Patient-Centered Financial Assistance Enables Self-Funded Strategy Without Compromising Care
The Challenge
A mid-sized employer was preparing to transition to a self-funded health plan when a member was diagnosed with a high-cost medical condition. The diagnosis triggered a proposed $500,000 stop-loss laser, creating a significant financial barrier that threatened the viability of the employer’s self-funded strategy.
Without an alternative solution, the employer faced difficult choices:
- Accept the laser and absorb significant financial risk
- Delay or abandon the move to self-funding
- Restrict benefit options for employees
The employer needed a solution that balanced plan affordability while ensuring uninterrupted, high-quality care for the member.
Our Solution
OneVeracity implemented a patient-centered financial assistance strategy designed to reduce employer risk while prioritizing member care.
Working collaboratively with the employer’s HR team and the member, OneVeracity:
- Evaluated care pathways and financial assistance eligibility
- Shifted qualifying care costs from the employer plan to a charitable care program
- Structured a flexible benefit design aligned with long-term sustainability
This approach allowed the employer to maintain employee access to care without absorbing disproportionate financial exposure.
Our Impact
Through coordinated clinical, financial, and benefits strategy execution, OneVeracity delivered a solution that protected both the employer and the member.
Key outcomes included:
- Employer successfully moved forward with a self-funded strategy
- $500,000 stop-loss laser avoided, eliminating a critical financial barrier
- Implementation of a dual-option RBP/PPO benefit plan that balanced flexibility and cost control
The Bottom Line
This case demonstrates how coordinated financial advocacy can reduce employer risk without limiting access to care. By aligning charitable care programs, modern benefit design, and active care navigation, OneVeracity helped the employer achieve long-term plan sustainability while prioritizing the member experience.
OneVeracity’s integrated approach combines clinical insight, financial advocacy, and flexible benefit design to solve high-cost challenges for self-funded employers.
