Many health plans tell us they’re struggling to find new opportunities to contain administrative costs. They feel they’ve tried everything. If you’re tapped out on ideas for finding savings options but continue to feel pressure to contain costs, you’re not alone. Let’s consider a largely unexplored area for potential cost savings. You won’t need to purchase new systems. You won’t need to engage additional resources—and savings can be identified using claims data you already have.
Specialty vendor purchases are critical to the care and quality you provide to members. We understand the struggles plans face with managing multiple vendors and contracts. Burdens brought on by a lack of resources, expertise, understanding of risks and the inability to negotiate the best deals when contracting. For small- and mid-sized health plans in particular this is a recurring pain point.
An untapped potential
Plans could realize savings through optimal specialty services management, administered by experts who are dedicated to analyzing specialty vendor cost containment opportunities and recommending changes that get you closer to your goals.
Durable Medical Equipment (DME) is one example. Our research shows DME is an exploding expense. In a recentDME success story, our vendor partner discovered a 25% savings potential for a Medicaid plan by replacing their DME vendor with a preferred partner. With 290K covered lives, the plan had savings potential of $1.27 PMPM or $4.4M annually. Over five years, the plan could potentially realize a $27M savings opportunity.
How could this work for you?
The potential to improve your medical loss ratio lies in:
Expert utilization management
Proper use of nationwide provider networks
Good claims management
We understand this kind of oversight requires time and expertise - not always available through your in-house resources.
Our specialty services management solution combines potential cost containment with specialty vendor management in areas that are typically the greatest expense. We’ll conduct a no-cost claims analysis, consult with you on our findings, and make recommendations to target potential savings areas such as: DME, Specialty Pharmacy and Premium Enhancement.
We’ll collaborate with you and our vendor partners to identify, develop and implement a plan customized for your needs. After implementation, we’ll closely monitor your satisfaction with the performance of our partners in helping you achieve savings/revenue targets. There’s no software to replace and no extra resource assignment.
If you’ve tapped out the majority of your administrative savings potential, it’s time to examine cost-containment opportunities with your medical expenses.Contact us todayto get started with your free claims analysis.