Introduction
Rising healthcare costs are forcing employers to rethink how they design and manage benefits. Many are turning to self-funded health plans as a way to take control of spending. One company leading this conversation is Self Fund Health, led by CEO Jonathan Baran. His model challenges conventional assumptions about provider loyalty, insurance structure, and employee behavior. Moreover, his results suggest that meaningful savings are achievable — even if it means sending workers on a plane to another state.
Flying Patients Across States to Save Money
Consider a Wisconsin employee who needs open heart surgery. In-state, the procedure costs at least $200,000. However, Baltimore-based Johns Hopkins Health System can perform the same surgery for just $80,000. So Self Fund Health put the patient on a plane — and the employer saved $120,000 in a single claim.
Baran draws a straightforward comparison to consumer behavior. Employees routinely drive hours to save a thousand dollars on a pickup truck. Therefore, they will do the same for healthcare — provided the process is simple and the incentives are clear.
“Every single one of your employees will travel three states away to save a grand on a pickup truck,” Baran told Becker’s. “They do the exact same thing for healthcare when you make it really simple for them.”
This logic forms the core of the Self Fund Health model. Consequently, the approach is gaining attention as employer frustration with healthcare costs continues to grow.
How Self Fund Health Works
Self Fund Health currently covers nearly 10,000 total lives. Furthermore, it primarily serves companies with 50 to 500 employees — a segment often overlooked by larger self-insured platforms.
Members who choose providers with fair pricing receive services at no cost. On the other hand, those who go outside the approved network face a deductible. In Wisconsin, the company defines “fair” as 200% of Medicare rates or less. This transparent pricing structure gives both employers and employees a clear framework for decision-making.
As a result, employers gain predictability over their claims spending. Meanwhile, employees gain real financial incentives to shop for care.
Primary Care as the Cost-Control Gateway
Why Primary Care Is the Starting Point
Primary care is the foundation of the Self Fund Health model. Baran argues that wherever employees go for routine care is where they eventually go for expensive procedures. In other words, primary care acts as a funnel into downstream high-cost services.
“Where you go for primary care is where you go for expensive care,” Baran explained. “This is what primary care serves as: It’s the funnel to get you further downstream.”
Independent Doctors vs. Health Systems
Notably, Baran highlights that independent primary care physicians — not large health systems — tend to offer the most transparent and competitive pricing. Health systems, by contrast, often direct patients toward in-network facilities, regardless of cost-effectiveness.
Breaking the Epic Lock-In Problem
Baran raises a pointed concern about electronic health record giant Epic. He describes the platform as “the digital four walls” that trap patients within a single health system’s ecosystem. Even when better or cheaper care exists elsewhere, patients stay because their records, referrals, and providers all sit inside that walled environment.
“You’ve got to break this chain,” he said.
This lock-in effect works against the price-shopping behavior that self-funded plans depend on. Thus, Baran sees it as one of the structural barriers employers must actively work around when designing cost-effective benefits.
Self-Funding vs. ICHRAs: Two Opposite Approaches
The Case for Self-Funding
Some employers have moved toward Individual Coverage Health Reimbursement Arrangements, or ICHRAs, which give workers a fixed allowance to buy their own coverage. Baran, however, sees this as the opposite of engagement.
He describes the self-funded approach as leaning all the way in — treating healthcare purchasing like any other business expense. That means examining cost, evaluating quality, incentivizing behavior, and actively managing outcomes.
“Option one is … you lean all the way in, and you learn to buy healthcare like you buy anything else,” he said.
Why ICHRAs Hand Off Responsibility
ICHRAs, Baran contends, do the reverse. They effectively remove the employer from the equation entirely.
“ICHRAs are the entire other end of the spectrum, which is the employer saying, ‘Peace, I’m out of this game. It’s up to you now,'” he said.
For employers who want lasting cost control, self-funding demands active involvement. ICHRAs, by contrast, substitute flexibility for accountability.
Why HSAs Fail to Bend the Cost Curve
Health savings accounts are widely promoted as a cost-management tool. Nevertheless, Baran challenges their real-world impact on healthcare spending.
His critique is direct: HSAs primarily benefit executives with high enough incomes to max out contributions. Rank-and-file employees, meanwhile, often cannot afford to fund these accounts meaningfully.
“What have HSAs done to help us change the cost of healthcare? Let’s be real: HSAs are tax-deferment vehicles for the executives, not for the rank-and-file employees,” Baran said. “HSAs have done nothing to bend the cost curve.”
Kevin Knight, Chief Marketing Officer of Sidecar Health, echoes this skepticism. He has questioned HSA effectiveness separately, specifically citing poor price transparency as a barrier to informed decision-making.
The Cultural Shift Employers Must Make
Changing Behavior, Not Just Structure
Going self-insured is not enough on its own. Baran insists that employers must also change how employees think about healthcare purchasing. Without a cultural shift, simply switching financing structures will not produce savings.
He uses a vivid analogy to make this point. Complaining about Whole Foods prices and then switching from cash to credit card does not reduce the grocery bill. Either buy less, or shop somewhere cheaper.
“The only way you’re going to spend less on your groceries is if you buy less groceries, or you go somewhere else where the cost of the groceries is cheaper,” Baran said.
Active Management Is Non-Negotiable
Self-funded plans require ongoing oversight. Employers must track claims, identify high-cost patterns, and continuously incentivize better purchasing decisions. Moreover, they must be willing to guide employees toward providers — even out-of-state ones — who offer superior value.
Key Takeaways
Self-funded health plans offer employers a powerful alternative to traditional insurance — but only when paired with active management, transparent pricing, and a genuine cultural commitment to cost-conscious care. The Self Fund Health model proves that employees will travel for savings, that primary care shapes all downstream costs, and that neither HSAs nor ICHRAs replace the discipline of true self-funding.
