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Why Employers Should Consider Self-Funded Insurance Plans?

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As more employers look to reduce healthcare costs and expand their plan and program options, the self-funded model is proving to be a win-win for employers, their third-party partners, and employees because of the flexibility, cost savings, and increased transparency it offers. Self-funded insurance has been gaining popularity throughout the U.S. over the past 20 years, with 65% of the U.S. workforce covered by a self-funded insurance plan in 2021.

What is self-funded insurance?

With self-funded insurance, the employer assumes the financial risk and provides health benefits directly to their employees, in contrast with the fully-funded model, through which employers purchase insurance from an insurance company, which manages the financial risk on behalf of the employer. Self-funded insurance plans give employers more control over how their health plans are designed. Through customization, employers can better meet the health needs of their workforce and reduce overall claims expenses for their population.

Frequently asked questions about self-funded plans.

Does self-funded insurance offer tailored plan design options?

Employers can make more strategic decisions about plan options, have access to a wider network of providers and vendor partners, and can become part of a proprietary network. If health claims are lower than expected, employers can transfer those savings to optimize their health options by introducing and expanding services like wellness programs, patient advocacy, clinical care management, fertility care, maternal care, and behavioral health programs.

An additional advantage is unbundling – being able to pick and choose specific services helps ensure employers are getting the best options at the best price, along with the flexibility to pay for only the products they need to best support their employees.

Does self-funded insurance offer better health care choices?

Self-funded insurance third-party administrators (TPAs), like HealthComp, are important partners to help support employers with plan administration and plan design, as well as facilitate enrollment and processing of medical claims. TPAs help manage financial risk through cost-containment solutions, such as pharmacy benefit management, clinical care management, and employee advocacy programs.

What is a pharmacy benefit manager and how can they improve cost management?

A pharmacy benefit manager, or PBM, is like a third-party administrator but only in connection to a prescription drug program. The PBM is primarily responsible for processing and paying prescription drug claims. In addition to paying these claims, they can negotiate discounts and rebates with drug manufacturers, contract with pharmacies, and develop and maintain the drug formulary.

How does self-funded insurance improve the employee experience?

On the most basic levels, there is no difference in experience between a fully insured plan and a self-funded insurance plan. Employees will still receive member ID cards, they will have access to an online portal, a health plan to view covered and non-covered services, and they will go to the doctor and have their claims processed as they normally would.

There are, however, some areas where employees will feel the difference. Self-funded insurance offers the potential for greater savings to employees. Employer savings can be redistributed as additional benefits for employees like a wellness program or health plan discounts for employees. Employers may offer incentives for participation in a wellness program. Employees may have access to better-quality care and doctors, lower pharmacy costs, and lower out-of-pocket costs and copay. With a self-funded plan, employers can also offer programs that cater to their employee population directly instead of relying on a one-size-fits-all approach through a fully insured plan.

Combined with a TPA, self-funded insurance plans can help employers better manage their health care costs as they are subject to fewer regulations and thus have lower administrative costs. The costs of employee health plans are also based on the number of employees enrolled in the benefit plan each month and the organization’s overall health. The healthier an organization’s employee population is, the lower the plan costs are for the employer. Implementing programs like clinical care management and patient advocacy through a TPA can help ensure an overall healthier, and thus less expensive, employee group.

Chad Harris

Chief Executive Officer

 

Chad Harris serves as the CEO of HealthComp and is a value-driven healthcare leader with over twenty years of experience running business process and information technology businesses as a senior executive. Chad has a reputation for creating and controlling rapid growth by focusing on the intersection of customers, market dynamics, and the new digital world.

 

Chad has held many senior executive positions and led global teams of more than 10,000 people across dozens of counties. Chad has grown both large and small businesses, from those with less than $100M of revenue to those producing multiple billions of revenue, focusing on delivery, customer satisfaction, and innovation to create market leadership.

 

Chad's philosophy is to inspire change by doing what comes naturally, putting the needs of others before his own, working incredibly hard, and focusing on "how" to accomplish things, never "if they can be accomplished."

Thomas Martel

EVP of Enterprise Accounts & Strategic Partnerships

 

Tom serves as the EVP of Enterprise Accounts & Strategic Partnerships at HealthComp. In this role, Tom focuses on strategic initiatives aimed at accelerating HealthComp’s growth nationwide. His passion lies in assessing market and enterprise structures and creating efficiencies that enable teams to deliver best-in-class performance.

