From our VP of Corporate Development, Gordon Larson.
Bundled pricing is a hot topic in healthcare. Not surprising, with “fee for service” pricing being blamed as one of the key contributors to both overutilization and the wide price variation in healthcare costs.
It is also becoming clear that self-insured employers (especially the Fortune 500) believe that one of the best ways to control the wide variation in healthcare costs, is to implement programs that provide incentives to use providers that are willing to offer predictable bundled case rates.
This does make sense from the employer’s perspective:
THEY KNOW THAT THEY ROUTINELY INCUR CLAIMS FOR KNEE REPLACEMENTS THAT RANGE FROM A LOW OF $28,000 TO OVER $60,000 (WITHOUT COMPLICATIONS!) THEY ALSO SEE A SIMILAR WIDE VARIATION IN OTHER ORTHOPEDIC, SPINE, CARDIOVASCULAR AND GENERAL SURGERIES.
THEY ALSO KNOW THAT THE WIDE VARIATION IN COST IS NOT JUST WITH SURGERIES, BUT ALSO IN THE COST OF ROUTINE LABS, ADVANCED IMAGING, PHYSICAL THERAPY AND OTHER LESS INVASIVE PROCEDURES.
But while bundled pricing makes sense for the employer, from the perspective of a TPA administering bundled case rates can be problematic.
Claims systems are designed to process “fee for service” claims, with PPO discounts applied to billed charges, then allocated to the employer and employee per the plan’s deductible, copay, and coinsurance terms.
With “fee for service” claims arriving separately from the hospital, surgeon, and other professionals, it is difficult to control the cost and timing of payments.
The Super Option is the solution. At Access HealthNet we have developed proprietary technology that allows a TPA to administer the entire bundled case rate program. Our technology manages everything from an employee scheduling services with providers offering transparent bundled case rates, to billing, electronic claims processing, and dashboard reporting at all levels. Access HealthNet’s cloud-based technology also integrates with a TPA’s current operating systems for reporting and control.
Self-insured employers are seeking access to predictable bundled case rates. TPA’s can now offer access and administration on over 1,100 standardized bundles for diagnostic, therapeutic, and surgical procedures.
With Access HealthNet and the Super Option it is now possible. Let’s get started.