PPACA – Self-Funding, Direct Contracting Offers Effective Solutions

Self-insured health plans, combined with stop-loss insurance to alleviate the risks associated with catastrophic claims, offer an effective solution to a large number of employers striving to be in compliance with the new law while continuing to offer health care coverage and keep costs under control.
The new health care paradigm revolves around provider accountability whereby groups of doctors, hospitals, and other health care providers collaborate to provide the full range of medical care for patients. This creates an environment in which the employer, not the insurance company, has the opportunity for direct contracting.
November 26, 2012  By

Joseph Berardo, Jr., chief executive officer and president of MagnaCare spoke with CCH, a Wolters Kluwer company, about the impact of the election on health care. In short, he says employers can expect the following:

  • President Barack Obama’s reelection means that the implementation of the Patient Protection and Affordable Care Act (ACA) will continue as planned. Therefore, employers will continue to be impacted by the law.
  • In its current form we should expect the number of uninsured to increase based on the lack of affordable products and the disincentives for small employers (under 30 employees) to continue to provide coverage.
  • With ACA deadlines fast approaching, pressure is building on employers who are paying more for their benefit plans without receiving the same value in return. This is an opportunity to explore health insurance funding alternatives, with self-insurance presenting a highly attractive option.
  • Self-insured health plans, combined with stop-loss insurance to alleviate the risks associated with catastrophic claims, offer an effective solution to a large number of employers striving to be in compliance with the new law while continuing to offer health care coverage and keep costs under control.
  • ACA provisions promote quality health care in which the needs of patients, families, and communities guide the actions of all those who deliver and pay for care. Toward this end, it incorporates evidence-based results with the aim of fostering a delivery system that works better for clinicians and provider organizations—reducing administrative burdens and helping them collaborate to improve care.
  • The new health care paradigm revolves around provider accountability whereby groups of doctors, hospitals, and other health care providers collaborate to provide the full range of medical care for patients. This creates an environment in which the employer, not the insurance company, has the opportunity for direct contracting.
  • Customized plan designs that encourage employees to use “Integrated Provider Networks” for physicians and services enabling patients to receive richer benefits and lower cost sharing when they go to an inner network provider. When partnered with a health care services company, this micro-network of physicians creates a competitive and unique product with a focus on service, care coordination and overall health improvement.

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