Alternative health plans are disrupting the healthcare system. Is participation in one the right choice for your employees?

Challenges facing the healthcare industry today are much the same as those of years past. But what has changed is their scale. Healthcare costs continue to rise, and interacting with the healthcare system has been labeled as one of the most complex experiences for Americans.¹ The ramifications of this situation are extremely troubling for families, especially those living one paycheck away from financial distress. Millions of people need innovative solutions to help manage their health and their healthcare spending.

What is an Alternative Health Plan (AHP)?

New insurance startups could hold the solution. Employers across the country are exploring alternative health plans (AHPs) that promise to replace cost and complexity with savings and simplicity.

Now offered by several major health plans, AHPs replace the traditional insurance plan design and carrier relationship with a new plan option that individuals must elect at open enrollment. One such option is Coupe Health (Coupe).

Coupe has no deductibles, no complicated paperwork and no surprises. Members enjoy a straightforward and intuitive health plan that is designed to offer control over their healthcare and true peace of mind.

Coupe is different from other plans for several reasons:

1. Quality and network optimization

Most AHPs measure provider quality to steer patients toward higher-value care, which doesn’t simply mean low cost. These providers may have higher reimbursement rates, but they reduce overall healthcare costs with better outcomes, fewer complications and readmissions.

Coupe enhances traditional national networks to offer patients a wide variety of providers and facilities, but rather than tiering or narrowing the networks, Coupe identifies the best providers within a geography for each clinical category. By ranking providers this way, Coupe directs members to seek care from high-quality, efficient providers, so members do not have to sacrifice great care to save money.

2. Price certainty

While many AHPs have shifted to simple copay designs, Coupe uses fixed copays. Members know what they will pay before receiving care.

3. Elimination of third-party bills and Explanations of Healthcare Benefits (EOBs)

Coupe also simplifies the payment process by paying providers in full at the time of service. At the end of the month, members receive a single billing statement that includes the copays incurred over the previous month. Through this simplified process, members no longer have to manage bills from providers and Explanation of Healthcare Benefits (EOB) statements.

4. Financing support

Another way Coupe stands out is through its financial wellbeing benefit that allows members to pay their statement balance over time. This helps members avoid high interest rate financing to cover healthcare costs, so there is no need to put off necessary healthcare for themselves or their families. This is a major step in addressing affordability in our industry.

5. Clinical navigation

Some AHPs include clinical navigation capabilities that help connect patients to high-value providers in their community. Coupe Health identifies if a member is engaging with a lower-quality provider. In that case, a Coupe Health Valet will intervene, helping the member find a high-quality provider and coordinating appointments when needed. This helps members achieve a positive health outcome faster and less expensively.

6. Concierge/app-focused experience

The Coupe Health member-facing app combines technology with human interaction. This user-friendly tool empowers members to access and manage their Coupe-related healthcare in the palm of their hand, while its Health Valet service team assists members in finding top providers, answering healthcare questions, and resolving billing issues.

Performance results

Reports indicate that Coupe has helped reduce employer and member plan costs by 12 percent, while delivering high member satisfaction. In fact, 92 percent of members report they prefer their Coupe health plan over their previous plan.²

Providers also report that they have reduced their administrative burden for billing, collection and bad debt, enabling them to focus on practicing high-quality care. Also, Coupe has seen an 85 percent increase in top provider utilization for impactable care, which can reasonably indicate that members are seeing better clinical outcomes and lower cost of care.²

To learn more about Coupe Health, please contact your sales representative or account manager.