Populytics Health Management Solutions

Gain control over employee health care by going directly to the source

As the region’s leader in population health management and health care analytics, Populytics is uniquely positioned to deliver an innovative alternative to employer-sponsored health care. Populytics Health Management Solutions (PHMS), which is a direct employer-to-provider model, meets the demand for a larger, comprehensive well-being strategy for today’s forward-thinking, self-funded employer. We put the focus on total cost-of-care for your employee population and provide the infrastructure and competencies to address each aspect. PHMS delivers care across the entire continuum from prevention/wellness and mental health support to chronic care management. Then we enhance service through utilization and pharmacy management. It’s a progressive solution that is gaining traction across the country.

How does direct contracting work?

Here are the basics:

A self-insured employer and a health system – or in our case, Populytics, subsidiary of Lehigh Valley Health Network (LVHN) – directly negotiate key terms by which the provider manages the total cost of care to the employer’s employees and dependents, without the extra layer of an insurance company.
The employer assumes the financial risk and responsibility of paying its employees’ medical claims.
Populytics performs the role of third-party administrator (TPA) and assists with plan design, enrollment, claims processing, and other health plan management needs.
A commitment by the provider is central to the arrangement: to coordinate and manage the employee population proactively and effectively.

What are the benefits of direct contracting?

Working with a provider without an insurance company in between gives employers the advantage in the volatile and complex environment associated with traditional plans. Direct health care offers:

Customized plan design flexibility
Minimization of constraints imposed by traditional insurers
Transparency into costs and quality
Enhanced patient relationships through direct involvement with connected providers
Reduction of unnecessary tests and procedures
Better value by delivering care that puts an emphasis on outcomes
Improved quality of care and increased employee experience
Clearly identifiable care gaps and ability to close them

Why Populytics?

PHMS was born out of our robust history of health benefits administration, a direct affiliation with one of Pennsylvania’s largest health care networks, and our close alignment with clinicians. Because of our strategic collaborations offering administrative, interventional, and clinical capabilities, Populytics is able to provide employers with the multiple services of an integrated TPA. Our infrastructure has flexibility and customization far beyond what a traditional insurance carrier can provide to self-funded clients. We also successfully managed the LVHN Employee Health Plan – covering more than 30,000 members – for a 30-year span, providing cost and material efficiencies, tier-one quality care, and high value to patients/employees.

Contact us for more information

If you’re interested in an alternative solution to employer-sponsored health care, reach out to our team. We’ll be happy to explain PHMS from your company’s perspective and show you how it can make a difference.