Why

It's What People Want

Health insurance costs have become crippling for many employers and families. Insurers have responded as best they can, shifting more of the cost onto beneficiaries and offering highly restrictive networks of only the lowest cost hospitals and other health providers.
People still want a broad choice of health care providers, but they also want to lower the amount they spend on health care. Our plans retain total freedom to use any health care provider and give guaranteed episode pricing for the full range of services in a patient’s episode of care. In our plans, people will make their selection of health care providers knowing the allowance available in their health plan and exactly what their out of pocket cost will be, based on the choices they make.
Employees and their families can access guaranteed prices for the majority of major health care episodes, creating certainty about the level of out-of-pocket-expense.Disclosing the range of guaranteed episode prices for various providers allows plan beneficiaries to make informed decisions when selecting the site and provider of health care.

Economic conditions facing U.S. businesses will become more challenging over the next few years and employers will have a heightened level of price sensitivity. Health benefits are one of the largest non-payroll expenses for businesses and our programs offer a compelling way to lower costs while protecting employees from having costs shifted to them
Employers and benefit consultants are seeking ways to drive the cost of benefits down and to engage employees in helping them do that
Employers want a competitive health care marketplace that leverages natural competition to keep costs in check. Integrating bundled payments into their benefit plans promotes greater competition on service, cost and outcomes

Our framework for cost management starts with Advanced Primary Care, delivered both virtually and in-person. Within each geography we serve, we start with a foundational relationship with leading Primary Care practices who embrace our view of shared responsibility for the health and welfare of employees and their dependents.
For a wide range of complex diseases and conditions, we rely on Episode of Care allowances and contracts. We deliver guaranteed pricing for a defined set of episodes that represent approximately 50% of spending for most employers. We believe in organizing and paying for health care using the episode framework – because that’s the way patients experience the health care system, and it fits the way physicians and health professionals think about the whole patient experience.
For services that are not primary care, and don’t lend themselves to episode of care definitions, we use standard contracts and networks to access discounts and to assure compliance with our programs.