Payer Platform for Self-Funded Employers Targets Member Engagement

Self-funded employers take on the responsibility of covering their employees’ medical costs.

The strategy is particularly appealing for large employers because they can exert more control over healthcare spending compared to fully-funded health plans.

But this approach can also leave employers looking for point solutions and contracting with numerous third parties in order to target employees’ needs. Navigating through various parties’ platforms to find support and locate benefits information can be challenging for employees.

As the largest customer-owned health insurer in the US with almost 17 million members, Health Care Service Corporation (HCSC) could not afford to ignore this dilemma.

“If an employer has now contracted with three or four other vendors to provide specific services in healthcare, we want it to be a seamless experience,” Kevin Cassidy, chief growth officer of HCSC, told HealthPayerIntelligence.

In addition to the need to pull together multiple contracts, self-funded employers must find ways to put healthcare decision-making in their employees’ hands and improve member engagement.

“We know that when people are more engaged in making decisions around their healthcare, they make decisions for higher quality healthcare,” Cassidy noted.

As a service provider for self-funded employers with 90 years’ worth of experience in the insurance industry, HCSC already had strategies to accommodate those two aims.

First, the structure of self-funded coverage somewhat reduces the contractual burden on employers. Payers, like HCSC, that are engaged in a self-funded plan continue to contract with providers and health systems on behalf of their employer client. Thus, employers can manage their clinical partnerships in a more streamlined manner by coordinating with their payer.

Second, in order to help improve member engagement and member experience, payers offer employees opportunities for one-on-one conversations. Through HCSC’s telephonic offering, members can ask questions to enhance their understanding of the health plan’s benefits and bolster their ability to control their healthcare spending.

However, the payer also wanted to provide a digital resource that employees and employers could use.

In search of solutions, HCSC turned to a vendor that would provide a digital platform to complement the payer’s existing, one-on-one offerings.

“We do quite a bit of development ourselves, but we also looked out into the entrepreneurial markets to see who is developing a digitized platform for employees to access their benefits that they get from their employers,” Cassidy explained.

HCSC’s chosen platform aims to help employers and members maneuver through their healthcare services and healthcare coverage by consolidating employers’ various third-party, contracted services.

With this tool, HCSC hopes to streamline a range of services, from assisting employers in administering benefits to managing employees’ healthcare spending.

Having all of their benefits and coverage details in one place should help members make more informed healthcare decisions.

“Our goal is to really increase engagement in health care because the by-product of that is higher quality, lower costs, and a better member experience,” Cassidy stated.

“Candidly, the member experience often in healthcare is not positive. So, how do we really support the member and make sure that they have a positive experience? When you're working on those three things, you have much better outcomes on behalf of your members, and then you have a much better healthcare experience and better healthcare results.”

The platform allows for curated programs informed by population health data. It can connect employers with virtual providers and other programs that will address health needs among employees.

Employers can benefit from streamlining their offerings as well. Administration, adjudication, eligibility, billing, payments, and reporting and analytics are all managed through the platform.

Employees access the tool through a mobile app while employers can navigate their plans and programs through a web-based interface.

“Together, our combined offering will make benefits administration easier for employers, and at the same time, help individuals get connected with the care options that can best meet their needs, when they need it,” Maurice Smith, HCSC’s chief executive officer, said in the press release.

The payer will offer this platform to HCSC self-insured employer clients and their members in Illinois and Texas starting in January 2022.

In recent years, multiple payers leveraged technology solutions for their self-funded employer clients. Even during the coronavirus pandemic, growth in this space did not stop.

In August 2020, Verily—Alphabet’s life sciences and healthcare subsidiary—and Swiss Re Corporate Solutions announced their Coefficient Insurance Company (Coefficient), a payer built for self-funded employers.

Specifically, Coefficient offered stop-loss insurance, a common technique that protects employers from catastrophic medical costs. This solution targeted employers’ concerns about how to control high and rising healthcare spending.

Verily’s leadership indicated that the payer would embrace technology solutions in order to support their healthcare spending management services.

“Over time, we look forward to integrating Coefficient with Verily’s employer health solutions, including mobile health devices and innovative care management programs, in order to align payment models with better health outcomes,” Andy Conrad, chief executive officer of Verily, anticipated when the companies made the announcement.

Meanwhile, for years Aetna Whole Health has used its CVS HealthHUBs to pursue the triple aims of value-based care in its self-funded employer plans.

Aetna Whole Health contracted with accountable care organizations in the Atlanta region to bring down healthcare costs and improve patient outcomes. The value-based contracts were upside risk and relied on care coordination.

“Over the past two years, we worked diligently to improve both the experience and cost structure for our members in the market. The result is a product that truly acts as a bridge, allowing more coordinated and accessible health care options, designed to lead to better outcomes,” Frank Ulibarri, Aetna's president in Georgi, said at the time.

As payers provide more technology options for their self-funded employer clients, employers may benefit from solutions that streamline third-party offerings and enable member engagement.