Intalere Member Best Practice Spotlight – Lexington Clinic – Creating a Preferred Network to Improve Employee Health and the Bottom Line

Issue

Rising healthcare costs have led to an environment in which employers, providers and payers are seeking new models of care to maximize quality of care for their employees at the lowest cost. Traditional methods of controlling costs and promoting healthier employees – wellness initiatives like weight loss competitions, fitness trackers and free gym memberships – have failed to have a significant impact on total plan spend or the actual long-term health of employees.

Solution

Lexington Clinic worked with a benefit broker to engage self-funded employers in restructuring their health benefit plans to create a premier network featuring Lexington Clinic. This network provides significantly reduced cost-sharing for the members and an incentive to utilize Lexington Clinic for medical care. The overall network provided in the original plan is untouched, and members are still free to seek care wherever they prefer. However, having a new premier network in place at a lower cost than the original in-network tier has successfully encouraged members to obtain care at Lexington Clinic facilities. Member employees also have direct, expedited access to Lexington Clinic for same-day, routine and specialty care appointment via a dedicated Member Navigator.

Outcome

When comparing data from before and after implementation of the premier network, ancillary cost dropped more than 40% and facility outpatient costs more than 30%. There is strong evidence that through careful plan design, making use of co-payment selection and deductibles, beneficiaries can be steered toward providers of choice. In this premier network, employers and partnered provider groups receive a better overall picture of expenditure and health outcomes.

About Lexington Clinic

Lexington Clinic was founded in 1920 and is central Kentucky’s oldest and largest medical group practice. Lexington Clinic has nearly 200 providers and serves more than 600,000 patients every year. Lexington Clinic has providers in 30 different specialties and has more than 25 locations throughout central Kentucky.

Check out the project video and view the Lexington Clinic page in the 2018 Intalere Best Practices Compendium.

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