When it comes to providing
According to the annual Kaiser Family Foundation report, the average premium for employer-sponsored family healthcare jumped by 22% in the last five years, while rising as much as 54% over the previous ten years. PricewaterhouseCoopers predicts that employer medical costs will increase by 6.5% in 2022.
First Choice Health, a healthcare organization that caters to small and mid-sized companies in the northwestern United States, is determined to reimagine health insurance plans with a critical eye to the traditional insurance system, which favors wider networks as a solution to cost-effective healthcare. It’s a strategy that isn’t working for anyone, says Jaja Okigwe, CEO of First Choice Health.
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“We can't do any worse than what we're doing right now,” he says. “We're kind of in Einstein's definition of insanity. I think until we do something different, the costs are going to continue to go up.”
Instead, FCH is working to localize its healthcare plans, partnering with healthcare providers in a given community to offer a concise list of accessible care options through a clinically integrated network. In doing so, there is less of an incentive to direct patients to higher cost facilities without cause.
For instance, if an employer is in Bend, Oregon and selects St. Charles Medical Center, this hospital then provides the employee’s healthcare services. The direct-to-employer contracting puts more autonomy in the hands of the employer, while giving employees more transparency and ease around who and where they can receive care.
“It still looks very similar to the process that you follow as an employer,” says Okigwe. “We're going to do all the services behind the scenes, but it's really St. Charles who you've bought, as opposed to Blue Cross Blue Shield, Aetna, Cigna or United.”
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Not only does FCH take care of the administrative work between the employer and hospital, but the company also strives to ensure their providers — local hospitals — are more accessible, by introducing telehealth practices and following up with physicians directly on behalf of patients.
Still, a localized system may offer a healthcare network that could be regarded as limited if solely dependent on providers in the community. However, Okigwe says local networks versus traditional health insurance companies can be viewed similarly to fast food versus high-end restaurants: an extensive menu does not mean better food.
“When you're sitting there trying to pick from [a fast food] menu, it's sort of dizzying,” says Okigwe. “I don't think that having the biggest, broadest thing necessarily guarantees quality experience or outcome. We can narrow choices but offer better solutions upfront.”
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FCH still plans on offering guidance for those who need to go outside their community. As the largest independent provider network west of Mississippi, FCH also works with a national provider network to connect people to the appropriate care.
As healthcare becomes an increasingly vital issue for millions of Americans, there will be added pressure to move away from the status quo. If employers are often finding themselves choosing between limited or broad networks that do not guarantee local healthcare access or quality care, it may point to a needed adjustment in the healthcare ecosystem.
“I'm not really sure what all the answers are,” Okigwe says. “But the system needs help in creating simple solutions for folks.”
