Healthcare Innovators

Ron Leopold consulting

High Cost Medical Claims Consulting

Ron Leopold consulting

High Cost Medical Claims Consulting

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8 Things that really Matter to self-Funded employers

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

One broker or consultant sale can touch multiple potential clients. If you convince a trusted advisor for one client, your innovation has a better chance with other similar clients.

2) Why aren't health plans doing this, or covering this?

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

Maybe the client's insurance carrier does what you do, but doesn't do it particularly well. Maybe the plan doesn't cover your test or treatment because it is both expensive and prone to over-utilization. You need to know the answer to these questions before walking in the door.

3) Experience counts. Especially experience with other employers.

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

3) Experience counts. Especially experience with other employers.

Have you done what you say you can do with other employers? What was their employee (or plan member) experience? What does your client reporting look like? What service level agreements do you have in place?

4) Relatedness does NOT imply causality

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

3) Experience counts. Especially experience with other employers.

Just because your solution is relevant to a big issue- it doesn't mean that what you do will solve for the entire issue. Innovators often believe that since their solution "touches" a costly issue, the returns they can boast include the entire costs of that issue. Credibility is critical, here.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

Ultimately, you will face clinicians, actuaries, technicians who will be able to provide peer-to-peer review of your product's claims. Check your science.

6) Provider buy-in always helps.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

If you're already in the market, how have treating providers responded? It's always better to have them on-board and endorsing your solution. Do you have medical specialty society endorsements?

7) You need to make the case why the employer needs a third-party to solve this challenge.

"We're already getting this from our insurance carrier or another vendor. I see that you could do this better- but I'm not sure we need another third-party." Solve for that.

8) This is a "long sale," usually timed on annual cycles.

7) You need to make the case why the employer needs a third-party to solve this challenge.

Part of understanding the self-insured employer marketplace is the understanding of the annual cycles which are based on employee benefits renewals. This should not come as a surprise to you in a finalist meeting.

Value drivers and considerations for self-Funded employers

Medical Costs

In 2021, the average health insurance cost for employers was $16,253 annually, or 73% of the premium, to cover a family and $6,440, or 83% of the premium for an individual. These premiums for families and individuals have increased 22% over the last five years and 47% during the previous 10 years. [Kaiser Family Foundation; 2021]

Health Outcomes

Compared with high-income peer countries, the United States has a 46 to 50 percent higher disease burden rate for 20- to 40-year-old workers, and a 17 to 33 percent higher disease burden rate for those over 40 years old. [Innovating employee health: Time to break the mold?; McKinsey; Sept 2021]

Member Satisfaction

Self-insured employer plans usually cover employees and their spouse/partners and dependents. Employers depend on their medical carriers and their administrative services to provide access to good medical care, pay an appropriate (and pre-specified) amount and respond to covered members as customers.

Improved Productivity

At the heart of employer health plans are employees on whom companies depend for business success. The relationship between health and productivity is strong, but complex. Direct costs of health-related absence and disability can be dwarfed by "presenteeism." The focus on wellness and wellbeing is shifting to employee engagement and performance.

Attraction and Retention

Employer-provided health coverage is important for recruiting, but even more important for retention. A recent AHIP survey shows that: 56 percent of U.S. adults with employer-sponsored health benefits said that whether or not they like their health coverage is a key factor in deciding to stay at their current job. 46 percent said health insurance was either the deciding factor or a positive influence in choosing their current job. The role that healthcare innovation can play to support this is considerable.

Brokers and Consultant

Rule of thumb: Larger employers tend to work with larger consultant organizations who charge by the hour and bring sophisticated resources and broad subject matter expertise. Smaller employers tend to work with brokers who earn commission from placing medical insurance business- but often include value-added services to those client relationships. Knowing the players and understanding the working dynamics (and how they may vary) is invaluable to successful growth in the self-insured employer marketplace.

