The Challenge
Commercial – Analytics-based
³ÉÈËÊÓƵ analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by:
- Significantly improving savings for the employer and its members
- Engaging important providers in the new process
- Preserving the community’s provider-patient relationships
The Solution
³ÉÈËÊÓƵ strategically combined network access with reference-based pricing:
- PHCS Network access to preserve existing member relationships with their healthcare professionals
- Data iSight pricing to deliver fair, consistent and transparent pricing of hospital and other facility claims
The Results
³ÉÈËÊÓƵ’s revised solution delivers greater savings on more claims:
- 10-point improvement in savings
- 8-point increase in charges reduced
- Guaranteed member protections on 62% of claims reduced, compared to 0% with Medicare-based pricing