The Case for Self-Funding Your Company's Health Care Benefits

Andrew L. Wilson


Every year… every budget cycle… employers throughout the country, regardless of industry, whether large or small, simple or complex, go through the same hand-wringing about how to reduce costs and improve their bottom line. And every year, every budget cycle the same questions are asked by employers, “How do we control rising healthcare costs while keeping employees relatively happy with the outcome?”


Often this yearly and dreaded task falls on the Human Resources executive (sometimes with a “nudge” from the CFO) or the senior partner in the firm or perhaps the husband and wife that started the company. All of whom are equally perplexed about how to accomplish the task, knowing that any change to the current employee offering will not only bring significant consternation by employees, but also a significant amount of work for the HR department (no matter with whom those tasks may lie) to change carriers, complete enrollment paperwork, answer questions, issue new cards, etc.


Often the HR executive turns to their broker or consultant to “shop” the current employee offering and plan design to like carriers in the hopes of slowing the rising tide of costs, typically going with the cheapest one, thus completing the requisite due diligence of the task as required from above. As is often the case, the results of this exercise manifest themselves with skyrocketing rates the following year, thus starting this yearly “cycle of dread” all over again.


Unfortunately, many employers participate in this yearly ritual without considering perhaps the most practical and beneficial option for them regarding cost control and the health and wellness of their employees, and that is self-funding their health benefit plan.  


Most employers know that in a self-funded plan, the employer provides health benefits to employees with their own funds. They hear that it is typically a cheaper option, which initially sounds great, but then comes with the caveat of assuming the risk of paying all of the claims of their employees. This is where interest usually wanes however…the idea of assuming this uncertain risk, versus the traditionally “fully insured” model in which the insurance carrier bears all the risk.


This uncertain cost exposure along with the perceived administrative burden often seems too daunting for further consideration. No employer wants to expose themselves to claims that could negatively impact their bottom lines or even perhaps the viability of their companies. These are the common concerns and the most often misconceptions of the self-funded plan.


Not only is self-funding a sensible and practical option for employers…big and small… there are a number of advantages to it that not only can benefit a company’s cost curve but the health and wellness of its employees as well. While cost control is undoubtedly the most obvious benefit employers are typically looking for, self-funding is also a way for employers to offer valuable health and wellness benefits that keep employees engaged and productive thus limiting turnover.


Probably the most known advantages to employers of self-funded plans is that under the Employee Retirement and Income Security Act (ERISA), plans are exempt from state insurance laws covering reserve requirements, as well as state mandated benefits and premium taxes. Each of these is significant in their own right and all of which can result in considerable cost savings to the employer.


However, a major additional benefit of self-funded plans is that there is greater flexibility to design a plan that meets the needs of employees while still being affordable. Benefit companies like Crescent Health Solutions, have the ability to access claims data to help employers identify areas of focus regarding potential health issues that are driving a company’s claims costs. Data such as this, in addition to information gathered from simple employee health-risk assessments, can help employers make decisions to allocate their resources that not only will help keep costs and turnover low but will also be in the best interests of their employee’s health.


Managing claims through targeted wellness and disease management programs can be important aspects of a self-funded program. With self-funded plans, employers can establish wellness and health education programs targeted to their employee’s specific needs such as high blood pressure, diabetes, etc., to help them lead healthier lifestyles. These programs have evolved over time to offer nutritional guidance, exercise programs, smoking cessation, and mental health counseling to name a few. The end result is that self-funding and its ability to target the specific needs regarding the health of a company’s employees, can have a significant impact on employee engagement and wellness as well as positive bottom line impact. This type of specific plan steering and flexibility is a hallmark and benefit of self-funding.


While all of this sounds well and good, most often the main concern employers have regarding the idea of self-funding is the risk associated with being directly responsible for paying all of its medical claims. Claims can often be higher than anticipated or there can be unexpected claims, all of which can have a significant impact on an employer’s financial performance.  


A well thought out plan however, can mitigate this risk through a stop-loss insurance policy. How does a stop-loss policy work within a self-funded plan?  Employees still pay premiums and deductibles, and the employer covers all claims incurred up to a certain “dollar level” called the “aggregate attachment point.” This “attachment point” essentially sets the employers maximum exposure to costs…whether an individual high end claim or when all claims exceed a certain threshold amount. Stop-loss insurance then reimburses the employer for costs associated with the catastrophic claim or simply the higher than anticipated over-all claims activity, thus mitigating the risk to the employer.


Crescent Health Solutions can provide for all of your self-funding needs, from walking you through the initial analysis to designing your health benefit plan.  Crescent offers a comprehensive provider network, can provide detailed claims review and analysis, tailor wellness and disease management programs for your employees' needs, as well as identifying the attachment point and coordination of protective stop-loss insurance. 


