The Employer Advantage model aims to control aggregate healthcare costs for self-funded employers through establishing accountable primary care teams, alternative compensation models, and ensuring triple aim outcomes of improved health, lower costs and high patient satisfaction. The model involves analyzing claims data to design programs, and convening focus groups of employees and primary care providers to develop an enhanced primary care program that employees will opt into and practices can meet accountability standards through. The goal is for large regional employers to adopt this model to establish a community-wide system with value-based care delivery and financing.

1. A Framework for Enhancing Benefits and Reducing the Aggregate
Health Care Spend for Employers, their Employees and Covered
Dependents
mployer Advantage Health Care Services (Employer Advantage) has
developed and implemented a model for controlling the aggregate cost of
healthcare spending under an employer sponsored health benefit plan. The
model, designed for self-funded employers and self-funded employer
cooperatives, is focused on establishing and developing a team of community
based primary care practice teams ready, willing, and able to be held
accountable for cohorts of covered individuals aligned
with their respective practices. In exchange for
accepting these roles as enhanced primary care
practice teams, the employer would be asked to
agree to alternative forms of compensation that
would empower the practice team to effectively
manage the needs of the covered individual
cohort. Employer Advantage leverages historical
claims data and practice level audits to set goals,
track activities, measure results, and ensure
desired outcomes. The desired outcomes fall into three basic
categories of effort; improved health status of the population, reductions in
aggregate spending, and high levels of patient satisfaction and activation. These
categories are often referred to as the Triple Aim.
mployer Advantage, following engagement as a vendor to an employer,
would convene two sets of focus groups. The first set would consist of
covered individuals, from among that self-funded employer’s employees and
covered dependents, who would be asked to provide feedback and insight into
what it would take to create an enhanced primary care program they would be
most likely to voluntarily “opt in” to. The focus group would be provided
foundational information and definitions of
key terms and concepts. The second focus
group set would consist of key primary care
practice representatives from throughout
the targeted communities represented by a
covered individual geo analysis. This
primary care focus group would be asked
to provide feedback and insight regarding
what it would take to develop a model for
“The Employer Advantage
model represents a solid
solution for self-funded
employers interested in
improving the health status
of their employees and
their dependents covered
under the self-funded
benefit plan, lowering the
overall cost of the self-
funded benefit plan, and
delivering high rates of
benefit plan participant
satisfaction.”
Paul Grundy, MD, MPH,
FACPM, FACOEM
IBM's Global Director of
Healthcare Transformation
A Proposal for Enhancing Benefits and Reducing the Aggregate Health Care Spen
For Broome County Government Employees and Covered Dependents
mployer Advantage Health Care Services (Employer Advantage) has developed an
implemented a model for controlling the aggregate cost of healthcare spending un
employer sponsored health benefit plan. The model, designed for self-funded
employers, is focused on establishing and developing a team of community based prima
practice teams ready, willing, and able to be held accountable for cohorts of covered ind
aligned with their respective practices. In exchange for accepting these roles as primary
practice teams, the employer would be asked to agree to
alternative forms of compensation that would empower the
practice team to effectively manage the needs of covered
individual cohort. Employer Advantage uses historical
claims data and practice level audits to set goals, track
activities, measure results, and ensure desired outcomes.
The desired outcomes fall into three basic categories of
effort; improved health status of the population, reductions
in aggregate spending, and high levels of patient satisfaction
and activation. These categories are often referred to as the
Triple Aim.
mployer Advantage, following engagement as a vendor to Broome County Gover
would convene two sets of focus groups. The first set would consist of covered
individuals, from among Broome County employees and covered dependents, wh
would be asked to provide feedback and insight into what it would take to create an enh
primary care program they would be most likely to voluntarily “opt in” to. The focus gro
would be provided foundational information and definitions of key terms and concepts.
second focus group set would consist of primary care
practice representatives from United Health Servic
(UHS), Lourdes Hospital (Lourdes) and Endwell Fam
Physicians (EFP). This primary care focus group wo
asked to provide feedback and insight regarding wh
would take to develop a model for primary care
performance and accountability. The focus group w
be provided foundational information and definitio
key terms and concepts. The primary care focus grou
would be acknowledged and celebrated for having achieved
recognition by the National Committee for Quality Assurance
(NCQA) as a Patient Centered Medical Home (PCMH). They
would also be challenged, as part of this business model, to
demonstrate a level of proficiency as a NCQA PCMH model
A Proposal for Enhancing Benefits and Reducing the Aggregate Health Care Spen
For Broome County Government Employees and Covered Dependents
mployer Advantage Health Care Services (Employer Advantage) has developed and
implemented a model for controlling the aggregate cost of healthcare spending un
employer sponsored health benefit plan. The model, designed for self-funded
employers, is focused on establishing and developing a team of community based primar
practice teams ready, willing, and able to be held accountable for cohorts of covered ind
aligned with their respective practices. In exchange for accepting these roles as primary
practice teams, the employer would be asked to agree to
alternative forms of compensation that would empower the
practice team to effectively manage the needs of covered
individual cohort. Employer Advantage uses historical
claims data and practice level audits to set goals, track
activities, measure results, and ensure desired outcomes.
