Additional Health Management Programs
While Solutions! will generate significant savings for the plan, enhance benefits for the people, and assist the employer in meeting their fiduciary goals, there are additional specialty products and health management programs that serve these goals as well. Listed below are opportunities that are effective in managing costs and meeting fiduciary obligations:
1. The concept of Solutions! is to move care from the fee-for-service open-ended system to more predictable pricing. One method is the utilization of bundled rates for complicated surgeries performed in Centers of Excellence. This model actually transfers some of the risk of unforeseen complications costs to the providers.
2. In some situations, the utilization of on-site clinics may be inappropriate for a given employer. To replace the clinic model of primary care there are other Direct Primary Care resources that can be utilized.
3. A fiduciary duty tracking system makes it easy to stay in compliance.
4. A management program that provides oversight of the activities and successes of people taking GLP-1 drugs for weight loss protects the employer plan from excessive utilization and exposure to cost.
5. Prescription drug programs inadvertently pay claims for drugs issued that are not FDA-approved and are hence not covered by the plan. A simple audit will locate these events and, based on the employer’s direction, seek reimbursement from the PBM for the amounts paid.
6. Data warehousing and analytics capability to maximize risk identification both with covered people and provider utilization and cost.
7. When patients really understand their medical conditions using Information Therapy, the impact on quality and cost is significant.
If you want more detailed information on any or all of these programs, please refer to the program when filling out our contact form.