Call Crescent today at 800-707-7726 to see if self-funding makes sense for your company.



Andrew L. Wilson is Chief Executive Officer for Crescent Health Solutions, in Asheville, NC.





January 30, 2017 – The Western North Carolina Association of Health Underwriters has deemed February 7, 2017, as Health Insurance Awareness Day. WNCAHU, the local chapter of the National Association of Health Underwriters, is hosting an event to be held at the Asheville Chamber of Commerce, 2nd Floor Board Room from 11:00 A.M. until 1:30 P.M.


Following a brief presentation regarding the status of the healthcare marketplace, a panel of experts will assemble to share their perspective and take questions from the attendees. The panel will consist of Jimm Bunch, CEO/President of Park Ridge Health, Michael Weizman, M.D., Physician/Owner of Our Family Doctor, LLC, and David Block, CLTC, President of Insurance Specialties., Inc. and Pine Street Insurance. The panel discussion will be moderated by Blake Spell, Director of Sales for Crescent Health Solutions.


Admission to the event is free of charge and open to the public.

Media Contact:  Jennifer Moore, Chief Operating Officer

Crescent Health Solutions 828-670-9145 ext. 104


Crescent Health Solutions & Sona Benefits Partner with Givens Communities


(Asheville, N.C.) – December 6, 2016 - Crescent Health Solutions, a leading provider of flexible, cost-effective and easy-to-use healthcare delivery solutions, welcomed Givens Communities to the family on October 1, 2016.   Givens Estates, Givens Highland Farms, Givens Affordable Communities and all their employees now have access to the broadest PPO network in western North Carolina and to all of the benefit plan administration capabilities Crescent has to offer.  In addition, Crescent partnered with Sona Benefits to bring Givens Communities a fully integrated pharmacy benefit solution with a local feel.


“The team here at Crescent is very pleased to have Givens entrust its employee benefits program to us.  Givens does so much for seniors in our community through quality care delivery and outreach ministries.  Adding them to our list of clients is certainly a blessing”, said Blake Spell, Director of Sales with Crescent.


“While our relationship with Crescent is still relatively new we could not be more pleased to this point.  Their transition and implementation of our benefits program was seamless and flawless”, said Amy Staton, Human Resources Director with Givens.


“The team at Sona is very happy to be able to expand our relationship with Givens to now service not only residents, but the employee base as well.  Partnering with Crescent truly maximizes the resources of both organizations to benefit the Givens Communities”, said Todd Tamplin, President, Sona Benefits.


About Givens

Givens Communities is a Christian, ecumenical not-for-profit corporation committed to providing the full continuum of quality care to seniors within its community and to providing outreach ministries in the larger community.

Since its inception in 1975, Givens’ goal is to optimize the quality of life for residents and staff by encouraging a healthy and balanced lifestyle. Through our ongoing commitment to wellness--integrating mind, body and spirit--Givens Estates, Givens Highland Farms, and Givens Affordable Communities is dedicated to meeting the emerging needs of current and future residents in finding fulfillment, dignity and purpose in daily living.


About Crescent Health Solutions

Crescent Health Solutions is a diversified health services organization licensed in North Carolina, South Carolina, Georgia, and Oklahoma specializing in providing flexible, cost-effective and easy-to-use healthcare delivery solutions, including health plan administration, a 40,000+ member PPO network with more than 5,500 providers and 58 hospital and specialty facilities, third-party administrative services, health and disease management oversight and provider value-based clinical integration improvement.


About Sona Benefits

Sona Benefits is a unique partner that simplifies the complexities of Pharmacy Benefit Management while helping organizations of all size achieve their goals.  The Sona Pharmacy Network provides members access to over 64,000 pharmacies nationwide.  Our mission is to provide transparent prescription management services that yield value to plan sponsors while ensuring solutions are in the best interest of plan members.  We combine technology driven data analysis, customized plan design, Medication Therapy Management, and Disease Management to better control healthcare costs while improving the health of members.

Contact:  Jennifer Moore

Crescent Health Solutions 828-670-9145 ext. 104






(ASHEVILLE, N.C.) December 1, 2016 – Crescent Health Solutions a leading provider of flexible, cost-effective and easy-to-use healthcare delivery solutions, licensed in four states, including health plan administration, PPO network offerings, Third Party Administrative services, health and disease management oversight and provider value based clinical integration improvement, has appointed Andrew L. Wilson, Chief Executive Officer.  Mr. Wilson will be succeeding Myrna Harris, who is retiring after 17 years as Crescent CEO.


