How COVID-19 Is Opening the Door to Direct Contracting

As employers look to bring employees back to work and customers through the doors, the looming issue is how to do so safely. Many employers have sought the council and partnership of local hospitals and health systems to help them navigate this uncharted territory. Hospitals and health systems not only have medical expertise and resources, they also have a great deal of experience in dealing with COVID-19. These strategic partnerships benefit both the employer and the health system.

Benefits to Employers

Employers benefit by having the expert guidance of established hospitals and health systems that provide medical expertise and an abundance of resources. Having served on the frontlines during the pandemic, hospitals and health systems have extensive knowledge to share with employers as to what works, what doesn’t and the best ways to ensure the health and safety of employees. By partnering with well-respected institutions, employers are also demonstrating to their customers and employees that they are committed to health and safety. Having a health and safety plan backed by medical experts also helps employers mitigate risk should legal issues arise.

Benefits Hospitals and Health Systems

Hospitals and health systems benefit from these partnerships by restoring lost patient volume to their facilities. Opening the door to employees of partnering businesses provides gains in primary care visits, clinic visits and elective procedures. This results in increased revenue as payments from employer-based health plans exceed the reimbursements from Medicare and Medicaid. And, if the health system can help employers keep their doors open and employees healthy, this results in lower unemployment and less uninsured patients, impacting the bottom line of the hospitals providing their care.

Employer and Health System Partnerships

Here’s a look at some employers who have partnered with health systems to get their employees safely back to work:

Direct Contracting

Even before COVID-19, Whole Foods Market partnered with Adventist Health to provide healthcare services to the company’s employees in Southern California. The direct contracting relationship allowed for Whole Foods to skip the insurance middleman and negotiate directly with Adventist Health to develop a customized health plan. The self-funded plan gave Whole Foods employees personalized and integrated care while providing Adventist Health with a wider footprint and more patients.

As healthcare costs continue to rise, employers will continue to seek ways to cut costs and develop health benefits that are more tailored to the needs of their employees. And as only a small percentage of large, self-insured employers currently participate in direct contracting, there is an abundance of opportunity for hospitals health systems looking to partner.

As direct contracting options present themselves, it’s important for hospitals and health systems to ask themselves if they have a seat at the table. Employers are looking for partners who can bring medical expertise, develop benefits plans designed to meet the needs of their unique populations and create personalized care for their employees that includes care navigation and health coaching.

Applied Health Analytics positions hospitals and health systems as the preferred providers of population health services within the communities they serve. Applied Health Analytics understands the population health needs of employers and links its proprietary risk analytics and intervention technology with health system resources to offer employers a complete array of evidence-based education, early detection and prevention initiatives. Employer specific data is stratified using Applied Health Analytics’ risk stratification and engagement technology to help health systems deliver an unparalleled level of population-specific intervention.

Applied Health Analytics can help health systems secure a seat a table by offering employers a variety of proven tactics, including:

  • A Risk-Stratification Engine: Purposefully designed algorithms, health risk assessments, biometric and claims data work together to provide a prescriptive view of individual and overall population wellbeing. The data engine offers accurate access to analytics and analysis that is easy-to-use and query to empower change and measure impact.
  • Care Coordination: The risk-stratification engine identifies individuals by health risks, behavior change needs, health history or gaps in care and targets these individuals to promote health system services, products, partnerships or PCPs.  Key to any successful strategy is the ability mitigate health risk by aligning such risk with the resources of community-based physicians and hospitals.
  • Health Coaching: One-on-one interaction between a participating employee and a health system representative has proven to drive member engagement and promote positive outcomes.   As these health coaches intervene to manage goals, report progress, record patient history and encourage incentive attainment, hospitals and health systems advance the impact of employer-sponsored health initiatives by aligning health professional resources with the needs of an individual.  All this is accomplished within Applied Health Analytics’ technology platform, further promoting the interests of the employer and sponsoring health system.

As more employers turn to heath systems to guide them through COVID-19 and beyond, there exists a large opportunity for hospitals and health systems to work towards direct contracting. Having the right tools and technology can help secure a seat at the table for these discussions. Contact Applied Health Analytics to learn more about building employer relationships and creating opportunities for direct contracting.