By Courtney Beckers
There has been a noticeable trend in the marketplace for employer groups to shift toward self-funded healthcare plans. This approach offers numerous advantages, such as increased flexibility and potential cost savings. According to Statista, the percentage of U.S. workers covered by self-funded plans rose from 44% to 65% between 1999 and 2023.
However, some employers have voiced their concern over a lack of utilization review, case management, negotiations and other solutions that would ensure the best care for their employees while minimizing unnecessary costs. These groups venturing into the self-funded arena often find themselves navigating uncharted waters.
Enter Hines, a leading authority in healthcare management solutions. With almost four decades of success in the self-funded space, Hines offers a comprehensive suite of services designed to address the needs and concerns of employer groups embarking on the self-funded journey.
A cornerstone of effective self-funded healthcare is the ability to negotiate favorable terms with healthcare providers directly. Hines understands the importance of securing the best possible terms for our clients, from Pre-Certification to Negotiations and every step along the way. Hines’ team of experts work to ensure all procedures meet established criteria for medical necessity and appropriateness. Our solutions provide employers with the confidence that their healthcare dollars are being spent wisely with minimal waste.
One often overlooked aspect of the switch to self-funded is the need for preventative measures, disease management and holistic care. Hines offers an entire wellness program designed to empower employees to avoid potentially life altering diagnoses like heart disease and diabetes. Our team of health and wellness experts also offer disease management to help workers with chronic conditions like hypertension maintain their quality of life. One example of the need for preventative holistic approaches lies in diabetes. According to NIH, spending on diabetes alone reached $419 billion dollars in direct and indirect costs; that’s 1 dollar for every 4 dollars spent on healthcare. According to Harvard Health Publishing, over 90% of type 2 diabetes diagnoses can be prevented through lifestyle changes. Hines offers holistic solutions to keep workers healthy and productive.
We champion this approach by identifying and addressing inefficiencies in healthcare delivery. Ensuring resources are utilized cost-effectively by leveraging our team’s robust clinical expertise to evaluate the appropriateness of healthcare services and interventions, while leaning on data-driven insights to steer employees towards preferred providers. From coordination of care for chronic conditions, to facilitating access to specialty services; Hines is dedicated to working proactively and empathetically with employees and healthcare providers to optimize outcomes and minimize costs at every checkpoint along the way.
While the shift towards self-funded healthcare presents exciting opportunities for employer groups, it also underscores the need for comprehensive support and expertise. Some care management companies offer a part of what we do, only Hines offers end-to-end full-service solutions that are centered on an employee’s wellness journey. It’s this member-centered approach that ensures maximum savings without sacrificing quality of care. In short, Hines’ proven solutions for employer groups are a necessity to navigate the complexities of self-funding with confidence.
To speak more in depth with Courtney about comprehensive support, please email her at cbeckers@hinesassoc.com
Dylan York contributed to this article.
