Direct-to-Employer Healthcare Executive Insights

Last month, we explored how health systems and medical groups think about existing geographic footprints when exploring direct-to-employer (D2E) healthcare. You can read it here.

This month, we’re sharing our takes on D2E healthcare in markets with more and less value-based care activity.

As part of IntoValue’s collaboration with health systems, medical groups, and employers, we share executives’ perspectives on direct-to-employer (D2E) healthcare arrangements.

Each month, we’ll share how these leaders are thinking about building relationships directly with each other.

Value-Based Care for Self-Funded Employers

Employers and care delivery organizations recognize the untenability of traditional fee-for-service care models: lackluster outcomes, too costly, and increasingly adversarial to name three. Moreover, most of these models rely on arcane processes like prior authorization to control costs and limit access to care, causing poor outcomes and decreased employee and employer satisfaction.

So value-based care for the employer market must be the answer, right? Let’s share some insights from our discussions with employers, health systems, and medical groups.

Provider organization leaders frequently express that market prevalence of commercial value-based care solutions is variable across the nation. Some regions of the US have care delivery organizations already invested in value-based care for other lines of business (e.g., Medicare Advantage) and see a natural extension to other activities (e.g., bundles, population health, risk-sharing). Leaders in some regions with increased value-based care market activity seem more amenable to exploring novel arrangements delivering true value directly to employers and, in-turn, employees. Some expressed that generating additional returns from investments made to serve other value-based programs would be attractive.

By contrast, healthcare executives in markets where fee-for-service is alive and well expressed less initial interest in value-based care. But that should not imply that these same leaders are not aware of the fundamental shifts in how medicine is reimbursed and delivered. To the contrary, some in predominantly fee-for-service markets see working directly with employers as an opportunity to reduce or eliminate many frustrations stemming from traditional payer contracts and to return more decision-making to provider organizations.

D2E works in both fee-for-service and value-based care markets. The key to enabling success is in building alignment on employers’ desired outcomes from benefit offerings by supporting and augmenting the capabilities of provider partners.

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