HR leaders will face big challenges in the year ahead — including, another year of rising health plan costs and worsening population health. To understand how HR plans to move forward and what support they’re receiving from insurers and plan administrators, Maestro...
People-Focused Healthcare: How We’re Cutting Costs, Not Benefits
By Steve Kaltrider, Senior Director of Product
One of the most common issues we hear about healthcare today is the cost. Unexpected bills, surprise charges, rising premiums, lack of insight into what something costs and why, not knowing how to find a fair price for good care. The list goes on.
What’s worse is how few options employers and members have to control those costs. Much of the data that could provide insights and answers is inaccessible through fully insured plans or costs extra. These barriers often leave many employers with no other option than to pass along premium increases to their members or cut benefits in an effort to preserve the bottom line.
We believe that healthcare costs shouldn’t be a mystery and that employers shouldn’t have to resort to slashing benefits to save on costs.
Our approach to self-funded benefits is built around people and our cost management strategies are designed to have long-term positive impact on both the member and the employer’s bottom line.
Here’s how we’re making benefits more cost-effective for our clients.
Better access to the right care, including virtual options.
Alongside confusing costs, knowing where to find the right care can be confusing for many members (and those “wrong” choices usually result in extra costs for employers). A study found that over 70% of ER visits are unnecessary and those bills can really stack up—on average, ER visits are 12 times more expensive than a visit to a primary doctor.
We work with our clients to help them build better access options into their plans, like:
- Bundled surgeries and procedures
- Virtual second opinions
We also help our clients make sure their members have the resources they need to know where to seek the right care, like using Healthcare Bluebook. Access to good care is more than just setting up the partnerships and relationships. Members need the resources and support to know where to seek the best care at the right time.
Network options designed around the local needs of employers and their members.
Part of knowing where to get the right care is having access to it in the first place. We help our clients figure out the best network access strategy for their needs, and sometimes it’s not as broad as using a national network (though we’re integrated with several).
Where national networks have a broader reach, we’re also able to help our clients design their plans with more flexible or tailored options, like:
- Direct contracting with local providers and facilities
- Narrow networks designed around quality care
- Third party arrangements focused on services like labs, imaging, and prescription drugs
Repricing services that use industry and market baselines (and no, RBP isn’t your only option).
Above all else, everyone deserves a fair price for good care. Yet today’s healthcare has made it pretty tough to determine just what a fair price should look like.
We’ve designed our repricing services to give our clients more options, flexibility and insight around fair costs for quality care, like:
- Direct contract processing
- Out-of-network repricing using our in-house tools, preferred partners and market insights
- Alternative reimbursement strategies using industry baselines, like Medicare and Cost Plus
It’s important to us that our clients experience better benefits at a fair cost. When we work with our clients, we’re really partnering with them to address pain points and tailor their plan designs to meet the needs of their people and the bottom line.
Get in touch with us to learn more about how our approach to self-funded benefits is helping our clients save an average of 70% on out-of-network claims each year.