Inside alternative plan design: the mechanics and behavior change driving employer cost savings | Craig Allen & Nancy Wang (Sidecar Health)

Sidecar Health's approach is different from traditional health plans: set a fair price for every service and drug, give members that budget upfront, and let them keep a portion of the savings if they come in under it or pay the difference if they go over.

Nancy Wang and Craig Allen, who lead strategy and actuarial at Sidecar, walk through how that model works, from the actuarial complexity of pricing every service and drug to the member education and behavior change required to make it work at the employer level.

The conversation covers why mid-market employers facing 40-80% rate increases are increasingly open to alternative plan designs, what 20% medical cost savings through consumerism looks like in underwriting, and why the Trump administration's proposed no-network ACA rule is less disruptive than critics suggest, given Sidecar operates as a fully ACA-compliant plan today without a traditional network.

They also touch on where the consumerism model could apply beyond the employer market, the shift in employer appetite from absorbing increases to demanding something different, and why the category of "alternative plan design" may not stay alternative for long.

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