Alternative health plans and the evolution of care

The paradigm has already shifted in healthcare benefits. While traditional health plans, with their rising costs and antiquated clinical offerings, fail to meet employee health needs across the country, it is clear employers and members alike need an alternative.

Firefly Health Chief Clinical Officer, Dr. Nisha Basu joined Senior Clinical Director, Kris Young for a webinar, “Navigating a New Paradigm: Alternative Health Plans and the Evolution of Care,” sponsored by Firefly Health.

With moderator Erika Randall of HR Daily Advisor, they discussed clinically integrated alternative health plans, the shifting paradigm of health insurance needs and offerings, and how the benefits you offer can transform employees’ health plan experience.

What is a Clinically Integrated Alternative Health Plan?

A clinically integrated alternative health plan…

• Embeds care delivery deeply within its model and processes
• Increases access to care for its members
• May offer care directly to its members, for example a virtual care team
• Interacts with members on a patient-provider level, understanding their health history, goals, and pain points.
• Prioritizes a quality-minded approach to guiding provider utilization.
• Emphasizes proactive care, lowering costs for members and employers.

Why are AHPs the future for health coverage?

Traditional health plans are based on an outdated coverage system established nearly a century ago, which hasn’t been truly overhauled despite the introduction of myriad point solutions and strategies such as high-deductible health plans (HDHPs) which simply shift costs.

Common health needs today are chronic. Patients need consistent care for widespread conditions such as diabetes or behavioral health.

Two factors are most important to members during open enrollment: 1) cost and 2) access to care. AHPs prioritize proactive primary care, management of costs, and personalization to each member. An AHP delivers by meeting the most important needs upfront.

“We aim to remove the barriers that legacy health plans often create,” Kris said. “Starting with cost, also looking at access. When you get those right, you don’t just see the numbers, you create a more equitable, more connected healthcare experience.”

What does a clinically driven AHP look like?

Clinically driven alternative health plans revolutionize member experience

Kris demonstrated the effectiveness of an alternative health plan through the journey of a patient, Regina. Regina’s previous health plan didn’t meet her needs – it cost too much, it took too long to make appointments, and every new provider she met didn’t have any information on her health history. That’s why she chose Firefly Health.

• Focus on primary care: Regina kept regular meetings with her Firefly Health care team. She told her nurse practitioner about respiratory issues she’s had for years.
• A personalized care team: While providers had previously treated Regina as a number in their system, her personalized care team reviewed her health history, got to know her on a human level, and made a recommendation to see a specialist. Firefly Health provided a cost-transparent resource for finding a high-value provider.
• Seamless experience: A detailed, coordinated handoff was made by the care team to a specialist, who diagnosed Regina with mild asthma and prescribed medication. Regina didn’t want to rely completely on medication, so her NP also prescribed physical therapy to assist her breathing.

What’s missing in your organization’s health offerings?

Spending for private health insurance rose 11.5% to $1.5 trillion in 2024. That’s a lot of buying power for employers offering health coverage and benefits. However, we’re not getting the full value of that enormous sum.

You can maximize value, patient outcomes, and ultimately employee satisfaction by offering an alternative to the cumbersome, outdated offerings presented by traditional health plans.

^{*This webinar is ideal for HR professionals, benefits managers, benefits consultants and brokers and anyone interested in transforming employee health benefits programs. Join us for an in-depth discussion of how to create a benefits plan that truly works for both employees and employers.}