A Cypress Series:
The Top 3 Advantages of Self-Funded Plans

Advantage #3 – Employee Engagement


Getting Employees Involved
One of the main fundamentals of a self-funded plan is employee education. The more an employee understands about the benefit plan and care options available, the better decisions he or she will ultimately make.


TPAs realize this and regularly work with employers to implement patient advocacy programs and tools that will help members navigate the best care at the best prices. They also have a wealth of how-to experience in organizing workplace wellness programs that can have a great impact on keeping employees healthy and reducing high-claim costs.


Members Making Informed Decisions
Added flexibility and cost savings are big draws to employers who are considering self-funding, but they also value the ability to involve employees and motivate them to take an active role in their health care and all the decisions that go along with it.


In a traditional plan where an employer is paying a set amount for insurance coverage on a month-to-month basis, there really isn’t a major incentive for members to choose to have surgery at one facility over another. Even if that means facility A is going to charge 40% more than facility B for the same procedure.


Put yourself in a self-funded employer’s shoes and it’s a whole different perspective. If an employee is given the information needed to make an informed decision as to why facility B is the better option upfront (high-quality care at a much lower cost), everyone benefits.


The total billed is less, which means the employer pays a lower claim amount and the plan is able to benefit from these added savings. This is a big step in the right direction as employers work to maintain the costs of offering employee benefits.


Employee Advocacy & Wellness
With an eye toward cost containment, self-funded employers know how confusing and complex it can be to navigate the health care system. That’s why they work so closely with TPAs to find proactive ways to educate employees and give them the tools they need to be smart consumers in the decision-making process.


A few examples of how TPAS and employers partner to put employee engagement in action:

  • Medical/patient advocacy – Many TPAs offer medical advocacy programs that connect members with professionals who can help pair them with the right providers and procedures. These programs offer one-on-one guidance for choosing specialists, getting pre-authorizations and finding the best-rated facilities.
  • Employee wellness – One way to keep the cost of claims down is to keep employees healthy. TPAs work with employers to customize wellness programs that incorporate on-site risk assessments, professional coaching, health challenges and more. Many of these programs are structured to include incentives for participation and health improvement.


The Educated Health Care Consumer
Self-funded plans put a lot of emphasis on employee education and engagement. Employees who are informed about their care options make better decisions about where to receive treatment and who to receive it from. This can be a big factor when it comes to keeping claim costs in check. Additionally, members who take part in workplace wellness efforts often prioritize their health, and this can also play a part in controlling claim expenses.


For more information on other top advantages of self-funding, read our full whitepaper on The Top 3 Advantages of Self-Funded Plans.

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