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ALLENTOWN, PA – WellNet Health Plans has launched a self-insurance program aimed at small businesses and is partnering with two of eastern Pennsylvania's largest provider networks, Valley Preferred and Berkshire Health Partners.
By locking up two providers for its health plan, WellNet can now actively market its self-insurance program to mid-sized businesses along with a provider network that is comparable to traditional health plans. The two providers count more than 5,000 doctors and operate 33 hospitals in 12 counties in the Lehigh Valley.
"Between the two providers, our network looks and feels … like (one of) the Blues … with access to the same doctors and access to the same facilities," said David Feinberg, WellNet's co-president. "The difference is, instead of going through the big Blue network and their bureaucracy, we have contracted directly with the providers in that area."
The difference between the WellNet offering and traditional insurance, Feinberg said, is the transparency of costs to businesses signing up for the self-insured program, along with an opportunity for businesses to get a rebate at the end of the plan year should their healthcare expenses by less than projected.
Under the program, companies pay a fixed premium to WellNet, just as they would for conventional insurance. If a company's employee 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 (and) how much we predict you are going to use in claims," Feinberg said.
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 employees.
"For self-insured companies, one of the biggest issues if you are small- or medium-sized is the ability to get your data," said Henry Cha, president and CEO of Healthcare Interactive. "One of the things we have done 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 application they just have one that works."
The fact that WellNet and Healthcare Interactive have teamed on a self-insurance offering is not surprising. Both companies have executives serving on the board of advisors of the Healthcare Performance Management Institute, whose mission is to empower employers to actively manage healthcare costs and benefits by providing relevant aggregate claims data.
"Health performance management allows companies to harness anonymous data on their employees' potential health risks in order to tailor their health benefits accordingly," said George Pantos, executive director of the HPM Institute. "Using the P2P platform from Healthcare Interactive gives employers the information they need to do this effectively."
Through the WellNet offering, self-insured members 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 who are at high risk of requiring care to ensure they are getting the services they need to stay healthy.
While currently focusing on Pennsylvania, WellNet doesn't plan to limit its services to that state. With an exclusive license to use P2P for plans of less than 5,000 lives, WellNet is seeking new partnerships with PPOs with the intention of expanding to another 10 markets nationwide in 2011.