Prior to joining Crescent, Mr. Wilson served as President and Senior Principle at Shoreline Associates, a national consultative consortium focusing on transformational value-based care delivery, integrated provider network development, cost efficient hospital operations, and healthcare legislative policy analysis and development.


“We are pleased to welcome Andy to our leadership team,” said Carolyn Coward, Chairman of the Crescent Health Board of Directors.  “Through his many notable contributions, we believe he is the right person to lead us into the future in this new paradigm of health care delivery.”


Mr. Wilson has held numerous leadership positions in the industry, including as  President and Chief Executive Officer of St. Alexius Hospital and Health System, a three-hospital system located in Bismarck, ND and President and Executive Director of  Synergy at Saint Joseph’s, Inc., an Atlanta, Georgia based joint ventured Integrated Delivery Network.


While in Atlanta, he was instrumental in developing “best practice” clinical integration strategies that improved bottom line performance as well as quality, safety and patient satisfaction and participated in the first Centers for Medicare and Medicaid "gain sharing" physician/hospital initiative in the country, allowing physicians and hospitals to share in savings for efficiencies in caring for Medicare patients.


Mr. Wilson has also been very involved in the changing paradigm of healthcare delivery and policy in the country as contemplated through healthcare reform.  He played a significant role and was an instrumental advocate in Washington for the Frontier State Amendment that was included and approved as part of the historic ACA Health Care Reform Bill.  The Amendment pays providers in rural states at a 1.0 Floor for Medicare reimbursement, greatly improving their financial position and economic status.


Mr. Wilson holds a bachelor’s degree from Michigan State University and an MBA from Saginaw Valley State University.

Media Contact:  Jennifer Moore,

Crescent Health Solutions 828-670-9145 ext. 104






(ASHEVILLE, N.C.) – December 1, 2016 – Crescent Health Solutions a leading provider of flexible, cost-effective and easy-to-use healthcare delivery solutions, licensed in four states, including health plan administration, PPO network offerings, Third Party Administrative services, health and disease management oversight and provider value based clinical integration improvement, has appointed Virgil Thrash, MD, Chief Medical Officer. 

Dr. Thrash will oversee Crescent Health’s Clinical quality and Health Management activities focusing on care management optimization, disease management and patient Safety.

“We are pleased to welcome Dr. Thrash to our quality management leadership team.  He is a well-respected physician leader, and he understands how important it is to deliver high quality care to our key stakeholders,” said Andrew L. Wilson, Crescent Health Solutions Chief Executive Officer.

Dr. Thrash is an actively practicing Internal Medicine Physician with Biltmore Medical Associates, in the Asheville, NC.  He obtained his bachelor’s degree from Emory University, and is a graduate of the Medical College of Georgia. He completed his residency at Parkland Memorial Hospital in Dallas, Texas.  He is board certified in Internal Medicine.

Contact:        Jennifer Moore, COO

Phone:          828-670-9145, Extension 104




Crescent Health Solutions Achieves URAC Accreditations


Asheville, North Carolina, June 11, 2015:  Crescent Health Solutions, Inc. has earned accreditations for Provider Credentialing and Health Utilization Management from URAC, a Washington, DC-based organization that establishes standards for the health care and managed care industries. “Crescent’s Board of Trustees and leadership are committed to meeting quality standards to ensure the best possible services for clients.  We are very pleased with the performance of Crescent’s leadership and staff, and achievement of these accreditations is evidence of our commitment to quality,” states Carolyn Coward, Chair of the Crescent Board and attorney with Van Winkle Law Firm.

Founded in 1990, URAC is a leader in the accreditation of health and managed care organizations, currently offering more than 30 accreditation programs across the continuum of healthcare services.  URAC is an independent, nonprofit organization, dedicated to promoting healthcare quality through accreditation, education, and measurement.

“By applying for and receiving URAC accreditations, Crescent Health Solutions has demonstrated a commitment to quality healthcare,” said URAC President and CEO Kylanne Green.  “Quality healthcare is crucial to our nation’s welfare and it is important to have organizations that are willing to measure themselves against national standards and undergo rigorous evaluation by an independent accrediting body.”

Crescent Health Solutions was founded in 1999 as a provider-sponsored Preferred Provider Organization.  Today the company offers a full suite of services to employers who self-fund or partially self-fund group health plans for their employees and dependents, including Third Party Administration (claims administration); Utilization Management, case management, disease management and wellness programs; a network of more than 3500 providers in Western North Carolina as well as access to networks throughout the USA; and pharmacy benefit management programs.  Crescent employees also work with two carriers that offer Medicare Advantage plans and fully insured group products, along with providers of ancillary products such as group life, dental, and long-term and short-term disability insurance.  For additional information, please visit our Website:  www.crescenths.com.