Direct contracting is getting easier

Sensing the growing appetite for direct-to-employer partnerships, some consulting firms and other third parties are launching programs to help health systems cut out the insurance company and get as close to the customer as possible.

CSuite Solutions and Key Benefit Administrators this month launched a program to help providers develop their own branded direct-to-employer products and market them to nearby self-insured businesses large and small. Already, about a half-dozen healthcare providers have signed on to the program.

“Healthcare providers in the U.S. should deliver the healthcare that they deem to be necessary for their patients and shouldn’t be dictated to by a whole host of other organizations,” said Key Benefit Administrators CEO Larry Dust. “By eliminating those players, we’re bringing the employer and patient back to the healthcare provider where we believe they belong on a face-to-face basis.”

Providers are more equipped to manage the health of patients and lower the costs of care than an insurance company, officials of CSuite and KBA argue. Already, many providers are trying to sidestep the middleman by developing their own health plans, but going that route requires significant startup costs. Some providersponsored plans have struggled to turn a profit and consequently shut down.

The direct-to-employer contract, however, keeps the financial risk centered on the employer, who also pays for reinsurance. Providers are rewarded for lowering the cost of care and following specific chronic-care protocols.

CSuite estimates that startup costs for the directto-employer program range between $250,00 and $450,000. Meanwhile, CSuite and KBA do much of the back-office heavy lifting, like developing the provider network, helping to structure plan benefits and processing claims.