The following is a Q&A with Melina Kambitsi, Ph.D., The Alliance’s senior vice president of business development & strategic marketing, who spearheaded the organization’s transition to a self-funded benefits plan.
Why did The Alliance choose to self-fund their health plan?
The Alliance aims to serve as the voice for self-funded employers, yet we ourselves were not yet self-funded as a small employer. As a not-for-profit cooperative, we strive to remain a trusted partner to our employers and their brokers, so we wanted to make the same investment into our employees that our employers were. Now we’re taking the same risks, fighting the same fight, and have the same interests at heart.
What was the biggest challenge of self-funding such a small health plan?
Hands-down, for any company, the challenge is always going to be lack of data. When it’s your first year of self-funding, you have no data to begin with. You’re taking somewhat of a leap of faith. You know that you’ll save money down the road by improving the plan, but there’s a lot of question marks on year one.
What partners helped you develop the self-funded plan?
Because WPS Insurance is both our TPA partner and Stop-Loss carrier, their experience with the performance of our Smarter Networksâ helped support our agenda. WPS knows our network very well and as a result, they were able to price it accurately, which means there was less trial-and-error when we started self-funding.
What types of incentives does The Alliance use to help keep costs down and employees healthy?
We offer an on-site flu shot clinic every year, an HSA incentive, a health and wellness incentive for completing biometric screenings, and an EAP and Teledoc. Plus, the behavioral health providers we’ve added to our Comprehensive Network with steerage opportunities vastly improves our employees’ access to High-Value Health Care.
What are some plan improvements you’re looking forward to?
Like many employers, we’re still unsatisfied with our prescription benefits. Right now, it’s like the wild, wild west. Due to our size, we haven’t been able to properly strategize prescription benefits with our medical claims from a PBM perspective. The Alliance is also looking forward to creating our own direct primary care clinics in the near future.
If you could give one piece of advice to someone in your shoes looking to design a health benefits plan for their small business, what would it be?
Follow the money. Ask where it goes. Look at your data, and if you don’t yet have data, find data that is relative to you. Transparency is key.
What excites you the most about self-funding?
You’re very much in control of your own destiny. Knowing the cost-saving mechanisms, where the money is going, and being able to put all the pieces together to offer very good care for your employees is a great feeling; we’re not beholden to a carrier who wants to increase our renewal by 30% without good reason. It feels very strategic and that we are in complete control our health plan outcomes. We want to continue offering great benefits moving forward, and self-funding allows us to do that.
If an employer wants to self-fund with The Alliance, or has questions about self-funding in general, what should they do?
I invite any employer that is considering self-funding to reach out to me. I am more than happy to discuss the X’s and O’s of self-funding with any employer or broker, regardless of their size or affiliation with The Alliance.
