By Joe Maher, CPA, MBA
Vizient Associate Principal, Sg2 Consulting
This is the second of a two-part series on the benefits of direct-to-employer services for providers.
Direct-to-employer healthcare offerings benefit from proof-of-concept, and often your employees can provide an excellent test group. As health systems pursue employer engagement through direct-to-employer healthcare solutions, two of the first questions health systems marketing their services to local employers should expect are: Have you done this with your own employees? and How did it go? Organizations that can speak to their personal experiences will achieve much more credibility in these conversations.
Health systems that test their offerings — including specific programs such as wellness, EAP, on-site clinics, vaccine programs, occupational health, mobile offerings, etc. — on their employees are guaranteed to garner key learnings that will build toward external success. Engaging with patients through employment relationships is a much different medium than traditional clinical and acute care. Health systems that have recently reworked employee benefits offerings can appreciate this added dimension.
An advantage of rolling out new offerings to health system employees early on is the insight it can provide teams looking to bring direct-to-employer services to a larger market. Organizations that use their employee population can expect valuable, transferable learnings on process, structures, implementation and scalability including the following:
- The decision-making process often takes months with input from several key stakeholders. It starts with identifying the right leaders and experts, which will span across multiple departments. Incorporating feedback from various constituents while moving the process forward requires balance and leadership. It is critical to know who the final decision makers are and ensure they are effectively engaged early in the process.
- Agreement on the scope and goals is essential to maintain focused progress. Establish the overarching framework for what success looks like. This can help organize the discussion and decision-making progress to identify tactical decisions, including plan design, employee accountability and additional program offerings. It will become a critical tool for reorienting the group when the process gets bogged down in the details.
- Expect to make compromises. While the process may start with an ideal state, there will be budget, politics or other constraints that require flexibility. Knowing mission-critical from the start and what can be tabled for future years will allow more agility in these discussions. Similarly, working within the constraints may provoke innovative thinking that advances the process.
- Develop a realistic timeline commensurate with the goals and implementation efforts. Health systems that work through the process can translate many change management learnings into best practices and recommendations for employers. These include communications, staging, implementation and ongoing support. In addition, having this experience will help health systems serve as trusted partners for employers as they work through their key decisions and likely tradeoffs.
- Create economic alignment with provider partners. For health systems engaging their provider networks in the process, some may decide that an up/down financial arrangement may be implemented. This will entail working through key terms, including target setting, attribution, methodology and downside responsibility. To the extent possible, identify where there may be flexibility in these terms and expectations to accommodate different possibilities with different employers (e.g., claims administrator, stop-loss coverage, network structure, etc.).
- Understand what scales and what does not. For health systems to engage more broadly and directly with local employers, knowing what scales can help prioritize employer engagement is important. Health systems that are realistic about where they can deliver in the direct-to-employer space are better positioned to establish impactful engagement. Forging the right partners from the beginning (e.g., claims administrators, technology vendors, etc.) can accelerate the ability to serve a larger market.
While rolling out all direct-to-employer healthcare offerings internally first may not be viable, many of these lessons learned are transferrable across programs. Even though comprehensive direct-to-employer engagement is relatively new for many health systems, there may be invaluable relationships and insights to leverage from within the organization. This knowledge may stem from previous programs serving employees internally or externally. Health systems that can build on their experiences will be better equipped to engage with employers around their unique positioning in the healthcare ecosystem at large.
No matter where your organization stands on its journey to engaging with employers and integrating value-based care, our experts are equipped to provide unique insights and impactful recommendations in prioritizing opportunities and positioning your organization for select value-based care undertakings. Learn more about Vizient’s Direct-to-Employer Healthcare Solutions and reach out to speak with a value-based care expert.
About the author
Joe Maher is associate principal, consulting at Sg2, a Vizient company. He collaborates with health systems, provider networks and industry partners to develop and drive strategies that better position organizations for success in an evolving environment. Within value-based care, he partners with organizations to bring together economic models and structures that align with the organization’s clinical care delivery approach. Maher’s expertise includes local and regional clinically integrated networks, value-based contracting, two-sided total cost of care arrangements, direct-to-employer contracting and aligned governance.