All aspects of plan operation from administration to cutting edge plan designs are managed for you. Today, however, with the ever rising health care costs, this isn’t enough. Our program goes much further because we partner with our clients to be proactive in identifying potential future claims and we design plans to maximize the latest, most sophisticated claim management system available.
- Early Indicators Forecasting: Revolutionary predictive modeling technology accurately categorizes plan members into various probability groups, thus, identifying and stratifying the likelihood of required surgeries. These identified groups are then addressed with specific action steps for each probability tier; both the health plan and its members benefit tremendously from this early identification and intervention. By utilizing this technology, we are able to “proactively” work with plan members to manage when and where a surgery should be. We provide plan members with the most qualified options to provide the highest quality, savings and satisfaction.
- Surgery Benefit Program: Your members have access to the best surgeons and Centers of Excellence in the country. It is a turnkey program where all aspects of a member’s surgery, from explaining, assisting with assembling medical records, making travel arrangements (if needed), to taking care of all registration and billings issues, is handled by our patient care coordinators so the member can focus on his/her surgery and recovery. The result is ‘best in class’ availability to the member to allow predictability and control over major, non-acute surgeries and dramatic savings for the plan and the member.
- State of the Art Wellness Programs: We offer personalized, state of the art, wellness programs as part of every plan. Through health risk assessments, disease management programs, on-line wellness coaching and information and personalized one-on-one, custom designed wellness coaching, we are able to drive down the demand for services along with the cost of services to significantly reduce the cost of health care services.
- Health Advocate: As part of your health care plan, we provide your members with an advocate that is available 24/7/365 to assist them with any questions, concerns, problems, or advice they may be looking for assistance with. This includes plan design questions, second opinions, assistance with scheduling appointments with providers, advice on “best in class” providers, advice on alternatives available for any particular illness or condition, information on all available plan benefits, assistance on negotiating claim payments, providing area specific pricing for a multitude of procedures, helping members negotiate the best price for a procedure “up front” and helping members navigate through all of Medicare’s options and procedures. This service is available to all adult plan members, their parents and parents-in-law.
- At a minimum, quarterly, we will review your programs performance to verify the plan design is maximizing our claim management tools and working to reduce your plan costs. We will make specific plan recommendations based on the plan performance to further control current costs and eliminate future costs. Health care in the 21st century is not about being reactive but about pro-actively managing your plan through innovative plan design, employee education and involvement and a healthy workforce.