The desired outcomes fall into three basic categories of
effort; improved health status of the population, reductions
in aggregate spending, and high levels of patient satisfaction
and activation. These categories are often referred to as the
Triple Aim.

2. 2
primary care performance and accountability.
The focus group would be provided
foundational information and definitions of key
terms and concepts. The primary care focus
group would be acknowledged and celebrated
for having achieved recognition by the National
Committee for Quality Assurance (NCQA) as a
Patient Centered Medical Home (PCMH). They
would also be challenged, as part of this business model, to demonstrate a level
of proficiency as a NCQA PCMH model practice to meet the Triple Aim results
and outcomes, as overseen by Employer Advantage, on behalf of the self-funded
employer and its covered individuals.
n addition to facilitating prospective covered individual participation and
primary care performance and
accountability, Employer Advantage
would analyze 36 months of historical
claims data to identify employer
needs, opportunities and key
program design elements. The
claims analysis would help drive
delivery system modification decision-
making and payment reform strategy. The current system of delivery
and finance, based on fee-for-service healthcare transactions, causes
communities to adopt and maximize models focused on the alignment of care
that is paid for versus care that addresses the actual needs of covered
individuals. This means covered individuals only seek and/or agree to care they
believe is covered under the benefit plan and often refuse or ignore care that is
more closely aligned with their actual health status needs or wants. The
Employer Advantage approach to analyzing claims data helps to identify these
circumstances and recommend the types of strategies that lead to value based
care delivery and finance in a highly transparent fashion.
mployer Advantage suggests this type of initiative for self-funded
employers who are among the largest employers in a region, which would
set the stage for a community wide model of care delivery and finance other
employers could benefit from. The first self-funded employer could serve, for
example, as a foundational member of a community wide employer cooperative
for both private and public employers and/or business group on health for all
employers.
For more information contact:
Jed Constantz, Co-founder, Chief Strategy Officer/Vice President Client Relations
615-427-4225 ex 137 / jconstantz@eahcs.com
A Proposal for Enhancing Benefits and Reducing the Aggregate Health Care Spen
For Broome County Government Employees and Covered Dependents
mployer Advantage Health Care Services (Employer Advantage) has developed and
implemented a model for controlling the aggregate cost of healthcare spending un
employer sponsored health benefit plan. The model, designed for self-funded
employers, is focused on establishing and developing a team of community based primar
practice teams ready, willing, and able to be held accountable for cohorts of covered ind
aligned with their respective practices. In exchange for accepting these roles as primary
practice teams, the employer would be asked to agree to
alternative forms of compensation that would empower the
practice team to effectively manage the needs of covered
individual cohort. Employer Advantage uses historical
claims data and practice level audits to set goals, track
activities, measure results, and ensure desired outcomes.
The desired outcomes fall into three basic categories of
effort; improved health status of the population, reductions
in aggregate spending, and high levels of patient satisfaction
and activation. These categories are often referred to as the
Triple Aim.
n addition to facilitating prospective covered individual participation and primary care
performance and accountability, Employer Advantage wou
analyze 36 months of historical claims data to identify
employer needs, opportunities and program design
elements. The claims analysis would help drive deliv
system modification decision-making and paymen
reform strategy. The current system of delivery a
finance, based on fee-for-service healthcare
transactions, causes communities to adopt and maxim
models focused on the alignment of care that is paid for versus care that
addresses the actual needs of covered individuals. This means covered individuals only see
and/or agree to care they believe is covered under the benefit plan and often refuse or igno
care that is more closely aligned with their actual health status needs or wants. The Employ
Advantage approach to analyzing claims data helps to identify these circumstances and
recommend the types of strategies that lead to value based care delivery and finance.
mployer Advantage suggests this type of initiative by Broome County Government, a
one of the largest employers in the region, would set the stage for a community wid
model of care delivery and finance other employers could benefit from. Broome Co
could serve, for example, as a foundational member of a community wide municipa
cooperative for public employers and/or business group on health for private employers.
Respectfully submitted,
Jed C. Constantz, Chief Strategy Officer
December 2016
“Employer
Advantage has a
model of
transparency and
process of care
redesign that
lowers an
employer’s cost in
the first year of
engagement.”
Paul Grundy, MD,
MPH, FACPM,
FACOEM
IBM's Global Director
of Healthcare
Transformation