EmployerDirect Healthcare is fundamentally changing how large, self-insured employers offer healthcare coverage to their employees.
The company is disrupting healthcare delivery for self-funded employers by aligning incentives for employers, employees and providers. "Providers are winning by increased volume, lower administrative burden, quick payments and zero bad debt," says Clint Hampton, who was recently named CEO of EmployerDirect.
EmployerDirect is a solution for self-funded health plans, their members and their network of quality health providers. The company contracts directly with self-funded employers to supplement their existing health benefit plan. The self-funded employer market is huge, with predictions placing more than 150 million Americans participating in self-funded plans, whether directly or through third party administrators. Around 80 percent of all companies with 500 or more employees are self-insured.
High deductible health plans (HDHP) have become extremely popular to help reduce overall healthcare costs. This year, around 80 percent of the menu plans offered by employers are expected to be high deductible with deductibles more than $1,200.
Employers often have an out-of-pocket maximum for employees soaring over $4,000 or $5,000. "Think about taking that much out-of-pocket for your procedure; it is a big hurdle for employees," says Mr. Hampton. "Employers typically waive the out-of-pocket expenses for employees if they're using SurgeryPlus."
With more patients paying higher out-of-pocket rates, it also becomes harder to collect in full and can create bad debt for ASCs. It's difficult to chase down the bill from patients to employers and insurance companies.
Here are a few trends Mr. Hampton is seeing in healthcare that are making an impact on his business:
1. HDHPs are lowering costs for employers and creating actual consumers out of patients.
2. Patients often aren't aware of all the real costs they will have to pay, which is increasing bad debt to providers.
3. Quality and transparency will continue to grow in importance to the patient.
"EmployerDirect is the employee benefit that is profitable to the employer, while driving customers to the provider," said Mr. Hampton. "The providers win because of increased volume with zero bad debt."