8 Ways Self-Funded Health Plans Can Enhance Preventive Care - main content

8 Ways Self-Funded Health Plans Can Enhance Preventive Care

With employers breaking away from their dependence on standard insurance providers and transitioning to self-funding their health plans, employees can capitalize on the opportunity to access advanced preventive care while utilizing other cost-saving measures. In self-funded health insurance plans, employers ditch the ever-increasing premiums paid to insurance providers, as they themselves assume the responsibility of paying claims filed by employees and health care providers.

Promoting Workplace Wellness to Curb Rising Healthcare Costs

The success of this self-insured model is based on optimal utilization of advanced preventive care because it is the crucial first step towards not only averting high-cost claims, but also helping in protecting employers’ bottom-lines. A national survey of employer-sponsored health plans indicate that the average health benefit cost per employee rose by 5.2 percent in 2023 with predictions of a sharper increase in the future. Such reports indicate that existing wellness initiatives and employee wellness programs often based on health risk assessment surveys and biometric screenings, may not be tapping into the real potential of preventive care.

To reduce these rising healthcare expenses as well as improve employee health, Envita Health™, a Managed Service Organization (MSO), has launched clinician-designed healthcare plans. These meticulously crafted plans utilize leading health metrics, going beyond standard blood pressure and lipid profile, for true preventive care. Envita Health™ plans are aimed at elevating the concept of corporate wellness to the next level with innovative interventions. These smart interventions are designed to help in reducing the chances of life-threatening and chronic diseases among plan members, which in turn minimizes the risk of high-cost catastrophic claims. Studies indicate that overall, for self-insured employers, approximately 1%–2% of members drive 30%–35% of annual claims, and the preventive programs at Envita Health™ are customized with early intercepts, for checking members from sliding into this group.


Smart Customizations Addressing Every Company’s Specific Needs

The revolutionary healthcare benefit plans offered by Envita Health™, can be customized for varied employer groups, based on their employee needs and demographics. These smart customizations allow even small and mid-size companies to leverage the advantages of advanced preventive care through self-funded, level funded, and to a certain extent even fully funded or fully insured health plans. However, self-insured employers with level-funded or self-insured plans have the liberty to customize their benefit design allowing for maximum utilization of advanced preventive care. With Envita Health™, and its detailed stop loss insurance coverage, any company with more than 25 employees can reap the advantages of being self-funded employers. Self-funding allows employers to focus on innovative preventive care for elevating employees’ healthcare benefits while reducing overall long-term costs.

Revolutionary Plan Designs Rooted in a Prevention-Centric Approach 

Envita Health™ is unique in its offerings because their plan designs include the benefits of both Medicine 2.0 and Medicine 3.0. Medicine 2.0, refers to conventional medicine focused on diagnosing and treating illnesses, but Medicine 3.0 is aimed at utilizing the latest technologies to personalize treatments for disease prevention, early intervention, and overall holistic recovery, going beyond standard preventive care offered through other insurance plans.   

Here are the 8 ways in which employers can enhance preventive care, improve health outcomes, reduce absenteeism, and lower healthcare costs, while breaking away from the pricing complexities of insurance carriers:

1. Customized Benefits Plan Based on Detailed Claims Data

Envita Health™ provides an Individualized Company Data and Research Report which helps in analyzing the problem areas in each individual company’s member pool, based on their claims data. For example, if a particular company’s report shows high prevalence of lifestyle related health conditions, such as obesity, diabetes, hypertension, or musculoskeletal diseases, then the benefits plan can be customized to include proactive preventive interventions for counteracting the core causes of these diseases. Unlike other self-funded plans, the Envita Health™ team has specially trained physicians customizing advanced preventive interventions for plan members.

2. One-On-One Coaching on Employee Wellbeing

Each plan member is assigned a personal health coach trained in Envita’s unique personalized 3.0 medicine approach. Such one-on-one coaching sessions help to enhance employee engagement and participation in preventive care and serve a crucial role in initiating the required next steps for early identification of diseases, including mental health and behavioral health conditions. According to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey, mental health needs among workforces continued to climb this year, with 77 percent of large employers reporting an increase in conditions like depression and anxiety. Impactful stress management strategies integrated into employee wellness programs have the potential of checking the incidence of mental health conditions.

3. Specialty Labs Included in Advanced Wellness Programs

The one-on-one coaching sessions help in pinpointing members who need access to specialty labs that identify risk for various diseases including cancer and cardiovascular diseases, through advanced genetic testing. The results of these specialty labs guide the proactive preventive interventions required for each patient, while also enhancing employee satisfaction levels. With such attention to detail, employees also feel relieved about access to the latest technologies for prevention as well as early diagnosis and treatment. For example, with Envita Health™, members can gain access to specialty labs, such as a simple blood test to screen for 52 different types of cancers.

