Controlling claim costs begins with selecting the right Third-Party Administrator, Pharmacy Benefit Manager and Stop-Loss policy provisions. Then plan design, network access and eligibility requirements should be carefully considered along with proper fiduciary/legal document review.
Cost-Containment
After a good foundation is laid, we focus on cost-drivers:
- Care coordination
- Wellness programs
- Direct primary care
- Reference based pricing
- Renal repricing
- Imaging networks
- Telemedicine
- Transparency tools and reward programs
- Bundled surgical pricing
- Specialty Rx management
- Biometric screenings / gaps in care analytics
