High-Cost Medical Claims Solutions for Employers
High-Cost Medical Claims Solutions for Employers
Signed in as:
filler@godaddy.com
Solutions for the Self-Insured Employer
Solutions for the Self-Insured Employer
3% of an employer plan's members drive in excess of 56% of the cost of the plan.
For a plan of 10,000 members costing the employer sponsor $50 million: 300 people account for $28 million. Understanding who is high cost this year, and who will be high cost next year will help shape critical medical cost strategies.
Our team comprises of highly skilled consultants with extensive experience in various industries. We are committed to delivering quality services to our clients and helping them achieve their business goals.
Effective high medical cost solutions for an employer plan requires connection and cooperation between stakeholders. Condition-specific solutions are often required for back surgeries, cancers, neonatal care, extended substance abuse treatment, auto-immune disorders, and complications of hospitalization.
Let's talk about your high cost medical and Rx claim strategies.
Your data can help identify conditions that would benefit from disease-specific carve-out point solutions that can enhance what your members get from their health plan. Members with diabetes need specific solutions for diabetics. Members with cancer need cancer-specific strategies. Likewise for orthopedic surgeries, behavioral health conditions, cardiac care, asthma support and reproductive health.
Utilization data can help understand how members are (or are not) accessing health care services. A plethora of new and enhanced alternatives can supplement where and how members seek routine care and preventive screening. Underutilization and avoidance of health care put your members and your health plan costs at tremendous risk down the road.
High-cost claims analytics can help employers determine what care management carve-outs make sense for their members. Care management carve-outs are increasingly in demand for certain chronic conditions, post-op care; high-risk pregnancies; pre-term infant home care; cancer hospice, rare diseases and many other clinical scenarios. When your data shows inadequate care metrics through low utilization, gaps in care, or migration to higher-risk categories, condition management solutions are worth considering.
Second medical opinions, virtual centers of medicine and specialty telemedicine are revolutionizing how employer health plan members can access top medical expertise. It has never been easier to go beyond your health plan's network and provide plan members with access to top oncologists, neurosurgeons, rheumatologists, and internal medicine sub-specialists.
Medical and Rx data analytics can provide valuable information on where, when and how your members are receiving service. Many strategy considerations will benefit from understanding claimant health care access. Considerations for plan design, coverage of retail primary care, provider network assessment and hospital-based outpatient services warrant deeper claims data analytics.
Risk stratification and risk migration claims data analytics offer valuable insights into the health profile of employees and covered members in your plan. These data can be coupled with wellness programs metrics, such as, participation rates, utilization and outcomes data to help employers determine the efficacy and progress of their wellness interventions.
RON LEOPOLD CONSULTING
Ronald S. Leopold, MD, MBA, MPH
Copyright © 2022 Ronald S. Leopold, MD, MBA, MPH - All Rights Reserved.
Powered by GoDaddy