Control Healthcare Costs with Confidence
Empowering CFOs to Mitigate Risks in Self-Insured Healthcare Plans
As a Chief Financial Officer, you bear the critical responsibility of managing corporate expenses, particularly the financial and medical performance of your self-insured healthcare program. The unpredictability of healthcare costs can pose significant challenges, but Databridge is here to help you navigate these complexities with precision and confidence.
The Challenge of Unpredictable Healthcare Costs
Healthcare remains one of the few services where neither the consumer nor the provider knows the cost until weeks after the service is rendered. This delay is due to the intricate combination of plan benefits, provider contracts, and TPA (Third Party Administrator) agreements, making it nearly impossible to manage costs at the transaction level.
Our Solution: Actionable Cost Management Analytics
Databridge offers a robust set of tools designed to give you clear, actionable insights into your healthcare expenses. Here's how we can help:
TPA and Provider Performance Benchmarks: We use de-identified historical data to create CPT code level performance benchmarks. This allows you to compare your current program costs and utilization performance against other companies using competing TPAs.
Performance Comparisons: Our TPA-to-TPA and provider-to-provider overall performance comparisons help you identify opportunities to work with your TPA to improve cost and utilization performance. This includes refining provider network contracts to be more competitive and cost-effective.
Out of Network Referral Management: By comparing out-of-network referral costs, we help you refine your plan design to direct referrals to more cost-efficient providers.
Employee Cost and Utilization Analytics
Stop Loss Analysis: Reviewing costs absorbed by your stop loss program helps prevent premium increases.
High Cost/Risk Management: Identifying high-cost healthcare consumers above and below stop loss caps ensures they are managed appropriately by case managers.
Moderate Risk Monitoring: Auditing moderate cost/risk employees for compliance with evidence-based medicine protocols prevents them from becoming high-cost patients.
Engagement Gap and Compliance Automation
Automated Audits: Monthly audits of your eligibility, medical, and drug claims data identify cost-saving opportunities and automate outreach to close gaps.
Evidence-Based Protocol Compliance: Ensuring both providers and employees adhere to evidence-based medicine protocols.
Plan Design Improvements: Identifying areas for cost and utilization improvements through plan design changes and engagement programs to optimize current year cost performance.
Stay Ahead of Medical Cost Trends
Healthcare is ever-evolving, leading to annual cost increases. For instance, new studies on conditions like sleep apnea can drive up future costs. Databridge allows you to project future expenses based on current trends and adjust your plans accordingly, balancing clinical needs with cost constraints.