As consolidation pressures mount and insurer contracts squeeze independent practices, some physicians are finding an unlikely ally in employer-built health plans.
Carl Schuessler, co-founder and managing principal of Mitigate Partners, joined Becker’s to discuss how these plans could be a lifeline for independent practices, especially in smaller hospitals and rural markets.
Mr. Schuessler draws a stark contrast between traditional insurer-built, “self-funded” plans and employer-built models.
“Insurer-built plans are ‘self-funded’ but still stacked with insurer components that make them money. Employers don’t realize it. It’s like going to Vegas — the house always wins,” he said. “Employer-built plans are different. They’re built for the employer, their employees, their care. Their name goes on the ID card, not Blue Cross. And we layer in things like nurse navigation, chronic kidney disease management, musculoskeletal programs — 20+ cost-containment solutions.”
Physicians like these plans because they “pay quickly and more fairly,” Mr. Schuessler said. “Often 150% of Medicare, oncologists maybe 180%. Far better than what the [big insurers] pay. Plus, we cut red tape: pre-cert and prior auth exceptions in some cases. Doctors like that.”
These structural differences have ripple effects in physician recruitment and retention. In rural areas, where attracting specialists is notoriously difficult, the promise of fairer pay and greater autonomy can tip the balance, Mr. Schuessler said.
Employer-built plans may also help independent groups resist consolidation. Mr. Schuessler told Becker’s that his team is currently working with a large oncology network to create a “Centers of Excellence” model linked directly to employer-built plans.
“The idea is to help them partner with employer-built plans instead of getting crushed in the networks,” he said.
For Mr. Schuessler, the appeal of employer-built health plans is for physicians can come through restoring professional autonomy.
“We waive pre-certs and prior auths in many cases. That means physicians get to actually practice medicine, instead of being micromanaged by some insurer who’s never practiced a day,” he said.