Other Influencers

Health care purchasing coalitions, executive roundtables, industry membership organizations are among those influencers who help employer decision-makers navigate the complex landscape. These influencers offer powerful potential for healthcare innovators looking to shape and showcase their solutions.

Preparing for the self-insured employer market Space

1) Employers Like Solutions, Not Products

2) Interfacing With Employers and Their Plan Members

What is the product or solution you have to offer and how does it fit into an employer's ecosystem? How is it better than what they may already have. Why doesn't their medical carrier(s) provide this? How are you different? How is this solution different? How is it better? What else do you need to consider?

2) Interfacing With Employers and Their Plan Members

Does what you do currently work for the self-insured employer marketplace? What additional processes and functionalities need to be considered to satisfy employer client needs? What about employees and their families: how can you assure employers that plan member user experience will be positive?

3) Quick, What's Your Value Proposition?

In a single sentence: What is your value proposition? What is the problem you are solving for the self-insured employer client? What about the employee or plan member? Can it be measured? What is the return on investment (ROI) or value on investment (VOI)? How can it be easily measured?

4) Actually making the connection

3) Quick, What's Your Value Proposition?

Who should you sell to? What kind or employers should you target? How do you effectively reach them? What do you need to do to sell successfully? Where are the best channels? Who are the stakeholders and key players that might get your foot in the door?

Planning for the self-funded employer client

Is your product/solution ready for the self-funded employers?

Do you know the terrain? Do you understand how they make those decisions? How confident are you that you understand the priorities of your target client(s). Retail industry buyers vary tremendously from manufacturing industry buyers. Technology, municipalities, education, services, hospitality, energy all have their own personalities. Large companies buy very differently from small ones. Do you have a Broker and Consultant strategy?

Four important questions you should ask during Product Development:

1. What is your product/solution and why would a SIE want to buy it from you?

2. Can you deliver the client experience and the customer experience an SIE requires?

3. What is the value-proposition your product/solution offers the SIE?

4. How do you successfully identify and reach SIE clients?

Ron Leopold consulting

Ron Leopold consulting

Medical Consulting for Innovators and Investors

Marketplace Fit

Is your healthcare innovation viable in the employer market?

Innovator Scorecard

8 Things that really Matter to self-Funded employers

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

2) Why aren't health plans doing this, or covering this?

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

3) Experience counts. Especially experience with other employers.

1) Consultants and Brokers often hold the key for self-insured employer decision-making.

3) Experience counts. Especially experience with other employers.

4) Relatedness does NOT imply causality

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

3) Experience counts. Especially experience with other employers.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

6) Provider buy-in always helps.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

5) Evidence counts. Analytic validity, Clinical Validity and Utility are usually called upon.

7) You need to make the case why the employer needs a third-party to solve this challenge.

7) You need to make the case why the employer needs a third-party to solve this challenge.

7) You need to make the case why the employer needs a third-party to solve this challenge.

8) This is a "long sale," usually timed on annual cycles.

7) You need to make the case why the employer needs a third-party to solve this challenge.

7) You need to make the case why the employer needs a third-party to solve this challenge.

Value drivers and considerations for self-Funded employers

Medical Costs

Health Outcomes

Member Satisfaction

Improved Productivity

Attraction and Retention

Brokers and Consultant

Other Influencers

Preparing for the self-insured employer market Space

1) Employers Like Solutions, Not Products

2) Interfacing With Employers and Their Plan Members

2) Interfacing With Employers and Their Plan Members

2) Interfacing With Employers and Their Plan Members

2) Interfacing With Employers and Their Plan Members

2) Interfacing With Employers and Their Plan Members

3) Quick, What's Your Value Proposition?

3) Quick, What's Your Value Proposition?

3) Quick, What's Your Value Proposition?

4) Actually making the connection

3) Quick, What's Your Value Proposition?

3) Quick, What's Your Value Proposition?

Planning for the self-funded employer client

Is your product/solution ready for the self-funded employers?