Innovative Network Solutions2018-05-16T18:44:54+00:00

You don’t have to accept the status quo.

Health care and employee benefits pose a number of challenges for employers–but what are the solutions? Unless you’re thinking outside the box, you may feel like the only answer is to continue to absorb rising costs year after year. We don’t believe that your options are so limited. In fact, one of our missions at Anderson Thornton Consultants is to create a benefits solution that addresses both the quality of the health care being offered as well as the costs.

Our innovative health care networks focus on outcomes, reward quality care at reasonable costs, and rethink the way group health plans are organized. The results? Cost-efficient benefits combined with improved quality that offer companies better options.

Problem #1: Rising Insurance Premiums

OUR SOLUTION: Manage Risk Through Incentivized Care

We contract with clinics and health care providers in your area, incentivizing providers to manage chronic conditions and eliminate unnecessary costs. Rather than limiting care, this model improves the quality of care by encouraging a smart, data-driven approach to health care.
Providers are incentivized to order the right tests, the right procedures, and the right prescriptions for each patient’s care rather than everything a carrier will pay for. Improved quality and smart management of patient care also results in lower costs.
piles of paper with graph labeled "Plan" overlaid on it, with an arrow moving upward

PROBLEM #2: Higher Health Care Costs

OUR SOLUTION: Reduce Costs Through Fee-For-Value Pricing

In the current system, hospitals mark up their prices over 1000% and give insurance carriers a 30% discount. Because of this discount, the appearance is that insurance carriers are getting a great deal. The reality is that they are not. Those over-inflated costs are passed on to insurance carriers, who then pass them on to consumers through their insurance premiums. This current structure between health care providers and insurance carriers has created incentives to keep the cost of care high. One of those incentives is vast wealth in health insurance markets and hospital companies, with profits for both industries doubling since 2008. Employers are left holding the bill, without any control over the double-digit premium increases.
Rather than embracing the “fee for value” model that most hospitals operate under, we contract with hospitals, clinics, and other health care facilities under a “fee for value” model. Under this model, facilities are paid based on the Medicare reimbursement rate rather than billed charges. The fee for value model offers the contracted facilities a reasonable profit while maintaining a focus on reducing costs. We have seen rates reduced by up to 10-15% in the first year, lower than traditional health care plan rates in subsequent years. Physicians who provide services at the hospital or other health care facilities are paid in much the same way they are paid under other health care plans.
shot of a hospital operating room, including stretcher and various instruments

PROBLEM #3: High Deductible Plan Costs

OUR SOLUTION: Combine HDHP with Bridge Coverage

One of the common solutions to reduce costs has been to raise deductibles and co-payments or move to a High Deductible Health Plans (HDHP). These plans save on premiums but leave a large financial burden on employees. Because of this financial burden, employees may avoid care to save money. In some cases, this problem can be solved with a customized gap plan. These gap plans can offer coverage for office visits, pharmacy, and other qualified medical expenses and can be customized so that those that want to maintain the HDHP and contribute to an HSA can.
In most employer groups, 90% of the members spend less than $5,000 a year in medical expenses. These gap plans can be of great value to employees that live paycheck to paycheck. Oftentimes the customized health plan will be more affordable, because the vast majority of the claims are paid by the bridge plans and the HDHP covers claims above the limits of the bridge plan. Because the bridge plan covers the majority of the claims, HDHP premiums and future rates flatten out. This solution benefits both employers and employees, offering quality care for affordable prices.
white sheet of paper labeled Budget with multiple types of graphs on it

PROBLEM #4: Issues with Quality Health Care 

OUR SOLUTION: Focus on Outcomes Using Proprietary Data

Rework is expensive in any business. It is extremely expensive in health care.
Insurance carriers put tremendous importance on their network of providers, even at the expense of their clients. Most insurance plans focus on networks and preferred providers, without much attention paid to the quality of the care offered by those providers. If outcomes were measured as most networks were developed, 20 to 30% of the providers in those networks would not be included because of quality issues. Unfortuantely, in the current system, how efficiently a provider offers care, and the number of complications that patients experience, are not a part of the equation. In the case of complications, the hospital, provider, or facility all get paid twice–so there is no inherent incentive for providers to offer the best possible care.
In innovative health care plans like ours, we use proprietary data to help your employees choose their providers. If you’re looking, for example, for someone to perform a total knee replacement, we can look at the physicians who perform those procedures in your area. Do you want the doctor who does the most number of cases per year? Not necessarily. We’ll guide you to the providers who are most qualified, experienced, and effective, with the best possible outcomes. When the focus switches from services rendered to positive outcomes, costs are lower and patient care is far better.
man's finger pointing at a computer monitor with colorful charts and bar graphs showing data results

PROBLEM #5: Escalating Prescription Drug Prices 

OUR SOLUTION: Implement Smart Pharmacy Solutions

Pharmaceutical expenses comprise 30 to 40% of an employer’s total health care spend. If this trend continues, by 2020 the total pharmaceutical expense will make up more than half of every employer’s health care expense. We believe the smartest way to stop these expenses from ballooning is to implement a smart pharmacy solution. These solutions can include the typical mail-order option or can involve a more innovative contracted pharmacy option, which encourages employees and their dependents to use a specific pharmacy in exchange for flat rate prices. The pharmacy is compensated for its participation in the network, which offers them an incentive to offer outstanding customer service.
pills of various shapes, sizes, and colors

Over the years, our partially self-insured program has saved us hundreds of thousands in gross premium costs, generated competitive plans for our employees (who have seen mid single digit premium cost increases, including one year of zero increases and one year of 3%, while the market has seen double digit compounded increases), eliminated the bi-annual headache of switching providers which minimizes work and keeps provider networks consistent, and generated excess funding that resulted in a rebate in 2018.

Christopher Kliefoth, Nationwide Enterprises