Direct To Employer Self-Funded Insurance Program Launched by CSuite Solutions

DTE offers a delivery program for self-funded healthcare which enables health systems, providers, employers and the insured to all share the benefits and savings. Through reinsurance for losses and employer funding, risk management is optimized to mitigate typical risks found in traditional self-funded plans.

Tampa, United States - April 5, 2018 /PressCable/ —

New direct to employer self-funded insurance program launched to fix broken U.S. healthcare system. In the current healthcare climate, outpatient centers, hospitals, and physician groups (Providers), are rewarded mostly for the treatment of illnesses rather than their dedication to preserving and maintaining a patient’s health. This climate creates a system where administering treatment and receiving the revenue is a powerful incentive for practitioners, undermining the tenet that an ounce of prevention is better than a pound of cure. The challenge to change our broken healthcare payment system is what prompted a group of CEOs, each coming from senior leadership positions in a large US healthcare system, to join together in a healthcare consulting and advisory practice named CSuite Solutions. Their first major objective was to develop and launch a direct to employer, self-funded group health plan program that would allow healthcare providers to have a direct relationship with employers in their market without the need for an insurance company intermediary. The new program, called “Direct to Employer” (DTE), was designed by providers for providers. This proprietary self-funded plan allows the healthcare provider direct access to employee groups, patients, and the other populations within their communities, creating a better pathway for managing the health of these individuals. Providers are incentivized with rewards for reducing health care costs and creating savings through the application of patented population health protocols while working alongside area employers and other public and private institutions including local health centers of excellence.

Initially, the DTE program is targeting US health systems and employers in their primary and secondary market areas. Research shows that almost 56-percent of U.S. individuals have healthcare coverage through employer-offered programs. The DTE self-funded plan can also successfully be adapted for other segments of the population.

Stephen R. Mason, one of the co-founders and a managing partner at CSuite Solutions, said “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 Organizations (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.”

Unlike other traditional health plans and self-funded health plans available on the market designed by insurance companies, DTE was designed by former CEOs of large US healthcare systems, with accessibility to providers at the forefront. By specifically addressing the challenges providers face, the DTE program overcomes the challenges that typically arise when insurance companies manage health care coverage.

DTE aims to offer a delivery program for self-funded healthcare which enables health systems, providers, employers and the insured to all share the benefits and savings. Through a combination of reinsurance for losses which exceed a certain limit, and employer funding, the risk management component is optimized to mitigate typical risks found in traditional self-funded plans. This is not a new concept to insurance and non-insurance company third-party administrators (TPAs), but for provider-branded and marketed health-plans, this is new and exciting territory in the self-funded market for healthcare providers.

Larry Dust, CEO and Founder of KBA agrees, saying “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. Under this new model, providers and employers are ‘at the table’ together. They are equipped with the necessary clinical and financial data plus analysis to understand the cost drivers, evaluate clinical treatment protocols, identify areas of improvement and address real plans for reducing costs and increasing quality of life in the health of the populations they serve.”

By taking on board the lessons of the past and applying them to future plans, CSuite and KBA, who administers the DTE program, promote the use of provider resources for early detection and prevention, rather than treatment of illnesses. Typical insurance models have the added risk of underwriting medical claims, which CSuite and KBA feel should not be a risk that providers take. Many large, well-financed healthcare systems who themselves have become health insurers, have already suffered large underwriting losses..

The DTE program aims to increase the speed to market for group health coverage by providing guidance and a pathway to implementation in six to eight months versus a typical twelve to eighteen month implementation timeline for a standard fully risk insurance plan. Speed is not the only benefit, as this program also offers providers the opportunity to negotiate in a ‘free-market’ manner with employers, cutting out the expensive insurance ‘middle man.’ Start-up costs are as low as $250,000 to $450,000, a huge difference when typical insurance plans often start at $2 million, sometimes even more.

Jointly operated by Key Benefit Administrators (KBA) and CSuite Solutions, DTE is managed and administered by some of the top leadership in healthcare systems and third-party administrators (TPAs) in the world. CSuite Solutions alone brings over 200 years’ worth of combined experience through its partners, who have had great success in clinical integration, network development, provider-based insurance, revenue cycle optimization, volume to value transitions and accountable care organizations. One of the largest non-insurance TPAs in the U.S., KBA has a track record of 30 years when it comes to reducing costs associated with healthcare.

Mason suggests that employer health plans are about to be disrupted by this new self funded DTE program, saying “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.”

Contact Info:
Name: Stewart Schaffer
Email: [email protected]
Organization: CSuite Solutions
Address: 4830 W Kennedy Blvd STE 600, Tampa, Florida 33609, United States
Phone: +1-813-866-5100

For more information, please visit https://csuitesolutions.com/

Source: PressCable

Release ID: 325795