Dealing with insurance providers can be a hassle for both employees and employers, who are eager for easier access and simpler communications when it comes to healthcare. That’s why Northwell Health — the largest healthcare provider and private employer in New York State — has opted for a direct contracting healthcare program for its employee benefits plan, moving away from the traditional insurance model.
Northwell Health was looking to reduce the administrative burden that comes with providing care to more than 75,000 employees and dependents, and recently partnered with third-party administrator Brighton Health Plan Solutions. Moving forward, BHPS will handle all claims processing, provide employees with online and mobile support as well as customer service.
“This model removes the middleman and allows an employer to partner directly with the health system in developing programs and offering services that make sense for their employees,” says Michelle Zettergren, chief sales and marketing officer with BHPS. “They can partner with the health system on wellness and population health management, and really what Northwell is able to deliver is integrated care.”
About 11% of employers currently use a direct contracting model to secure improved pricing and improved care, according to data from Willis Towers Watson. Northwell’s new plan, which launches in 2022, will connect employees to a system of healthcare providers that all have access to employees’ care history — so if a primary care physician sends an employee to a specialist, that specialist will be able to stay connected with the primary care doctor during the course of their treatment.
In a traditional insurance model, care becomes more fragmented, Zettergren says. One doctor may recommend a specialist that is out of a patient’s insurance plan, which means they have to search for another covered provider and work to make sure each doctor they see knows what the other is doing.
“Northwell is delivering a much more integrated model,” she says. “All of their providers are connected and communicate together. The patient has a very different experience than they would in that traditional kind of fragmented system.”
The model provides benefits to the employer, as well. Northwell, for example, has negotiated discounted rates with participating providers that can result in 20% savings.
“There’s a really compelling financial value proposition that we’re able to create,” says Nicholas Stefanizzi, CEO of Northwell Direct. “The status quo isn’t working, the trend lines have moved in the wrong direction for employers, and they need a new way to navigate this new reality that we find ourselves in. There’s an openness to non-traditional alternatives to help solve a perennial problem.”