The Population Health Opportunity for Self-funded Health Plans

As we navigate the shift from fee-for-service to budgeted, value-based payment, there’s a golden learning and savings opportunity that many healthcare employers have not yet embraced: treating health plan enrollees – also known as your employees and their dependents – in self-funded health plans as a model for healthcare service utilization management and care coordination.

Think of it this way. A self-funded employer already assumes full risk for the members of the health plan. The benefits line of your income statement is essentially the cost of care for staff and family members. As we move toward a care management environment, you have the opportunity to prepare for what’s coming on a smaller scale and to offer your organization and community an easier glide path to success. Regardless of changes to the ACA, cost reduction is inevitable. Starting to learn how to change utilization and coordinate care with your own plan membership just makes sense.

This process starts with the claims data, which is already yours. Most organizations don’t utilize the data at a claim level, but when you act as the insurer you have the right to access it from your TPA or plan administrator. This information is free (again, it’s already yours) and is the key to understanding plan design, impacting utilization and implementing care coordination teams to improve care value. This means better care at a lower cost, which is a goal most healthcare organizations have in common.

We’re excited about working with organizations that want to get ahead of the curve and move toward this milestone on the path to population health management. To learn more, please contact us.


Troy Trejo is a Senior Consultant at Stroudwater and a leader in our Employer Health Strategy practice.