Opinion Based List:

Cost Management: Strategies for Self-Funded Health Plans

Submitted by PayerFusion on Fri, 09/28/2012 - 11:09


  1. Managing provider network reimbursement increases more effectively to achieve deeper discounts.
  2. Investing in wellness and disease management, and exploring ways to encourage plan participants to make healthier lifestyle choices.
  3. Building value-based plans that encourage greater use of clinics and other alternatives for minor illnesses and injuries. Promote the use of generic drugs and step therapy
  4. Managing imaging/diagnostic technologies more tightly.
  5. Using data mining to make effective plan design decisions that focus on high-cost conditions and atypical utilization patterns
  6. Using more aggressive hospital-admission management strategies that pay for quality outcomes, reduce readmission rates and channel patients to high-quality/high-value providers by specialty.
  7. Conducting aggressive, data-driven renewal negotiations.


Notes: PayerFusion discusses cost management strategies self-funded health plan sponsor can consider when creating their plan.

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