WellNet launches self-insurance program for small and mid-sized businesses
WellNet Health Plans announced earlier this week partnerships with two of Eastern Pennsylvania's largest provider networks, as the company launches a new self-insurance service aimed at small and medium-sized employers.
The addition of Valley Preferred and Berkshire Health Partners (BHP) will provide a comprehensive network of more than 5,000 doctors and 33 hospitals in 12 counties in the state and is a key element as WellNet begins to sign on businesses looking for alternatives to providing health benefits to their employees.
"Our plan is only as good as the partners we work with - the doctors and the facilities. If you talk to anyone in Allentown its like the Yankees and Mets: people either go to Valley Preferred our St. Luke's. Valley Preferred is aligned with and provides access to Lehigh Valley Health Network. BHP - which is not owned by St. Luke's but is a different network - gives us access to St. Luke's" said David Feinberg, co-president of WellNet Health Plans.
Locking up the access to the two provider networks now allows WellNet's self-insured offering to operate on the same footing as commercial insurers.
"Between the two providers, our network looks and feels everything like the Blues and large incumbents, with access to the same doctors and access to the same facilities," said Feinberg. "The difference is, instead of going through the big Blue network and their bureaucracy, we have contracted directly with the providers in that area."
Under the WellNet program, companies pay a fixed premium to WellNet, just as it would for conventional insurance. If its employees' medical claims fall below that fixed premium in a given month, the difference accrues as savings to be captured at the end of the year. If monthly claims go above the fixed premium, stop-loss insurance included in the plan covers the difference.
"Because this is a self-funded plan, when we provide a quote for the premium equivalent you know exactly how much you are paying to rent the provider network, how much you are paying for stop-loss insurance, how much you are paying for administrative services, how much we predict you are going to use in claims," noted Feinberg.
At the core of the WellNet offering is software and predictive modeling services provided by Healthcare Interactive Inc. based in Glenwood, Md. Using the company's Point to Point (P2P) platform, employers can track, in real-time, the performance and expenditures of their individual plan while suggesting ways in which the company might save money and also improve the health of their employees.
"For self-insured companies, one of the biggest issues if you are a small- or medium-sized company, is the ability to be able to get your data," said Henry Cha, president and CEO of Healthcare Interactive. "One of the things we have done as part of the cloud service we offer is to embed the data mapping and all of it as part of the cloud service so a small company doesn't need to worry how to get their data. Once they get our applications they don't need to worry about any of that, they just have an application that works."
Self-insured members also have access to health coaching services provided by WellNet. Using P2P with real-time data collection of prescription information of members, nurse coaches can identify and work with individual members that are at high risk of requiring care, to ensure they are getting the care they need.
"Everything we do within WellNet is to encourage consumerism and to encourage good behavior, but we don't mandate anything," Feinberg said. "Our whole goal with care management -- which differs from many out there -- is to keep you out of the hospital, not manage your costs once you are in the hospital."
Further, WellNet will share data with providers so they can also take an active role in managing the care of the high-risk members.
"WellNet's value proposition aligns perfectly with our dedication to our patients," said Jack Lenhart, MD, interim executive director of Valley Preferred. "Together, we look forward to delivering high-quality health care in a cost-effective manner."
For now, WellNet intends to roll out it program in the 13 county area of Eastern Pennsylvania. In development for about a year, the company did a soft launch of its offering in October and with it provider network now in place will now aggressively market in the service area.
But the company doesn't plan to stay in a single region. With an exclusive license to use P2P for plans of under 5,000 lives, WellNet is actively seeking new partnerships with PPOs with the intention of expanding to another 10 markets nationwide in 2011.
