More companies, big and small, are becoming self-insured employers. Here are eight things for ambulatory surgery center owners and operators to know about the landscape.
1. Forty-one percent of plans were self-insured in 2012, according to the Deloitte Self-Insured Health Benefit Plans 2015 report. There were 20,551 self-insured plans that year, the most recent year government data is available. Fifty-one percent of the plans are fully-insured and 8 percent of the plans are mixed.
2. The fraction of plans that were self-insured or mixed-funded declined from 56 percent in 2003 to 49 percent in 2012. The general trend among plans over the past decade has been away from self-insurance, but a fraction of the participants in health plans that are self-insured or were mixed-funded increased around 6 percentage points from 78 percent in 2003 to 84 percent in 2012.
3. Eighty-seven percent of multiemployer plans were self-insured or mixed funded in 2012. Forty-seven percent of single employer plans were self-insured and 57 percent of multiple-employer plans were self-insured.
4. Self-insured and mixed-funded sponsors are in better financial health than fully-insured sponsors when considering the ratio of operating income over total debt. However, the ratio of cash flow to total debt would suggest fully-insured sponsors are in a better financial position.
5. In 2013, 94 percent of employers with 5,000 or more employees self-funded their health insurance plans, according to an AmWINS Group report. Among companies with 1,000 to 4,999 employees, 79 percent of employers have self-funded plans. Only around 58 percent of employers with 200 to 999 employees have self-funded plans, and one-in-seven employers with less than 200 employees self-fund their plans.
6. Self-funded medical plans are exempt from Affordable Care Act-imposed taxes, fees and restrictions on fully insured medical plans. The taxes and fees on the fully-funded plans are slated to grow to 10 percent or more of the premium.
7. The self-funded employer market is predicted to include 150 million Americas participating directly or through third-party administrators. At the same time, high-deductible health plans are becoming popular to reduce overall healthcare costs. Around 80 percent of the menu plans employers offer are expected to have deductibles more than $1,200. Employers also have out-of-pocket maximums for employees soaring to more than $4,000 to $5,000.
Here are three key trends from EmployerDirect CEO Clint Hampton:
• HDHPs are lowering costs for employers and creating actual consumers out of patients.
• Patients often aren't aware of all the real costs they will have to pay, which is increasing bad debt to providers.
• Quality and transparency will continue to grow in importance to the patient.
8. Current estimations show around 6,000 corporations and their subsidiaries nationwide operate self-insured workers' compensation programs, according to the Self-Insurance Institute of America. Many other employers participate in group self-insured workers' compensation funds, meaning they pool together with other companies for collective risk.
Ambulatory surgery centers can take advantage of self-insured employers by contracting directly with the companies for coverage lower than at the hospital. Employers then send patients to the ASC for appropriate procedures. They can also become a designated center for large companies sending employees across the country to receive the best value care possible.