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:

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:

CSuite Solutions roles, responsibilities and expertise include:
Key Benefit Administrators roles and responsibilities include:

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.

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