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  • Sarah Devine

How self-funding helps mid-sized companies get ahead of large healthcare claims

When you sign up for health insurance what value does it add to your life? Sure, it’s something we are required to have, but what do we really mean when we say the phrase “health insurance?”

Did you know the word “insurance” comes from the 16th century Old French word “ensurance?” This roughly translates to “assurance; safe and secure.” Now, do any of these words actually come to mind when you call your insurance company or face the bill after a procedure?

Didn’t think so.

Instead, common associations are probably more in line with “dread,” “terror,” or “not again.” How did we stray so far from the original intent of this word? Excuse my French, but what the health happened?

We are stuck in a broken system

The fact of the matter is company health benefits are no longer a benefit. What was once an employment perk has been debased into a politically fraught, legal obligation that costs employers and employees alike. The bureaucracy of full-coverage has gotten in the way of the original intent of health coverage. Today, full-coverage companies are more interested in policy holders’ checkbooks than their health.

So what’s next? Is it time employers waved a white flag in surrender, and continue partnering with a system they know to be greedy? Allow the corporate healthcare machine to financially exploit the American populous forever? The short answer is no: the broken healthcare system only has as much control as we all give it. Every time we feed the monster it grows, but it’s about time we stopped feeding the monster. It’s time for an alternative.

How self-funding is bucking the norm

The traditional, dogmatic nature of full-coverage plans is too narrow. The “one size fits all” model alienates demographics that stray from the median, and it does not account for the individuality of care. A more holistic approach is necessary — that’s where self-funding comes in.

The self-funded model allows companies to handpick options to provide superior care to employees at a fraction of the cost. Think of it as “a-la-carte” coverage, where employers pick benefits that are important to their member group, skip anything unnecessary, and come out with a streamlined plan catered to employer and employee needs. Employers who self-fund can tailor their benefit plans to employee needs rather than adopting a canned program.

The premier care options that round out Novo Connection- include:

  1. Guided Healthcare.

  2. Predictive analytics.

Let’s explore these two features to understand how self-funding is fighting the good fight.

Escape the cycle of spending through guided healthcare

Over a decade of research has gone into developing a healthcare model that is customized for the mid-sized market, and all indications show a need for greater personalization when it comes to healthcare. Healthcare is confusing, and misunderstanding often leads to wasteful spending.

Let’s play a game — a very expensive, dangerous game:

You’re diabetic and can’t remember if you took your insulin or not. If you take it again, you run the risk of overdose; however if you don’t take it, and needed it, you’re in trouble too. What do you do?

  1. Call mom — mom always knows what to do.

  2. Fetal position/cry.

  3. Consult the Internet — no one ever posts incorrect information online, right?

  4. Call your insurance company for advice on what to do next.

No matter what, you answered wrong. Sorry, it was a trick question. Let’s review:

  1. Calling mom isn’t a bad idea, but she might not be any more informed than you.

  2.  . . .   

  3. The Internet cannot possibly account for the nuances of individual circumstance, and online medical sites can only offer general prognosis that likely doesn’t apply to your case.

  4. When was the last time you called your insurance company? And, if you did, do you think the call center agent would even care?

Novo Connection offers another option — the right answer — that you won’t find in the traditional health insurance model.

  1. Guided Healthcare —  Self-funding makes healthcare more affordable through customer support and advocacy.

Guided Healthcare is at the heart of the Novo Connection model and offers a more compassionate approach to healthcare. Healthcare inquiries are fielded by trained guided healthcare professionals who provide support to maximize savings by helping individuals proactively avoid future spending.

Anything that is unclear is subject to guided healthcare, whether that’s discussing claims, getting referrals, or just having someone to advocate for claims resolution. Guided Healthcare lifts the veil traditional coverage is trying to keep policyholders behind, reveals the truth behind healthcare spending, and optimizes care to the individual.

Through this personalized level of support, individuals avoid unnecessary spending by having a trusted companion to help them navigate the system. Education and support save both employers and employees on wasteful spending in areas they would have otherwise never considered.

Heightened transparency with predictive analysis

Consider this: every month thousands of dollars disappear from your company bank account out of the blue. Would you expect some explanation? Would that be fair?

Well, that’s exactly what happens when you partner with full-coverage healthcare. Traditional insurance plans do not share information on the collective health of employees, so money disappears without any explanation — poof!

In a self-funded plan, employers can incorporate apredictive modeling engineto better understand how healthcare money is being spent. After-all, any big decision in life should be looked at from all angles, so why is healthcare an exception?

A predictive modeling engine gains intelligence from historical data to forecast a company’s overall healthcare spend and better anticipate large claims on the horizon. With more transparency into healthcare usage, predictive analytics help identify at-risk employees and uncover costs that will occur in the future. This extra insight allows employers to implement data-driven cost trend solutions to meet financial objectives and prepare for the possibility of large claims. It also enables employers to be proactive about healthcare spending to deliver a program that meets the needs of their employee population — instead of throwing money at general, blanket coverage.

The purpose of self-funding is to let employers manage their own healthcare plan so they can forecast cost, measure performance, and prioritize benefits based on the employer group. Self-funding puts the control of healthcare spending back in the hands of employers to deliver better care and save money — without fearing the looming threat of large claims.

Contact Novo Connection to learn more about why standing up to full-coverage will reduce the financial burden of mid-sized companies and how self-funding is redefining the meaning of healthcare.

Posted by: Michael Poelman

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