Innovated Value-Based Care Models, we are Piloting or Scaling Across the State
Our healthcare system is broken. Escalating costs, poor quality, and budget-busting increases year after year are becoming tiresome and frustrating for employers and patients. As we all know, the adage states that the definition of insanity is doing the same thing repeatedly and expecting different results. Tweaking our system will not yield the desired outcomes because we have made minor adjustments for decades with no significant improvements. To improve this situation, employers must change their perspective on providing health insurance for their employees by looking beyond the traditional options.
SoNE HEALTH has embarked on an innovative model to provide precisely what employers seek by going beyond the traditional health insurance options available. This model is intended to disrupt the conventional health insurance middleman approach by connecting employers directly with healthcare service providers. These direct connections will foster a unique, tailored approach to each employer’s circumstances and employee population, while providing increased transparency and efficiency (quality and cost).
Traditional insurance approaches have a built-in incentive in their sales process, as they generate more profit for the health plan when employers utilize their proposed solutions and spend more on care. However, many of these proposed solutions often experience limited employee uptake and results, consequently failing to enhance cost and quality performance. The primary reasons for this lack of success are that most solutions are not tailored to meet an individual employer's needs or their population's needs because they are designed as a one-size-fits-all solution. Additionally, most employers fail to acknowledge that their employees lack trust in their health plan to manage their medical and other health-related conditions. Employees do however trust their physicians with their care, making the doctor-patient relationship the most crucial relationship in healthcare. To improve healthcare outcomes for an employer's population, employers must pivot themselves to more creative options, allowing them to work directly with the physicians who manage their employees' care.
Physicians and advanced practitioners in the healthcare system can diagnose, treat, perform procedures, and prescribe medications for patients. While some have referred to themselves as providers over the years, this has conflated the roles of hospital systems, health insurers, and pharmacy benefit managers with those of physicians. While essential to our healthcare system, these services are different, and all require physicians to operate their business. I’ll be provocative: They are vendors to physicians and patients. This is the paradigm shift employers must embrace to regain control over a significant portion of their operating costs each year.
A direct-to-employer approach allows for customization and individualization of the portfolio of services, direct connections to the clinical community needed to service the employer's population, and more innovative options for managing and controlling spending. These innovations include population health services, more personalized care management options, better pharmacy choices to reduce costs, and eliminating ineffective programs or point solutions, while interjecting or wrapping these services with advanced payment models that align incentives for the employer and the physicians. These aligned incentives produce greater primary care utilization, reduction of high-cost utilization, and improved quality.
Our experience as an employer and those currently aligned with our direct-to-employer programs have demonstrated cost reductions and quality improvements. We have stabilized our expenses, a reduction from the typical 15%-20% premium increases we were experiencing with the traditional health plan process. SoNE HEALTH has experienced an average medical savings of $85 per member per month, or 15.7%, and within our pharmacy spend we have achieved a $25 monthly reduction per member, which correlates to a 22% decrease in pharmacy spending. Additionally, we have observed the following results with our employees and other like employers: an 11% increase in primary care visits, a 16% decrease in emergency department utilization, a 10% decrease in costs, and a reduction in related employee contributions, copays, and deductibles.
SoNE HEALTH has established a stronger relationship to enhance these capabilities and outcomes for more employers, including an exclusive agreement with apree Health to bring additional cutting-edge technologies and features to our existing direct-to-employer program. Our new partner, apree Health, has a proven record of exceptional and innovative benefit designs, outstanding customer service, healthcare cost reductions, and user-friendly digital tools that guide employees to exemplary service at the right time. This model is integrated with the provider community through SoNE HEALTH, which focuses on connecting employees to advanced practice primary care providers. Our primary care providers have access to and authority over the extensive population health and care management services that we offer. The goal is to ensure employees receive the care and guidance they need, when needed, and more importantly, to avoid high-cost unnecessary care that adds millions in spending to your health insurance offering.
Our system is beyond bandage solutions to stop hemorrhaging healthcare costs. It’s time for a new approach. For more information about our direct-to-employer programs, please email John Sunde, Vice President of Payor and Employer Solutions at SoNE HEALTH.