4. Advanced Pharmacogenomics Program for Overall Holistic Health

Studies show that prescription drugs are the third leading cause of death after heart disease and cancer in the United States. Around half of those who die have taken their drugs correctly; the other half die because of errors, such as too high a dose or use of a drug despite contraindications. To avoid such consequences and to enhance the efficacy of medications, an advanced pharmacogenomics program determining the appropriateness of prescribed medications can prove exceptionally helpful. With Envita Health™, a specially trained physician reviews the results of this pharmacogenomic panel and provides medication adjustment recommendations, if deemed necessary to improve the patient’s health. Additionally, as a preventive measure, physicians may recommend drug-free options in cases where medication reduction is crucial for enhancing overall health.

5. Access to Integrative Medicine for Comprehensive Preventive Care

Advanced integrative care including research-based natural therapies and custom-compounded adjuvants increase the tool kit of options in preventive care. These options may be helpful for members identified to be at a high-risk for certain common conditions like obesity, which in turn is responsible for triggering many other diseases, such as diabetes, cardiovascular disease (CVD), and cancer. Proactive integrative measures to reduce the chances of such chronic and life-threatening diseases translates to a happy and healthy workforce, as well as lower healthcare costs. Studies show that the effects of obesity raised costs in every category of care: inpatient, outpatient, and prescription drugs. In fact, the aggregate medical cost due to obesity among adults in the United States was $260.6 billion, in 2016. Access to personalized integrative preventive care options may help significantly address these costs and improve employees’ overall health.

6. Concierge Navigation Prioritizing Most Appropriate Healthcare Services for Each Individual Patient

Concierge navigation educates and guides members to top-tier facilities with the best outcome rates for specific conditions needing treatment. This specialized navigation facility includes referrals to minimally invasive procedures and non-surgical options, likely in Centers of Excellence (CoEs) with a proven record of quality outcomes. For example, if a member is diagnosed with stage 2 breast cancer, then standard conventional treatment may include lumpectomy or mastectomy, followed by maximum therapeutic dose untargeted chemotherapy, but directing such patients to CoEs like Envita Medical Centers could enhance outcomes, avoid invasive surgeries, and reduce chances of recurrence. Timely intercepts guiding patients to CoEs with advanced treatment options not only help to prevent risk of disease progression or relapse, but it also drives down costs significantly. Envita’s costs are 3rd party actuarially certified to be 50 percent less than standard oncology while providing better integrative precision technology*.

7. Personalized Prenatal and Pregnancy Program to Prevent Avoidable Complications and Catastrophic Claims

High-risk maternity/ NICU (Neonatal Intensive Care Unit) care is one of the top 10 cost drivers of large employers. With this one-on-one coaching and proactive guidance program dedicated for pregnancy, prenatal, and postnatal care, the Envita Health™ team aims to proactively intercept cases of high-risk pregnancies. For example, through this dedicated wellness program women gain access to specialized tests and recommendations for promoting fetal health, which increases the chances of delivering healthier babies, counteracting employers’ concerns of high-cost NICU bills.

8. 2nd Opinion Program to Help with High-Cost Chronic Conditions and Health Issues

Meaningful 2nd opinion programs play a pivotal role in making more treatment options available to patients, and in certain cases, these consultations may pave the way for preventing other disease-related complications. Envita Health™ offers second opinion specialty care appointments for members who are diagnosed with cancer or a chronic condition. Cancer has overtaken musculoskeletal conditions as the top driver of large companies’ health care costs, further reiterating the need for a true 2nd opinion in oncology. Envita Health™ members gain access to second opinions by physicians who undergo continuous training and education to stay up to date with the latest research, developments, and technological advancements in the medical field. With their customized treatment protocols 88% of patients reported symptom score improvement with 95% fewer side effects*.

Call Us Today

Envita Health™ partners with a third-party administrator to manage the rules and algorithms of their unique plan designs. Their nationwide network ensures smooth plan administration for employers as well as employees and their dependents. These customized plan designs help employers in not only improving the health outcomes of their workforce, but in also promoting a more positive company culture by utilizing pioneering customized wellness programs. For any queries related to your health insurance plan, please feel free to call us at: 877-214-8660. May God bless you on your healthcare journey!

*Data is based on our analysis of records for 87 out of 129 patients that participated in Envita’s treatment program in 2020. 42 patients were removed from the cohort due to the patient’s inability to start or complete Envita’s prescribed treatment for a variety of reasons, including but not limited to, advanced disease state, disease progression, or inability to travel.