Innovative Financial Arrangement

Thanks to the integrated Providence-Swedish Health Alliance Network, Providence HealthEngage delivers an expected claims forecast that is approximately 6 to 8% below typical PPO network claims levels.

Everest Re Group offers specific and aggregate stop-loss if your aggregate claims exceed 120% of the expected claims level over the course of your benefits year.

The most unique attribute of the Providence HealthEngage solution is the aligned incentives between employer and the health system to efficiently and effectively manage your health care dollars.

Together, Providence Health & Services and you, the self-funded employer, will share in your health plan’s financial performance for annual aggregate claims between 80 and 120% of expected claims. If your health care claims exceed “expected claims,” between 100 and 120% of expected, Providence will take financial accountability by returning 50% of that excess claims to you after financial reconciliation. Conversely, if Providence HealthEngage is effective in maintaining your actual aggregate claims level below “expected claims,” then you will share 50% of that savings with Providence. Such shared savings will not exceed 10% of expected as the shared savings agreement is 50% of savings in the 20% corridor between 80 to 100% of expected claims.

Compare Financial Arrangements

(PPO and Stop-Loss)
Providence HealthEngage Self-Funded
(ACO, Stop-Loss, and ACO Performance Arrangement)
 Expected Claims  $300 PMPM
 $280 PMPM
 Maximum Liability (Stop-Loss)
 $375 PMPM (125%)  $336 PMPM (120%)
 Performance Corridor
 N/A  80-120% of expected
 Performance Arrangement
 N/A  50/50 shared alignment
 Net Max Liability  125% of expected  110% of ACO expected

Actual Claims Scenarios (at end of performance year, 12 months, all dollars PMPM)

Employer Claims Cost   Traditional Providence HealthEngage Self-Funded

 Employer Pays  Stop-Loss Pays  Employer Pays  Stop-Loss Pays  ACO Pays to Employer
 $400 PMPM  $375  $25  $336 (net $308)  $64  $28
 $350 PMPM  $350
 $336 (net $308)
 $14  $28
 $320 PMPM  $320    $320 (net $300)    $20
 $300 PMPM  $300    $300 (net $290)
 $280 PMPM  $280    $280    
 $260 PMPM  $260    $260, plus $10    Receive $10
 $200 PMPM
   $200, plus $28
   Receive $28