Direct to Uninsured (DTU)
Purpose
The DTU program borrows many of the strategies and technologies of the DTE program to target another critically important segment of the population you serve – the “working poor.” The working poor are incredibly important to all communities as they are often doing one or more jobs without benefits. DTU will also significantly raise your Community Benefit and population health strategy to a much higher level. Its purpose is to deliver high quality healthcare at a lower cost to a very vulnerable segment of the community.
There are several reasons why this population of workers is uninsured: - 1. The employers they work for do not offer any healthcare benefits
- 2. They do not meet the minimum hours with any one of their employers required to receive healthcare benefits
- 3. Their employers offer health care coverage, but they cannot afford the payroll deduction, plan deductibles or copays
- 4. They cannot afford to pay the premiums for a Healthcare.gov Marketplace Plan
This group falls through the cracks of various social safety nets because their income is too high to qualify for Medicaid, CHIP or other social assistance programs and too low to afford individual coverage at market rates. We believe that an individual health plan with modest cost and coverage that emphasizes urgent care and primary care could have a profound impact on the community as many medical issues that would normally become extremely serious and costly could be treated early and abated in an outpatient setting.
Cost
This program can be customized to each provider’s situation and local community’s needs. It can be funded in a variety of different ways from both private and public sources. One of the simplest and quickest ways would be to fund the program in part from an allocation of a provider’s Community Benefit funds as well as from reduced premiums which are set at a level that the working poor can pay.
Plan designs and pricing are determined by the Provider in collaboration with CSuite Solutions and Key Benefit Administrators. Once the cost of operating the program is estimated, the individual, employee, employer and public source (if available) contributions can be deducted and the amount of subsidy required to make up the difference can be determined. This subsidy is what would be covered by provider’s Community Benefit funds.
Implementation
The Direct to Uninsured Program, backed by the resources of CSuite and KBA, will allow Providers and employers to do the following:
- Offer very low cost health plans with the Provider’s brand to employees who in the past could not afford healthcare coverage
- Manage medical claims risk with 27 patented chronic care protocols and reinsurance
- Allow Providers and employers to work closer together to provide healthcare coverage to an entire segment of the population that cannot currently afford it
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
One of the synergies of doing BOTH DTE program and DTU programs is that they both share the same plan administration, claims processing and data analytics support services provided by Key Benefit Administrators. This benefit infrastructure and technology provide you with the ability to see exactly where the Community Benefit money is being invested as well as the resulting returns from those investments in real time. Since you control the plan designs, their pricing and the number of covered lives that you choose to have in this program, you can determine the amount of Community Benefit funds to be expended.
Community Benefit allocations have approached huge sums in recent years, in some cases hundreds of millions of dollars for many health systems, without much tracking or detailed analytics that measure the true impact of such large investments in population health. DTU is a new and innovative way to invest these funds and accurately measure the population health returns.