In the future of healthcare, self-funded plan sponsors have the power to fix what’s broken.
Too often, self-funded plan sponsors resign themselves to the status quo while continuing to manage through increasing costs and declining member experience. What they don’t realize is how much control they have. When a plan is managed well and operates with the right partner, plan sponsors gain powerful leverage over the entire healthcare game.
Just ask Brian LaBorde, EVP at DBM Global. After too many years under a fully insured BUCA model they graduated to a third party administrator (TPA), a move that left them feeling further from the goal than where they started. This is a move that every self-funded plan sponsor needs to consider, but the wrong partner won’t make it worth your while.
We met Brian and his team last year when they’d finally had enough. DBM was more than ready to fix everything that was broken and no longer serving the interests of its members or organization. That’s when they found Apostrophe, and invited us to be the TPA for the 1300-member fund in Arizona.
Before they came to us, DBM committed to overhauling how they view, manage, promote, and invest in their self-funded benefits plan from the top down. Guided by servant leadership and a proactive member-first approach, DBM’s plan is thriving after a year with Apostrophe Intelligent Health Benefits. It’s quickly becoming the gold standard.
“You put your money where your mouth was with your members and really made the differences show up in their benefits,” Cheryl Kellond, CEO and co-founder of Apostrophe, told Brian during a webinar conversation that included Jesse Gomez, SVP of Sales and Marketing for Apostrophe.
During the webinar, Brian shared many valuable insights about the transformation DBM has made for its members, the benefits plan, and the organization’s bottom line. You can watch it now to hear the entire 30-minute conversation, or read on to learn his 5 best tips to guide a dramatic change for your company.
Future of Healthcare III – The Power To Fix What’s Broken
5 Tips for Self-Funded Innovation from a Plan Sponsor
1. EXECUTIVE FOCUS AND OWNERSHIP
One reason self-funded plan sponsors struggle with their health plans is ownership. Often it’s just one more task on a long list for HR managers. Brian encouraged his executive team at DBM to look at their self-funded benefits plan as the substantial cost that it is. The key question they asked was “Why would you let some low level manager or people outside of your company run such a significant cost item on your P&L?”
That’s when they put an executive in charge of managing the plan. By elevating the importance of providing Intelligent Health Benefits to their members, Brian is connecting the dots between the business strategy and benefits delivery at an executive level. This ownership by top-level leadership has made a dramatic difference for DBM, and their partnership with Apostrophe has allowed them to provide better benefits for their members and a better bottom line for the business.
2. RUN THE PLAN LIKE A SMALL BUSINESS
Brian looks at DBM’s self-funded plan like a small business within the firm. When you see the plan from this perspective, you start asking more effective questions and marking successes and failures differently. DBM’s self-funded plan now tracks KPIs and constantly questions where and how to optimize.
“It’s a commitment to change the outcome so that each year you aren’t having this conversation about increasing costs and how you can’t invest in wage growth,” explained Jesse.
3. MEMBER EDUCATION IS PARAMOUNT TO SUCCESS
Moving to a TPA that includes Referenced Based Pricing (RBP) in their model can be drastically different for your members. They are used to making their healthcare costs reliable by making sure they seek care “in network.” With an RBP-based model, they don’t necessarily have a provider network, which requires a lot of education early and often. They have to navigate finding the best provider for them in a different way, which means you have to equip them with what they need to know on the back end to make it work for them at the doctor’s office.
“Teaching [members] to help themselves, help the plan, and make things go smooth is paramount to make this successful,” said Brian.
According to Brian, the key to success is education, early and often. He also suggests using every channel you can think of to get in front of your members. Some of the tactics include:
- Email campaigns
- Snail mail
- TVs in all lunchrooms
- In-person meetings
4. COMMUNICATE COMMUNICATE COMMUNICATE
“It’s impossible to over communicate,” advised Brian. DBM has made substantial investment in marketing the plan’s benefits, how to use it, and the members’ role in its success, costs, and outcomes. They’re doing everything they can to constantly keep the information in front of their members and engaged in their role with their benefits.
5. PARTNER WITH APOSTROPHE HEALTH
DBM had taken the path that many self-funded plans do by renting benefits from a fully insured BUCA before switching to a TPA that was not a great match.
They enlisted a benefits advisor and conducted their own research to identify a TPA to serve their vision and values. They found Apostrophe, named by Harvard Business Review for transforming healthcare benefits for self-funded plans.
The foremost thing Brian and his team sought out was member focus and prioritizing experience. No one can deliver on this like Apostrophe, as putting members first has always been core to our values and practices. There’s nothing in the industry quite like our White Glove Member Care, backed by a team that advocates for each member.
By partnering with Apostrophe, DBM members have another tool in their healthcare toolbox to support them in their healthcare journey. The Apostrophe Member Care team is available 7 days a week for members, and can help them with:
- Learning about their plan benefits
- Connecting them with virtual and telehealth medicine services
- Finding $0 cost-to-members medical services through our smart shopper program in their area
- Clarifying billing confusion, including billing code research and price comparison
What DBM has accomplished for its health benefits program in the past two years is remarkable and game changing. But it’s not exclusive. Any self-funded plan sponsor can make the same commitment and face the fear of change to realize similar success. DBM is truly on a path to innovation that can be replicated by any fully committed self-funded plan.