Focus: Reduce Medical and RX Claim Costs
We have created a menu of A la Carte products and services designed to have an immediate impact on current claim costs. Critically, all products are transparent and measurable, making it easy for employers and their benefits advisors to evaluate program efficacy. All products are fully integrated with our TPA, PBM, and Stop Loss carriers creating a seamless experience for employers and employees.
Cost Containment-Routine Claims
These products are designed to help employers reduce routine claim costs such as certain brand name and specialty drugs and elective procedures. In most cases they are voluntary, and the employee’s out of pocket expenses and co-pays are waived creating a win/win scenario.
- Transparent PBM-Show all pricing-100% pass through on rebates and no spread pricing-Single point of contact for all pharmacy related products
- Co-pay Assistance-Voluntary-Manufacturer’s co-pay assistance is maximized-Up to 30% savings for employer-Reduced or no co-pay for employee
- International RX- Voluntary-20%-60% savings to employer. Employee copay waived
- TeleSaver RX-Voluntary-20% savings for employer-Co-pay waived for employee
- Single Case Direct Contracting-Voluntary-Direct cash payments to provider-20%-60% savings for employer-Employee OOP Waived-Always a willing buyer and seller
- Reference Based Pricing-Providers are paid a % of Medicare
Cost Containment-Large Claim Mitigation
These products are designed to make self-funding “safer” by eliminating large claims and potential lasers
- Manufacturers Assistance Program (MAP)- Many high-cost brand name drugs are provided by the manufacturer at no cost to the employer, and employee co-pays are waived.
- Emerging large claim “purchase” program-Voluntary-Large emerging claims are “purchased” by philanthropic organizations eliminating them from consideration by the TPA and stop loss carrier. Employee out of pocket expenses are waived if employees choose to participate
Traditional Cost Containment
We work with stop loss carriers to minimize the chance a claim exceeds the stop loss deductible, and then mitigate the cost of the claim if it does exceed the deductible.
- Large Case Management
- Air Ambulance
- Centers of Excellence
A sophisticated data mining program that is used in lieu of medical underwriting. A detailed census is the only information required for underwriters to qualify employers, and provide stop loss quotes. It is a more employee and employer friendly "front door” for Discover, our product for 25-99 employees.
Health Risk Management
Our Risk Management program is designed to identify, manage, and measure specific health risks that can drive claims costs. The specific risks we consider are:
- Chronic Conditions
- Preventative Protocols
- Medication Adherence
Medical and RX claims are the primary sources of data we use to provide this service, however other data elements such as bio-metric screenings and Health Risk Assessments are also used to obtain a complete picture of an individual's risk profile. Like any risk management product, efficacy is determined by improving the underlying metrics which define each risk. Data Analytics, Transparent Communications, Incentive Management, and Health Claims Advisors, support employee engagement. There is no need for fuzzy ROI calculations as employers are provided access to a data analytics tool which identifies risk and measures the results. They can see for themselves how the program is working!