AnchorGroup places a great deal of value on utilization management because our clients have seen a significant return on investment in this area.
We work closely with clients to help them ensure they benefit from the best utilization/care management available. This leads to better outcomes for the members as well as a lower cost for the employer.
Plans are typically customized to the uniqueness of every client’s needs. They can be as aggressive or passive as the client desires, and we will assist with the design based on the client’s objectives and needs.
Examples of Successful Utilization Management claims cost reductions:
A self-funded trust went from a 3.5 million deficit to a 4.5 million surplus in year one utilizing one of our Utilization Management services (the only change made)! In year 2, the Plan made substantial enhancements to benefits offered to their members and still experienced an additional decrease in claim charges of a million dollars.
Claims costs were reduced by over 24%, and beat anticipated trend by over 34%. The client saved over 2.4 million dollars in year 1, and the only change they made was to add AnchorGroup as their consultants.
AnchorGroup prevented a six-figure surgery from taking place on a patient that should not have been approved for surgery by their Third-Party Administrator. The patient’s condition was not FDA approved for the surgery, and the claim would have been denied by the stop loss insurance carrier because they do not have to pay a stop loss claim if the procedure is not FDA approved. This would have placed the client in a terrible position as either the insured would have had to pay the claim, or the client would have to pay.