Why Self-Funded Health Plans Are Still Broken and How Employers Can Take Control

And exactly what's the offering when somebody becomes your customer? Is it the whole plan? What are different pieces involved, specifically what you offer currently?

Yeah, I mean, I think of this as a continuum.

So on one end of the continuum is the fully insured plan.

The fully insured plan, many know and recognize it, right? The challenge with it is that you have zero control, right? So you are a 50 life employer, you are a 200 life employer, you have a premium, you pay that premium, and it does not matter what the utilization is, right? I joke with folks to say like, Imagine this hypothetical thought experiment, right? That no one used health care on your fully insured plan.

It was a miracle, right? But guess how much you paid, right? You still paid that fully insured premium.

So you realize pretty quick in this fully insured model that it is a trap that you have to get out of, right? So you exit it.

And then typically next in the sequence is you you self-insure through one of those same carriers.

Well, now you're back.

You're still in the same trap.

You're just paying for it a different way.

Right.

So then the next step in the process is that what many folks do is they unbundle the health plan.

They take the health plan.

They blow it up into all these different pieces.

PBM, a TPA, a network case management.

All right.

And then.

Now you're moving in the right direction, but it's still quite complex.

And so what we've done itself in health is to say the next actual next step is we actually have to repackage that backup into cohesive health plan that functions and delivers the same product over and over again, because that's what the market wants.

but in a standardized way.

So what we do is we replace the existing health plan, whether any one of those options, whether it's a fully insured plan, whether it's a currently self-funded plan in whatever form and replace it with an aligned health plan to the employer.