Optimal Savings Realized through the “Net Cost of a Claim” Approach

Through our Out-of-Network Services offering we were able to provide significantly reduced rates for thousands of medical providers.

This case study focuses on a physician-directed Health Plan with a mission of providing quality health care at low costs for its members and providing the highest level of service. The Health Plan has grown to be the leading health benefits provider in the northeast region, with a full suite of commercial, self-funded, and government program offerings. It serves 24 counties and manages over 450,000 members.

The Health Plan was vying with market pressures to restrain escalating healthcare costs. To remain competitive, they needed to increase operational efficiency, reduce costs and adopt a methodology which would generate higher levels of savings on non-par claims. The featured Health Plan sought a validated vendor partner who could execute the desired methodology and deliver both accurate pricing and incremental savings on non-par claims; critical components necessary for achieving the Health Plan’s cost management objectives.


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Healthcare Focus