Self-insured employers: 6 key thoughts on new opportunities for ASCs

It's important for providers and payers to align incentives, especially for self-insured employers, and ambulatory surgery centers are able to do just that. ASCs provide high-quality services at a lower cost with the ability to improve the patient experience.

"ASCs are typically smaller and therefore uniquely positioned to implement cutting-edge programs such as true clinically and financially integrated bundled procedures," says Chad Somers, president and CEO of Benefits Management Inc., which was acquired by Nueterra Healthcare last year. "The benefit to ASCs from self-insured employers will be the additional volume of new procedures that can be done in lower cost venues of care."

Here are five key thoughts for ASC owners and operators on the self-insured employer market:

1. Self-insured employers could drive volume to ASCs by offering a flexible benefit design that reduces the employee's out-of-pocket expenses when an ASC is appropriate. "There is tremendous opportunity to improve quality and reduce cost across hundreds of procedures which could be done in a lower acuity setting," says Mr. Somers. "Tactically, self-insured employers can implement plan designs that provide a better benefit to their participants when services are rendered at an ASC."

2. The self-insured employers may operate in the bundled payment structure. "Self-insured employers can further control costs by shifting certain procedures to ASCs and participating in bundled payments for such episodes," says Mr. Somers. "This shift is currently underway as exemplified by the rapid increase in total hip and knee replacement procedures being performed in ambulatory care settings supported by a recovery suite or other post-acute care."

3. ASCs can take advantage of bundled payment opportunities with an appropriately risk stratified population. "ASCs can further benefit from self-employed insurers' ability to create more flexible design plans, engage a different consumer and enable centers of excellence," says Mr. Somers.

4. ASCs can connect with self-insured employers via third party administrators, broker/consultants or even directly to the employers themselves. Relationships between TPAs and ASCs are currently network-driven.

5. There are 63 percent of workers enrolled in self-funded plans, according to the 2015 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2015, which is up from 44 percent in 1999. "We expect this trend to continue, given the increasing healthcare cost trend and how employers will seek the cost-saving advantages of self-funded health plans," says Mr. Somers. "Specifically, employers are turning to self-funded options to avoid costly ACA mandates."

6. There are many employers willing and able to forgo the typical insurance plans and contract directly with high quality, low cost providers for their patients. "They desire to control their costs through transparent reporting, tailor benefit plans for population-specific requirements and contract directly with high-value physician networks and facilities such as ASCs," says Mr. Somers.

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months