How the Rising Influence of Self-Insured Employers Can Shape Your Private Practice (For the Better)

There’s no question: self-insured employers are a powerful force in driving decision-making and shaping the future of the healthcare industry. With the growing influence of these employers in mind, I recently joined Scott Becker on Becker’s Healthcare Ambulatory Surgery Centers Podcast to discuss how employers can directly partner with private practice physicians, ASCs, and physician-owned hospitals to improve outcomes for all involved.   

During the episode, I stated, “What I want is private practice physicians to win. In engaging in direct contracts, you've done a couple of things. You've removed the ASO, so all those unnecessary fees are out. You've removed the insurance carrier if you will, and you've made it very easy for employers to do business with private practice doctors. And they never knew that value was there (until now).” 

Here are three top takeaways on how everyone wins with direct contracts in healthcare:   

1. Empowering Patients and Providers: A Paradigm Shift   

Self-insured employers represent approximately 33% of all labor in the country, transforming the healthcare experience for their employees. One notable impact is the shift towards incentivizing patients to seek care from Ambulatory Surgical Centers (ASCs) and private practice doctors. By offering insurance plans with no copays, deductibles, or co-insurance, employers can remove financial barriers and encourage individuals to seek necessary care promptly. This approach benefits patients and reduces administrative burdens for physicians, eliminating the need for pre-authorizations and promoting efficient care delivery.   

2. The Role of Quality Data and Price Transparency   

A crucial aspect of improving healthcare is leveraging quality data and promoting price transparency. Employers, driven by their fiduciary obligations, are becoming gatekeepers who demand transparency and accountability. They are seeking data-driven insights to make informed decisions about where to allocate healthcare resources. Furthermore, employers encourage employees to consider traveling for care, allowing them to choose providers with the best outcomes at reasonable prices.   

Price transparency enables employers to assess and compare costs, fostering physician and facility competition. By knowing what they will pay in advance, employers can effectively manage their healthcare expenses. This push for transparency also benefits physicians, as they can be compensated based on their quality of care. As quality data continues to evolve and improve, it becomes a vital tool for employers to identify high-performing providers and reward them accordingly.   

3. Forward Contracts: A Promising Strategy   

Looking ahead, one of the most exciting developments discussed in the podcast is the concept of forward contracts. Employers and healthcare providers can enter into agreements based on utilization data, ensuring stable financial projections and creating win-win scenarios. For example, by analyzing historical MRI utilization, employers can proactively contract with radiology centers at favorable rates, providing certainty for both parties. This innovative approach not only benefits employers in terms of financial stability but also empowers providers, who can showcase fully booked contracts as a valuable asset when evaluating their businesses for investment or acquisition.   

In summary, the influence of self-insured employers is shaping healthcare decisions and driving industry transformation. Partnering directly with these employers incentivizes patients to seek care promptly, reduces administrative burdens, and establishes stable financial arrangements that ensure long-term success.