Why doesn't the employer's medical carrier already cover your service? What makes you different? Success in selling to the employer marketplace requires speaking their language. You need to be familiar with plan design and medical necessity determinations provided by the medical carrier. What ROI do you bring to an employer looking to lower medical costs, improve engagement and performance, impact worker productivity and mitigate health risks.
A growing number of healthtech, digital medicine, virtual care, population health and digital therapeutics companies are starting to target this marketplace. Solutions, including condition management, pharmacogenomics, care management, telemedicine, precision medicine, access to care and care coordination are some of the breakouts looking for a blockbuster experience.
Entering the self-insured employer market space requires a keen appreciation for the buyer (usually an Employee Benefits Decision-Maker) and the many moving parts they deal with on a regular basis. Plug and play capabilities, service excellence and coordination with other benefits need to be considered.
“Why should I pay for this if it isn’t covered by the insurance company?”
If an employer’s medical insurance company doesn’t cover a diagnostic or therapeutic service, why should the employer consider buying it separately?
The answer is found in the corridor between “medical necessity” and what can be argued is genuinely “medically necessary.” In order to prove that your product/service is medically necessary, you first need to understand the medical insurance company’s medical necessity policies for your technology.
Many healthtech companies promise medical cost reduction through marketplace innovation. But they often underestimate the level of detailed understanding of medical spending that SIEs and their advisors have. Increasingly, employers can influence cost trends and clinical drivers to an impressive degree.