Health care cost management
Health care cost management that doesn’t slow your business down
The well-being of your employees is one of your business’s most valuable assets. That’s why our plans focus on smarter investment in health, not just more investment.
We do this through fully integrated health, dental and pharmacy plans that connect the dots to reveal the bigger picture of each member’s health journey. With more insight into total health, we can focus on preventive care and early intervention to reduce costs and improve long-term health outcomes, an approach also known as Total Cost of Care (TCOC). And with more insight into how members use their benefits and where there are opportunities to influence, you can get a better sense of what’s really driving your costs, so you can make adjustments that support long-term affordability.
The result? A healthier, more engaged workforce who use their health insurance benefits as intended, while your business enjoys more cost-effective and consistent plan performance year after year.
Bringing the “Triple Aim” together: Health, Affordability and Experience
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.
A TCOC approach that controls health care costs differently
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.
Learn more about our independently proven cost management model
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.
Learn more about health care cost management
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