Direct Contracting with Providers along with a group health plan?

[jwarrendesha]

Good morning everyone.

In an effort to continue improving and taking care of those who come on to our book of business I was thinking about this. So here are the questions:

1. Has anyone here worked direct contracting with employers and providers?
2. If so, what did you learn during the process?
3. Did you do it outside of traditional health insurance or did you couple it with a HDHP or Self funded plan?

I'd love to get some feedback. Thanks!

 

[leevena]

I admire your enthusiasm to try this, but before you spend much time on it you should be aware that this is next to impossible, or worthwhile for most brokers to do. The amount of time needed is very significant. To get a discount deep enough to make it worthwhile requires tens of thousands of members, if that. You would need to build and maintain infrastructure to track the contracting, review of claims, coordinating with cost containment, etc.

We do only self funding and have turned to reference based pricing for many clients. We use a variety of networks, but our belief is that discounts mean very little in the scheme of things. We have had more success controlling costs via referenced base pricing, aggressive care management, bio metric and other wellness incentives, etc.

Good luck with your efforts.

 

[RGBC]

I would assume that direct contracting requires a lot of capital in order to work with fully-funded customers.

 

[leevena]

I have never heard of direct contracting for fully insured groups, only self-funded.