This article was published on May 14, 2018 on Employee Benefit Adviser, written by Kelly Bliss. 

Does this scenario sound familiar? Facing a second consecutive year of double digit premium increases, a mid-sized financial services firm recently decided to self-fund, but still had some trepidation over the prospect of becoming self-insured.

This was entirely understandable, as the company had been forced to make the decision while flying blind. Absent detailed utilization data, how was management supposed to know if they had opened themselves up to substantial risk?

As I explained to the firm’s VP of HR, much like stop-loss coverage, a comprehensive virtual care strategy that offers a full range of services can help guard against excessive risk. To help educate their clients, here are the three things advisers should know about why virtual care is an essential component of a self-funded strategy:

1. Telehealth covers both ends of the care spectrum. The common perception is that telehealth services excel at addressing commonly occurring low-risk conditions, such as sinus and upper respiratory infections, the flu, pink eye, etc. What many employers fail to realize is that a comprehensive virtual care offering also addresses the less-frequent and more complex conditions, including behavioral health conditions, that consume a majority of their healthcare dollars.


By addressing these higher-cost conditions through virtual care delivery, self-funded organizations can experience an almost not-to-be-believed ROI. A comprehensive virtual care solution that provides an entire range of care—from high frequency, episodic needs, to the most costly and complex medical cases including cancer—offers huge potential for cost savings that are especially appealing to employers considering self-funding.

2. Ensuring a correct diagnosis and appropriate treatment plan can save an employer millions. But according to a study by the Mayo Clinic, 26% of diagnoses are inaccurate. That’s why it’s invaluable to use the expert medical opinion services offered as part of a comprehensive virtual care solution to review an employee’s diagnosis. By funding the right treatments from the start, this service can lead to substantial savings for employers. They also increase employee productivity by eliminating the need to travel to seek expert opinions and then research and compare contradictory results. In fact, employers who use virtual expert second opinion services, see an average savings of approximately $36,000 per case.

3. Healthcare engagement is not just valuable, it is essential. For self-funded organizations bombarded with a plethora of point solutions, advisers should recommend that their clients view any potential vendor through the filter of employee engagement. No matter how potentially worthwhile a service, if the provider fails to successfully promote its utilization, that service will do nothing to improve employee well-being or drive down medical costs.

Shifting to self-funding requires due diligence to ensure success. Fully understanding how virtual care impacts self-funded organizations supports and reinforces that process.