and peace of mind of your organization and employees. Employers need to drive the evolution to value-based health benefits. Insurance carriers and many health plan brokers and consultants prefer the status quo even though it poorly serves employers and plan members. All employers offering health plans should ask themselves these four questions (click on question to get more information):
- How is my health plan performing and are my core business and employees at financial risk?
- Does my health plan provide my company competitive advantage?
- What are the challenges of status quo health care and benefits?
- What are better alternatives to status quo insurance carrier plans and networks?
Answering these questions reveals the power of value-based health benefits in solving many of the problems experienced by employer plans with status quo health benefits.
Enable Health can help your plan provide its members better health benefits and care at lower cost. Contact us to learn more.
