To manage the health and health spend of their employees, self-funded PSHPs focus on starting and scaling population health programs. But all too often, these self-funded PSHPs lack: (1) a clear leadership structure and defined expectations for collaboration between plan and health system leaders; (2) a unified vision directing plan goals; and (3) sufficient population health data and analytic capabilities.

To effectively and demonstrably improve employee population health, drive down employee health spend, and achieve sustainable ROI, self-funded PSHPs must first develop the solid foundation needed to do PHM the “right” way – with the appropriate coordination and ability to measure impact. If efforts are uncoordinated and unmeasured, expanding the breadth of PHM programs will only drive-up administrative costs without reducing employee spend.

There is no one-size-fits-all model for how self-funded PSHPs deploy employee population health efforts. However, in this report we identify three key priorities for leaders to focus on to successfully managing and measuring employee population health.

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Self-funded plans and their sponsoring providers have varied levels of integration, with many lacking a collaborative governance structure. Some self-funded PSHPs operate alongside their provider organization parent as a separate entity with its own leadership structure, while others are more integrated within the provider organization’s organizational structure. In either case, it’s important for any provider organization that sponsors a health plan to have a working relationship with plan leaders.

Leaders governing plan and provider arms should be aligned on a clear decision-making authority structure, specified standards for communication between key stakeholder groups, and a unified vision for the plan to inform how success is measured.

Key Findings

• PSHPs should ensure they have the right folks at their governing table and that each stakeholder has a clearly defined reason for being there.
• Once the right people are involved, plan leaders need to establish a precedent for regular communication between three groups: (1) provider organization executive leadership, (2) enterprise stakeholder groups, (3) employee plan members.
• PSHPs should ensure that all parties are operating around the same, unified vision for the plan defined by clear KPIs and a holistic, measurable vision of success.