Waterbury Health joins the trend

Waterbury HEALTH in Connecticut recently became part of an integrated delivery network set up by Brighton Health Plan Solutions, a New York-based company that brokers health care services between providers and employers.

In an integrated delivery network, or IDN, employees can receive their medical care exclusively from one health system. “IDNs have been around for some time,” said Robin Brand, senior director of research for The Advisory Board, a best practices research firm for the health care industry. “There’s been more interest in them in the past couple of years.”

One key feature of an IDN is that a patient’s care is better coordinated between providers that belong to the same network. From the patient’s perspective, it feels like a very different experience and the care is more integrated. And “if you have better coordination, you’re going to have fewer repeat tests or a lack of follow-up that could end up in higher costs down the line,” Brand said.

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Antibody Testing Options

Antibody testing is a way to find out if you had COVID-19 and recovered. (Learn more about antibody testing.) If you’re interested in getting tested for COVID-19 antibodies, here are your best options:

Primary Care Doctor

Your doctor may offer to do the blood draw in the office. Please be sure to request that the sample be sent to a free-standing lab participating in your health plan, not to a hospital lab. There is no member cost share for the blood test or the accompanying provider visit.

Free-Standing Labs

You can visit an in-network, free-standing lab (such as a BioReference Laboratories, Labcorp, or a Quest Diagnostics patient service center) for the blood draw. A prescription is required. To obtain a prescription, contact your primary care doctor. If you do not have a primary care doctor, you can contact any primary care doctor in the MagnaCare or Create network (depending on your plan). There is no member cost share for the blood test or the accompanying provider visit.

Self-Pay Testing

Otherwise, you can choose to self-pay and schedule an antibody test directly through LabCorp or Quest Diagnostics or other self-pay providers. You are responsible for the full cost at the time of the test if you choose this option. These direct-to-consumer options are NOT covered under health plans, including the MagnaCare or Create health plans, and cost significantly more than the insurance rates. There are no FDA-authorized antibody home testing kits at the moment.

While urgent care centers and hospitals do also offer antibody testing, keep in mind that these providers cost the plan significantly more to cover. You may also have more exposure to people sick with COVID-19 at urgent care centers or hospitals. For these reasons, we encourage you to instead call a primary care doctor for the prescription and visit a free-standing lab to safely get tested for COVID-19 antibodies.

Why more companies are switching to self-funded health plans

As health care costs continue to spiral out of control, employers are increasingly looking to self-fund their employee health care benefits.

With fully insured health plans, you pay a monthly premium to a health insurance company. Once the insurance company wins your business, it’s not unusual to be hit with a double-digit premium rate increase the following year. That explains why employers shop around for a new health insurer every three years, on average.

Self-funded health plans are not health insurance. You don’t pay premiums to an insurance company, and you don’t submit your claims to them. Rather, you set aside a certain amount for funding your employees’ health care claims. And you purchase stop-loss insurance to cover unanticipated high claims costs. Typically you would use a third party administrator (TPA) to manage your claims and advise you on your health plan.

5 advantages of self-funding over fully insured health plans:

1. Full transparency

Self-funded groups can access IT tools and services that makes it easy to analyze claims data. Having a direct window into the claims you are funding guides you to timely and targeted decisions that can improve your members’ health and well-being and control costs.

2. Cost savings

Self-funded benefit plans reduce your premium tax, immediately saving you 2-3% on the cost of the plan. Self-funded plans are subject only to the federal Employee Retirement and Income Security Act (ERISA) so there are no state mandate costs. Your TPA will negotiate fees with providers, and will arrive at reasonable reimbursements for services that offer significant savings over an employer’s typical fully insured plan. TPAs will also audit bills and implement other cost-saving programs. For example, MagnaCare’s innovative Redirection of Care programs find more convenient, lower cost, high-quality sites of service for your health plan member to receive the care they need.

3. Flexibility over covered services

Fully insured groups are subject to the insurer’s discretion and their specific population’s needs may not be met. In contrast, self-insured employers have the authority at any time to make informed changes to their covered services to ensure their population receives the care they need. This capability has proved especially helpful in times of change or economic downturn.

4. Better control over finances

With a fully insured plan, you pay the full premium regardless of actual claims. If claims don’t materialize, you don’t receive a refund. But with self-funded plans, you pay only for services received by your employees. And when eligible medical claims for a plan year do not exceed a predetermined limit, the plan keeps those dollars and they can be used to offset the following year’s expenses or reduce contribution levels.

5. Easier administration and lower operational costs

Your TPA approves or renegotiates claims, decides appeals, and handles other time-consuming administrative tasks. Overall administrative costs for a self-funded program handled by a professional TPA such as MagnaCare are usually lower than costs charged by the insurance carrier.

Contact us to see how much your company can save by self-funding your health care benefits. We’ll design a plan tailored to your employees’ needs. Our team of health care actuaries will work with you to help you determine the level of coverage you require, based on your historical claims data.