Austin has always been a hot health insurance market that operates under a different paradigm than its Texas neighbors to the North, South, East, and West.
Over the last decade, we’ve seen big shifts in the style and substance of the health plans we consume. With the rapid growth of our region and the favorable set of healthcare regulations that exist in Texas, the health insurance space has mirrored our growth.
There has been a huge expansion of technology-enabled health plans and innovation. These have targeted to both improve the healthcare experience of our community neighbors and subject our companies and our employees as beta tests for their “proof of concept” solutions they look to scale elsewhere.
But now in 2024 and into 2025, as the unfettered reign of cheap investment money has turned into more of a trickle than a flow, the moment of truth has come with investors demanding a profitable working product. With this occurring all around us both inside the health industry and outside the healthcare space, it is no surprise that some products and vendors haven't successfully matured on their journey from concept and product testing to becoming viable and sustainable products. But, we also have some companies that have matured and are starting to stack up as great choices alongside the stalwarts of the health insurance industry, and to no surprise they have been innovating to retain their place in our region as well.
This leaves us with several vendors to explore not only as a potential partner for your company but to also learn from and apply to any future vendor partnerships.
Customized Solutions
Self-insured health coverage currently reigns supreme in cost, customization, and high-impact cost-containment.
Incentive Networks
Austin has long had one of the premier models of cost-containment that others have sought to duplicate when it comes to the Whole Foods Health Plan. The model blends a selective network of top-tier providers at a free or substantially lower price point to their plan members alongside a broad national network of providers at a middle-of-the-road pricing structure. By steering their members to the high-quality network options these plans save money on the claims they pay, and in turn, save money on the insurance products these employers purchase for their high-risk protection.
The local success of this model, which expanded nationally, is now more accessible to other employers in our region than ever before. Their customized network has partnerships with plan administrators that can be accessed with as few as 25 enrolled employees, all the way up into the thousands.
Combining this top-tier network for cost savings, while allowing for the accessibility to a national network of providers and facilities when needed ranks as one of the hottest trends to provide the lowest cost health plans while simultaneously lowering the point of care expenses for your team members. And, for savvy employers who take advantage of this setup, quick customization to enhance the pharmacy experience ramps up the savings even faster.
Direct Primary Care
Austin is not only a hotbed for insurance solution vendors, but we are one of the nation's more robust regions for the Direct Primary Care (DPC) model. With a combination of independent practices as well as the multi-location clinic models in our region, it isn’t hard to build a plan around the DPC model. In this model, everything works on a membership basis, so there is no insurance claim to pay, and employers get to offer these services to their team members at no cost. And, we all know that high performing primary care is great for the employer and the employees.
Once employers are able to carve out the primary care claims from their insurance plans, they can purchase a lower-cost stop-loss policy to cover the remaining specialist, pharmacy, and hospital costs.
We are seeing this program deployed more often and more successfully than in years past with larger and larger employers now that technology is able to connect not only the Austin market, but also Direct Primary Care clinics across the nation for these employer groups and their employees.
Turn-Key Solutions
Curative
Curative has some time under operations now in their fourth year of business, and they have managed to expand outside of the Austin region to become a legitimate option for employers in Texas and beyond. While their company is still fresh, that expansion outside of Austin reinforces their investment to sustainability and it is nice to see more flexibility since we all have team members and families in other cities. Their plans include not only turn-key models built upon the self-funded platforms but also a fully-insured platform for larger employers.
The Curative model focuses heavily on provider and pharmacy steerage, but they put some teeth into their plans around member engagement. Knowing that they can have the biggest member impact with employees with whom they can have an open line of communication. They put their money where their mouth is and they will provide free care options for those employees that will complete their member baseline intake within the first 120 days of the plan year.
Decent
Decent has been resilient enough to come back to Texas. They have had quite the journey as they morphed from a product sold exclusively to individuals, then transitioned to a product sold exclusively to small group employers within a professional employer organization (PEO), and have now re-emerged as a turn-key solution for employers built on either a level-funded or self-funded insurance platform.
Throughout their transitions, they have been unapologetically focused on building health plans with the Direct Primary Care provider as centric to everything.
Just like the self-funded employers using the DPC movement as a cost savings, membership-enhancing solution, Decent has been doing it now through every iteration of their existence and they know the drill.
Sana
Sana has the Jay Parkinson factor working for them. They also have realignment of roles and goals working against them as they transition out of the golden age of investment funding.
The reductions in easy money looks to be a blessing here as they have leaned hard into the care model that Jay refined so well at Sherpa that he took into Crossover Health. Now placing SanaCare at the center of their plan designs and becoming smarter about bringing more clinical support in-house instead giving away a laundry list of outsourced solution vendors should improve the member experience and help them right the financial ship. And, they should start becoming financially attractive for their clients, former clients, and prospective clients.
Their pricing has stayed competitive with the mainstream competitors. And their ability to provide free care across a wide range of medical modalities is still ranking them extremely high for employers.
Aetna
Aetna may not be the sexy pick for a “what’s hot” list, but they have carved out a great product and price point in our market. For employers looking to have the brand name of an Aetna, Blue Cross, Cigna, or United Healthcare plan to provide comfort to their employees, this has been the top pick.
Their level-funded insurance platform for employers between 2 to 100 employees punches above its weight in benefits as it mimics coverage more akin to the large group offerings seen upstream. And their fully-insured products over 100 employees have been pricing more competitively these last couple of years against their big brand name competitors.
And, in the self-insured market? Aetna has purchased a good set of Third Party Administrators under their Meritain brand. Plus their ability to rent our their PPO to customized plans will continue to be a huge value proposition for Central Texas employers that need a highly customizable, but innovative balance.
JustWorks
You can’t go anywhere and not see the advertising budget JustWorks has plastered around our town over the past five years.
When it comes to PEO offered healthcare opportunities, they have shown enough relevance in pricing to keep themselves in conversation.
It’s their Aetna-based health plan options that are performing well here. From a pricing standpoint, they aren’t vastly different than the plans we get directly from Aetna. So, if their HR technology and payroll services admin fees at $100 per person don’t erode the savings, they can be a good fit for smaller companies. But, your workforce still needs to be healthy enough to get their good rates. And if your people fit their profile they also likely fit the profile to unlock deeper savings where your company can be rewarded with not only the rates today, but health plan dividends in the future.
Final Thoughts
The region remains a hub for cutting-edge solutions, offering a wide range of customizable options for employers seeking to balance cost, quality, and accessibility in healthcare. Whether through self-insured plans, incentive networks, or direct primary care models, companies have access to robust tools to manage costs and improve employee health outcomes. As the landscape shifts with changes in investment dynamics, the adaptability and resilience of vendors will determine their long-term viability.
For employers, the key lies in selecting the right partner that aligns with their specific needs, ensuring not only immediate benefits but also long-term sustainability in a rapidly changing environment. And, of course Generous Benefits is here to help navigate selecting the right products for your company.
