Presenters:
Carolyn Chew
Senior Director, Enterprise Sales at Firefly Health
Ron Fontanetta
Principal at RJF Strategic Advisory Consulting
Providing high-quality and affordable healthcare is a significant challenge for many employers, which can be frustrating with all clinical gaps and rising costs. It isn’t easy to offer adequate health benefits that truly meet the needs of employees. In hopes to deliver better experience, many organizations are exploring Alternative Health Plans (AHPs). Well-being is essential, and we are committed to finding solutions that support it.
Last week at our Meet a Vendor session, Carolyn Chew, Senior Director of Enterprise Sales at Firefly Health, and Ron Fontanetta, Principal at RJF Strategic Advisory Consulting, shared alternative health plans with expert tips and resources. Change in healthcare demands vision, persistence, and a grand ambition to make care more equitable, affordable, and human.
About Firefly Health
Firefly Health’s solution offers a comprehensive healthcare plan. Using a team approach, Firefly provides an affordable and differentiated health benefit combining hybrid advanced primary care, a nationwide provider network, and a full suite of TPA services with innovative plan designs.
The Core Challenges Employers Face
Traditional health insurance can be confusing and expensive. What is more important is that the health plan should be all about healthcare. It should reduce barriers to high-value care and use data to help members find cost-efficient and high-quality providers. While delivering health care, employers face:
- Employer cost and inflation. Offering comprehensive benefits is difficult since traditional health plans are becoming increasingly expensive.
- Clinical gaps. It is difficult to offer adequate health benefits that truly meet the needs of employees, leading to poor care and missed opportunities for early intervention.
- Employee experience. Navigating healthcare systems can be frustrating. It is often complex and decreases engagement with available benefits.
- Employee affordability. High out-of-pocket costs discourage employees from seeking necessary care, potentially leading to worsened health outcomes over time.
Alternative health plans are designed to make getting the right care at the right time more straightforward and affordable.
How a Well-Designed Alternative Health Plan Can Address These Challenges
A thoughtfully structured AHP can provide solutions that enhance both cost efficiency and healthcare quality. Here’s how:
- Improved Member Health Risk Management: Effective health management strategies can help reduce risks before they develop and become expensive medical conditions.
- Smart, Timely, and Effective Use of Healthcare Services: Encouraging preventative care and early interventions can significantly reduce expenses associated with chronic conditions.
- Creative Coaching Teams: Personalized health coaching can help employees be more informed and, thus, make better healthcare decisions.
- Strategic Partnerships: Collaborations with high-value healthcare providers can lower costs and improve health outcomes.
- Virtual Healthcare to Close Access Gaps: Expanding virtual care options and 24/7 on-call services ensure that employees, particularly those in rural or underserved areas, have timely access to quality care.
- Plan Design to Eliminate Cost Barriers: Lowering deductibles and co-pays and implementing value-based care initiatives can make healthcare more affordable for employees.
The 3 Critical RFP Considerations for Selecting an AHP
Employers should assess the performance of their existing healthcare offerings. Here’s what to look for in the current program:
- Low Enrollment in Medical Options
- High Illness Burden
- High Proportion of Underserved Populations.
- Cost Pressures and High Rates of Waived Coverage.
If employees opt out of coverage, it may indicate affordability concerns or dissatisfaction with plan offerings. Increased emergency room visits or hospital stays can signal gaps in preventative care. Employees in rural areas or those with limited access to quality care may struggle with their current health plan’s network.
If a significant percentage of eligible employees are declining benefits due to cost concerns, it may be time to explore alternative options. The key to sustainable cost management lies in a clinically integrated health plan. When evaluating alternative health plans, employers should focus on three core areas in their Request for Proposal (RFP) process:
- Care Delivery. The plan should incorporate an advanced primary care model and should effectively integrate digital provider networks to enhance accessibility. Additionally, robust mechanisms are in place to minimize care fragmentation, preventing unnecessary increases in healthcare spending.
- Network Optimization. The centers of excellence (COEs) should be included in the network and the plan should utilize reference-based pricing (RBP) to control costs. The plan should facilitate access to low-cost and high-quality care.
- Plan Design. The plan should outline methods to support navigation towards high-value providers and incorporate virtual or hybrid care capabilities. These services must be effectively integrated and include a way to measure improvements in affordability for members.
Get in touch with Firefly Health today!
Many AHPs focus on a singular aspect of innovation, such as cost control or digital healthcare expansion. Selecting the right alternative health plan requires a strategic approach. Saying all the above, employers can move towards a more effective and efficient healthcare model.
To further streamline your selection process, claim your custom RFP template to ensure you’re asking the right questions and evaluating the most relevant factors.
For more information, contact:
Carolyn Chew – carolyn.chew@firefly.health
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