 

Previously, Tom led Cigna’s largest employer segment, largest region which was comprised of several health plans including the two largest health plans. He worked closely with Market Presidents and their leadership teams to develop and execute local market strategy and deliver growth for the enterprise. Tom earned his degree from Saint Anselm College and holds certifications from The Wharton School and the Darden School of Business at the University of Virginia. In his spare time, he enjoys sailing and holds a Master Captain’s license with the U.S. Coast Guard. He is also active in community outreach programs including local food bank and shelter services.

Sanoj Balakrishnan

Chief Technology Officer

 

Sanoj Balakrishnan serves as the Chief Technology Officer at HealthComp. In this role, he oversees the company’s overall technology strategy and architecture, building secure and highly scalable distributed systems.

 

Most recently, Sanoj served as Head of Healthcare Digital Business and Technology at Cognizant, working with payers and providers in developing solutions that reduced healthcare costs and provided a best-in-class experience for members. Earlier in his career, he worked at technology organizations in a variety of software engineering and architecture roles. Sanoj earned his B.S. from University of Mumbai and Computer Systems Management from National Institute of Information Technology.

Justin Tran

Chief Growth Officer and EVP of Product Strategy

 

Justin serves as the Chief Growth Officer and EVP of Product Strategy at HealthComp. He has 8 years of experience in developing and delivering solutions that reduce health care costs, improve quality, and provide a best-in-class experience for members. Most recently, Justin was an Associate Partner and business unit leader at McKinsey & Company where he helped large carriers and healthcare technology companies build new clinical services and solutions for fraud, waste, and abuse. Justin earned his B.S. in Accounting and Data Informatics from Indiana University, Bloomington.

Tucker Stein

Chief Financial Officer

 

Tucker serves as the Chief Financial Officer of HealthComp. Tucker previously worked for The Boeing Company in a number of finance and strategy roles, most recently as a finance lead for the Transactions and New Business Development group. In this role, Tucker led investments and strategic partnerships for Boeing’s Space and Communications portfolio. Tucker earned his MBA at Stanford’s Graduate School of Business and his Bachelors of Science at the University of Redlands.

Tom Georgouses

General Counsel

 

Tom is involved in multiple areas of HealthComp including Operations, Compliance and Legal Affairs. Tom was admitted to the California Bar in 1990 and started his legal career with Stammer, McKnight, Barnum and Bailey, LLP. When he left the firm to join HealthComp in 2014, he was the Managing Partner (he had represented HealthComp since 2003). In private practice, Tom’s areas of focus included healthcare and transactional work. Tom holds a Bachelor of Science Degree in Business Administration-Finance from California State University Fresno and received his Juris Doctorate from San Joaquin College of Law.

Rishab Bansal

Chief Transformation & Operations Officer

 

Rishab serves as the Chief Transformation & Operating Officer at HealthComp. Rishab focuses on transforming and modernizing HealthComp’s operations to provide delightful and distinctive experiences to its members, providers, and clients. His agenda includes integrating all entities towards a One HealthComp vision, driving profitable growth, and delivering value and business outcomes.

 

In his former work over the last 2 decades, he has helped clients across industries to transform themselves by bringing industry-leading practices and digital and data-led disruption. As the trusted advisor to the C-suite, Rishab helped his clients leapfrog on their transformation journey to accelerate business outcomes and helped them unlock new opportunities to drive profitable growth, profitability, and enhanced experience for their employees and clients.


Elaine Davis

Chief Human Resources Officer

 

Elaine Davis serves as CHRO for HealthComp. Elaine previously served as CHRO for Continuum Global Solutions and has served in executive leadership positions for Xerox and GlaxoSmithKline. Elaine holds Bachelor’s and Master’s degrees from the University of California at Berkeley.

Judy Schott

Chief Operating Officer

 

Judy Schott serves as the Chief Operating Officer and is a customer-focused healthcare leader who transforms operations to simplify the experience and deliver excellence. With deep knowledge of third-party administration, claims, eligibility, customer service centers, and compliance, Judy’s focus will include integrating all entities of HealthComp while driving profitable growth.

Kim Randazzo

Chief Customer Officer

 

Kim Randazzo serves as the Chief Customer Officer. In this role, she oversees account management for all divisions and HealthComp clients. Kim brings a wealth of strategic experience in account management to the HealthComp executive team, along with a practical understanding of the insurance business and what it takes to be the nation’s leading TPA.

Prior to joining HealthComp, Kim oversaw sales, account management, wellness, marketing, and implementation teams for Gilsbar LLC’s self-funded, association and affinity clients, and worked as an underwriter with Ochsner Health Plan and as an account representative with USI Services, Inc. She has over 26 years of experience in the healthcare insurance industry. A graduate of the University of New Orleans, she received her Bachelor of Science in Management in 1997 and her Master of Business Administration in 2002.