Health care cost management
Group plan solutions that rethink health care cost management
Employee health and well-being always come first. But when health care costs go up, that can put a strain on your bottom line, making it hard to see where you can find value.
There’s a better way. Our emphasis on total cost of care (TCOC) through health and dental plans focuses on the bigger picture of health. Our goal is to help your workforce be more productive and healthier, lower the burden of illness, and reduce value-sapping medical costs for employees and employers alike.
With our extensive background and expertise in both health care and health insurance, we emphasize health maintenance to keep employees motivated and accountable – targeting and encouraging the right care at the right moment. Our plans support the unique needs of your employees and business with personalized solutions, member engagement and more, expanding the definition of what sensible population management looks like.
We’re a nonprofit health organization with mission-driven insurance plans that combine our expertise in award-winning care, personalized plans and innovative research. It’s how we collaborate and connect to improve quality and lower costs without compromising care.
Managing total cost of care isn’t new, but our approach to TCOC is different. We look beyond what health care claims cost and how to make them less expensive. Instead, we also look at the resources being used to see if they can be used more wisely.
What we’ve learned from our TCOC approach is simple but important: It’s easier (and more cost effective) to prevent medical issues before they need more serious attention. We’re resetting the conversation about costs by aiming to:
- Reduce the volume of care needed ¬ We identify and redirect higher-risk health populations through a combination of our proprietary tools and engaging outreach. We aim to help prevent medical issues from becoming more serious, which in turn helps keep members healthy, productive and happy (and helps keep employer budgets on track).
- Reduce intensity of care – Another part of our population management strategy is to steward employees’ health so they’re less likely to need more expensive care. But when that kind of care is needed (like at the hospital), we also make sure employees have the support they need through personalized disease and case management so they can get healthier sooner. It’s an approach that focuses on the patient while also endeavoring to reduce costs across the board.
How do we accomplish this? Through proactive health monitoring, outreach and engagement with both our providers and members. We don’t just focus on negotiating the cheapest reimbursement rates; instead, we focus on the whole person to create real value, for everyone, at every point.
Our goal is to make health care more affordable for everyone without sacrificing quality or experience. Our full-population, person-centered TCOC model accounts for:
- Member liability and plan payments
- 100% of care provided to a member
- All care, service sites, treatment costs and provider types
- All illness burden-adjusted costs, including primary care, specialty care, pharmacy medication, hospital care and more
- A provider’s price, resource use and efficiency
When all this comes together, we can focus on the overall cost of care by identifying and comparing price, resource use and utilization drivers based on population, provider, condition, patient and procedure levels. We can also build provider contracts based on value, shared savings and risk models, where care systems that deliver exceptional cost and quality are rewarded. That’s why we use TCOC measurements for:
- Patient-centered innovations
- Data analysis to support improvements
- Reporting transparency
- Network configuration
- Integrated health management using a well-being approach
- Clinical support by medical directors
- Provider consultation, contracting and collaboration
- And more
In fact, our measures of TCOC and resource use are one of only two measures of their kind to be endorsed by the National Quality Forum (NQF), and the TCOC metrics we’ve developed are used by over 300 licensees in over 40 states. Why? Because they work.
We’ve learned a lot from our TCOC-centric method. By creating trust through collaboration and communication, by identifying meaningful opportunities to engage members in their health journey, and by integrating care, claims and health management, employers and employees saved time and money while enjoying an improved experience.
Learn more about health care cost management
How to proactively manage employee population health and well-being What's total cost of care and how could it help your business? Three tips for employers on how to reduce health care costs without sacrificing quality of care How much group health insurance costs: What every employer should know Read more about total cost of care (TCOC)