Direct To Employer (DTE)
Purpose
Simply stated, DTE is a strategy for providers and employers to have a direct relationship without any payers in the middle. It is a new and exciting strategy that brings cost savings, better quality and free market forces into this incredibly important relationship.
More specifically, DTE is a provider-sponsored, health plan that has been designed for healthcare systems and hospitals to offer to area employers. It is a self funded health plan with reinsurance that results in no medical claims loss risk for the provider . This allows providers and employers the opportunity to work together to drive down the costs of healthcare. Like other free-market industries, pricing is transparent and there are significant incentives for both parties to achieve savings. This program, when implemented correctly, will substantially increase your share of the commercial market. Cost
For Providers, the cost of entry into this health plan model is a fraction of what it is compared to health insurance – hundreds of thousands versus millions of dollars. Also, speed to market is months versus years. The development and launch of the program by your C-Level peers at CSUITE along with operational support by Key Benefit Administrators (KBA) is what makes this all possible. KBA is the largest independent group benefits administrator in the US that specializes in self-funded medical plans. They are also our partner in delivering this program.
Implementation
The Direct to Employer Program backed by the resources of CSuite and KBA will allow Providers and employers to do the following:
- Offer self-funded health plans to area employers with the Provider’s brand
- Manage medical claims risk with 27 patented chronic care protocols and reinsurance
- Allow Providers and employers to work closer than ever before to reduce healthcare costs and share in the savings
CSuite Solutions roles, responsibilities and expertise include:
- 1. “Go-to-market” strategy and implementation
- 2. Readiness and market assessments
- 3. Network development
- 4. Clinical integration
- 5. Change management
- 6. Cultural acceptance
- 7. Comprehensive business plan
- 8. Agile project management with timeline
- 9. Program launch
- 10. Account management and oversight
Key Benefit Administrators roles and responsibilities include:
- 1. Structure the health plan benefits with providers and employers
- 2. Implement open enrollment and issue membership cards
- 3. Process claims and pay providers
- 4. Identify those employees who are in 27 chronic disease categories
- 5. Apply the appropriate regimens of care to those identified in each category
- 6. Significantly reduce healthcare costs by up to 30% based on past performance
- 7. Align productivity incentives by sharing cost savings between employers and Providers
- 8. Maximize the utilization of the Providers’ in-network doctors, nurses and other medical professionals
- 9. Increase economies of scale by adding thousands of lives that are currently covered by insurance or self-funded plans managed by insurance company-owned TPAs