Healthcare costs keep rising, and employers are looking for new ways to manage their employees’ care.
In a survey published by Imagine360, more than a third of respondents said they had skipped or postponed necessary healthcare because of the cost.
Imagine360, an administrator of self-funded health plans, aims to help employees “get back in the business of using your health plan,” President and CEO Jeff Bak told Becker’s.
“A lot of people can’t afford to use their health plan in a high deductible setting, and they don’t have the discretionary income to use the plan,” Mr. Bak said.
Imagine360 lowers costs through contracting directly with health systems, and by leaning on reference-based pricing, Mr. Bak said. In one example, the platform saved pest control company Rollins 19%, or $7.7 million, on its annual healthcare spending.
“When we select a high performance hospital system and directly contract with them, they typically are willing to give us a more competitive rate than you would see in a broad-panel PPO, because we’re saying to the system: ‘We’re going to steer people in your direction,'” Mr. Bak said.
In Imagine360’s survey, a third of respondents said health insurance premiums were the top contributor to healthcare affordability, while 23% said out-of-pocket maximums were the most important contributor.
A number of upstart and established insurers have introduced plan designs aimed at reducing out-of-pocket costs for employees. In 2024, Surest, a deductible-free option, was UnitedHealthcare’s fastest growing health plan. Aetna and Health Care Service Corp. have introduced similar options.
Centivo, a self-pay administrator, builds its network around what it calls “high-value” providers. Curative, a start-up insurer, offers plans with no deductibles or cost-sharing.
In Imagine360’s survey, 60% of respondents said they would travel to a primary care provider or hospital further away from their home for lower costs. As prices rise, employees are becoming more willing to have a smaller network for lower costs, Mr. Bak said.
“When we do these direct contracts, we see utilization contracts go from 30% to 50%. We see drive times increase by six or seven miles, which hospitals love to see. I do think there’s real value there,” Mr. Bak said.
Imagine360’s typical client has around 400 employees, Mr. Bak said. The company is looking to expand to both smaller and larger employers this year, he said, launching a product that helps small employers transition toward funding their own plan. The company is also targeting the largest employers, with 15,000 or more employees, by pitching Imagine360 as an option for employees to choose.
In the coming years, employers will shift away from broad panel PPO networks and high deductibles, Mr. Bak predicts.
“Coming up with plan designs that are going to incent use of the plan, whether it’s primary care, mental health and then a reasonable amount out-of-pocket when you have to have a procedure done — I think it’s going to be a lot different in 2035 than it is today. I think we’re going to see a shift back to incentivizing the right use at the right places, at the right time,” he said.
