Selling to Self-Insured Employers

Analyze priorities, budgets & barriers to adoption in employer-backed insurance plans.

This guide covers practical issues such as

Utilization

Map proven leverage points for influencing engagement. 

ROI measurement

Quantify clinical & financial ROI in the context of TCOC.

Broader value proposition

Tie into broader “Total Rewards” strategy including DE&I and A&R.

Integration & go live

Integrating into existing plan design for streamlined contracting, billing and communication.

Business model

Downstream implications on positioning as a PMPM “vendor” vs a FFS “covered healthcare provider”.

Shortcut learnings

Create an initial employer target list, prioritize conferences & channel partners.

Read the guide we've been providing to our own portfolio companies.

A must-read

Dr. Alan Spiro

President & CMO at Laguna Health

I have had the pleasure of working closely with all of these experts for many years, and this resource is an absolute necessity for any founder that is attempting to break into the self-insured employer market.

Zvika Goldstein

CEO/Co-Founder at Mellie

This is the cheat sheet I wish I had when starting Mellie as it would have saved me months of learnings.
The joint experience and knowledge of Julie and Jonathan, the co-authors, makes this a must-read.

The Self-Insured Employer opportunity

Over 100 million Americans receive healthcare coverage through self-funded employer-backed insurance plans.

These groups have flexibility & control over the design of their “Total Rewards” programs and seek offerings to attract & retain employees, control costs and improve well-being.

Vendor fatigue

Nonetheless, selling to self-insured employers presents unique challenges.

Assessing the viability of your startup’s offering demands a deep understanding of priorities, budgets and purchaser friction.

 

Avoid common mistakes

We’ve interviewed leading health benefits consultants to document what works and barriers to adoption when selling to self-insured employers.

Why we built this resource

Too often we’ve seen founders start selling into the self-insured employer market without asking themselves the right questions on viability ahead of time

These are the 50 questions to determine if a startup is a good fit for this channel & covers –

  • Determining relative priority of the value proposition  
  • Planning for potential barriers to adoption 
  • Identifying who pays with precision 
  • Leveraging health benefits consultant and aggregator partners

Learn from self-insured employer experts

About the Authors

Jonathan Friedman

Jonathan is a Partner at LionBird, leading new investments in companies in the healthcare delivery segment and serving on the boards of Laguna Health, Mellie, OneStep, Heyday Health, Ditto and others.

Prior to co-founding LionBird, he previously worked for the CEO of Azzorti, a multi-national consumer products company, managing new product launches, sales operations and other cross-functional projects.

He is a member of The Kauffman Fellows Program (class 24), has been frequently featured in technology publications such as TechCrunch and VentureBeat, and also compiles the popular LionBird Bites & Wings newsletters.

Julie Stone

Julie spent several years as a member of Willis Towers Watson Health & Benefits North America Senior Leadership team.

She was responsible for Intellectual Capital and Specialty Practices including health management, wellbeing, pharmacy, absence & disability management, dental, vision and more.

She designed and lead Learning & Development for the Health & Benefits practice and also was responsible for the business partnership with WTWs Research & Innovation Center. She led broad strategic initiatives across WTW’s H&B business and for large and complex employers.

Prior to joining Towers Perrin, Julie held a variety of roles in Prudential’s Health Care business including leading the integration team focused on networks, sales, and account management for the Northeast during the sale of the business to Aetna. Prior to that, she oversaw the execution of the sale of the New England Prudential health plan to Tufts Health Plan in Massachusetts. Earlier in her career, she led the national accounts underwriting team, served as an Account Executive for key national accounts, managed the health care data analytics team, the treasury operations, and spent six years leading the user design team in IT for Prudential’s managed health care business.

Julie worked with clients directly to develop health and welfare benefits strategies aligned with organizational/business goals as well as to design, implement and measure their health and welfare programs’ effectiveness through a variety of quantitative and qualitative approaches. Julie’s background and expertise covers the full range of health and welfare programs. She has worked with clients in a variety of industries including financial services, utilities, and pharmaceuticals. 

Julie has spoken at conferences sponsored by The Conference Board and the Business Group on Health, SHRM and other women’s health events. She has frequently been interviewed about health care by various media including The New York Times, The Wall Street Journal, The Washington Post, Kaiser Health News, Fox Business and National Public Radio.

LionBird is a venture capital firm investing exclusively in pre-scale digital health companies.

Since its inception, the firm has invested in more than 35+ founding teams and now has over $150 million in AUM. Our focus is on helping founders lay the best foundations for their companies to scale and succeed.

DISCLAIMER: By signing up for this eBook, you’ll also be subscribed (if you aren’t already!) to our once-a-quarter LionBird Wings digital health founder newsletter which provides digital health founders with practical, tactical advice on GTM.

Copyright © 2024 LionBird (Ventures) Ltd. All Rights Reserved