Apr 15, 2022Liked by Morgan Cheatham

Fantastic article, Morgan! Enjoyed it right to the end.

Expand full comment

Great article! Can you elaborate on this point? I didn't fully understand it:

"Still, most plan funding is sponsored by employers and most employers are increasingly turning to self-funding (as small as 250 employees), which means that every time a company brings a point solution to a health plan, that health plan has to turn around and sell that solution back to their employer clients"

Why does the health plan have to turn around and sell that solution back to their employer base in this scenario?

Expand full comment
Apr 19, 2022Liked by Morgan Cheatham

Alex, Morgan is describing the ASO (admin services only) aspect of health plans. Employers who choose to self-fund (bear the financial risk of their employees’ annual medical costs directly, rather than paying a premium to a health plan to bear that risk), they contract with health plans for a fee to manage all of the administrative functions (plan design, claims, network, grievances, etc) but the health plans don’t have any ‘skin in the game’ as the financial risk is borne by the employer.

Under this ASO model, plans routinely sell employers additional solutions - either as a ‘buy up’ (opt-in) or ‘bake-in’ (opt-out). You can think of this as the plan acting as a reseller and generally receiving some form of marketing credit/administrative fee from the solution provider.

Expand full comment

Hi There, I signed up for the workshop "Demonstrating Clinical Outcomes as an Early Stage Care Delivery Company," but I never heard anything. Is that happening today? Would love to attend if possible. Thank you!

Expand full comment