Victor Lustig
The American health care delivery system is about as jacked up as jacked up can get. Employers scramble to mitigate rising health care costs by hiring outside cost containment firms employing any number of strategies. This additional plan expense can effectively double or triple fixed costs leaving fewer budgeable dollars to pay claims.
Reference based pricing schemes can easily double or triple fixed costs, To prove out a return on investment (ROI) purveyors of RBP support services divert a portion of the provider reimbursement to their own benefit. The less a provider is paid the more in RBP fees can be charged while maintaining an acceptable ROI at the same time.
A percentage of savings fees is more of the norm than the exception. A percentage of savings off an inflated arbitrary number that no one ever pays is safer and more profitable than robbing a bank.
Adding cash pay strategies on top of reference-based pricing can generate fees that would make Victor Lustic blush with envy. One vendor charges a pepm fee plus a per managed claim fee on every cash paid claim transaction. This can produce a pepm fee far greater than a typical TPA medical management fee effectively turbocharging TPA administration fees to double or triple of what they otherwise should be.
The rise of these cost containment vendors has been meteoric over the past decade and their fall will be just as impressive as plan sponsors come to realize value can be better applied.
A new emerging vendor charges a competitive global all-inclusive fee that is half the cost of slapped together jury-rigged processes promoted by the usual suspects known to operate in this space.
The good news is we are seeing newfound competition in the market. That’s a hopeful sign of more innovation to come. We are seeing the rise of market alternatives, a new wave of innovation led by a younger generation with far greater insight than industry insiders mired in Yesterdayville.
Business is about solving other people’s problems. Solving the high cost of healthcare giving employers a competitive advantage is ours.
Status quo convergent thinking solves problems through a very narrow lens. Divergent thinking empowers us to solve problems with a wide lens allowing us to see what others don’t. You can’t fix what you don’t see. You don’t know what you don’t know. We see opportunities others miss. We do what others don’t. Winning together is our goal.
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.
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