Why Quality Matters for Self-Funded Health Plans

Feb 8, 2022

Patient with top-quality doctor

The secret to fixing healthcare and suppressing cost inflation? First, here’s what isn’t the answer:

  • Big box consultants
  • HDHPs
  • Reference-based pricing

The secret sauce to fixing healthcare is quality.

That’s right. It begins with the quality of providers your employees see. Top-quality doctors are more efficient, have better outcomes, and adhere to best practices, saving an average of 20% per episode of care.

Quality matters with self-funded health plans. This is because you pay claims as they occur. One of the appealing elements of self-funded plans is that because you’re paying claims as they occur, there’s the potential for employers to save significantly on overall health plan costs. 

At year-end, if you have a health plan surplus in your budget, you can use those funds for plan enhancements or other employee benefits. But, the key here is to reduce the cost of claims by encouraging your employees to seek out quality healthcare providers. Quality healthcare results in increased preventative care, reduced misdiagnoses and avoided unnecessary treatments.

Currently, the benefits industry lives with a “bigger is better” mentality when adding doctors to networks. As a result, quality simply is not considered. Instead, the focus is on growing networks with as many doctors as possible – whether they’re quality health providers or not. It’s time we stop that trend in its tracks. 

How do we steer quality for our clients in self-funded and fully insured plans? 

First, Totem uses the nation’s largest healthcare claims database to identify the highest-quality doctors in every community. Then, when paired with our concierge service, employees are encouraged to see those quality healthcare providers. 

When those members receive care from the identified physician, the plan covers 100% of the member’s out-of-pocket expense. This results in thousands of dollars in savings for employers and reduced out-of-pocket spending for members. 

A true win-win.

Quality is essential to all healthcare plans and to the well-being of employees. But, it’s crucial to those enrolled in self-funded plans. Don’t risk the financial liability of claims for low quality or unnecessary care when the answer is right in front of you: let’s start getting your people to top-quality doctors.

At Totem, we work with clients to implement self-funded health plans that make it easy for members and employers. To learn more about why quality matters for self-funded health plans, connect with a member of our team today. 


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