Our firm places a great deal of value on utilization management because of the type of return on investment we have seen.
We work closely with clients to help them ensure they are able to benefit from the best utilization/care management available to them. This in turn leads to better outcomes for the members as well as a lower cost for the employer.
Plans are typically customized to the uniqueness of not only each individual but also every client. They can be as aggressive or passive as the client wants and we will help with the design based on the client’s needs.
Success at Utilization Management claims cost reductions:
Self-funded trust went from a 3.5 million deficit to a 4.5 million excess in year one utilizing one of our Utilization Management services (as the only change made)! Year 2 the Plan made substantial enhancements to benefits offered to their members and nonetheless received an additional Decrease in claims fees of 1 million dollars.
Claims costs reduced by over 24%, and beat anticipated trend by over 34%. Saved over 2.4 million in year 1 with the only change being adding us.
Prevented a six figure surgery from taking place on a patient that should not have been approved for a particular surgery. Their condition was not FDA approved for the surgery and the claim would have been denied by stop loss as they don’t have to pay under that scenario. This would have placed the client in a terrible position as either the insured would have had to pay or the client would have to pay. Neither scenario would be recommended.