Advancing the Triple Aim Through Shared Provider, Patient and Employer Risk
Lexington Clinic uses an efficient and effective program geared to decrease costs for employers and increase population health. Lexington Clinic’s Direct-to-Employer model allows the organization to tailor care for specific employers, based on the needs of the population, allowing the plan to address areas of concern.
Through tools such as the preventive care assessment, Lexington Clinic is able to identify and help care for members who may already suffer from chronic conditions, as well as those who are at a high-risk or rising-risk. In addition, Lexington Clinic increases patient participation by utilizing care managers assigned to clinical cohorts. These care managers work closely with member navigators and increase the touchpoints between members and clinic staff – whether in-person, via telephone or electronically – they are working to make access and compliance as simple and swift as possible. The result produces a system that provides quality healthcare while decreasing both overall and per-member per-month spend.
Health Plan Assessment of Ancillary Care Benefit Optimization: An Employer-Based Case Study
Direct-to-employer contracting is a proven value-based care delivery model offering a premier network of healthcare providers who demonstrate quality at sustainable expenditure thresholds. This study presents a deeper dive of the Provider Employer Pathways direct-to-employer (DTE) model offered by Lexington Clinic in which a self-insured employer-sponsored health plan’s ancillary spend is reined in with zero-entry-cost lab and diagnostic radiology destinations in a premier network. The result is lower overall plan cost, better longitudinal care management for the employee and increased screening and diagnostic testing compliance among plan members.
Health Plan Assessment of Population Analytics Driven Preventive Care Opportunities: A Multi-Employer-Based Case Study
With the unparalleled financial success of a premier network direct-to-employer health plan benefit program, a clear next step is in analyzing the effect of preventive health measures within that framework as a means to achieve greater population health outcomes. Two employer groups, All-Star Manufacturing (ASM) and All-Star Engineering (ASE), together with their partnered physician medical group and OptumOne Analytics, deliver a closer look at preventive health opportunities with an expectation that successful implementation of these measures will result in an efficient risk reduction platform while maintaining positive trends in expenditure control. Cost savings are found to be substantial, with meaningful improvement to health outcomes via early detection of certain malignancies.
Health Plan Economics of Preferred Network Implementation — An Employer Perspective
Given the proven, large-scale success of preferred network implementation, a self-funded employer stands to significantly improve the health of its employee population and reduce expenditure by designing a health benefit plan utilizing similar network selection methods. This study examines one such employer plan and analyzes the costs and health outcomes over analogous six month periods before and after implementation. It finds that cost savings can comfortably be around 4 to 5 percent.