Healthcare Innovators / Self-Insured Employers
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?
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.
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
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.
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.
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.
Additional Insights
Understanding Medical Necessity: Guidance to Address Medical Insurance Coverage
How Healthtech Companies Can Successfully Access the Self-Insured Employer Market
How Healthtech Companies Can Successfully Access the Self-Insured Employer Market
[Click image for link to article]
“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.
How Healthtech Companies Can Successfully Access the Self-Insured Employer Market
How Healthtech Companies Can Successfully Access the Self-Insured Employer Market
How Healthtech Companies Can Successfully Access the Self-Insured Employer Market
[Click image for link to article]
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.