A mid-size Texas employer went from a BUCA to a Reference Based Pricing plan last year. The benefits remained the same. However, a change was made in the way providers are paid. In lieu of paying through secretive managed care contracts, the plan paid medical providers based upon a transparent reimbursement schedule tied to a percentage of Medicare allowable charges.
Here are the results:
- Direct plan savings of $4.1 million (mature 12 months)
- 20% reduction in Rx spend
- Three direct hospital contracts with no outliers, stop loss provisions or charge based reimbursement – strictly Medicare based
- +900 direct professional agreements with local physicians and free standing surgical centers
- Balance billing <2%
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.
Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.
Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.
2019 RiskManagers.us All Rights Reserved
