Tools to Save You Money
MBA has gathered an impressive set of tools to save you money:
- HealthSteps™ Wellness Plan
- Medical Management
- Prescription Benefit Management
- Provider Network Layering
- Underwriting advantages
MBA has found that no one tool or idea can bring you optimum savings or mitigate rising health care costs on its own. By utilizing all of these tools, MBA has been successful in curbing the increases experienced by other group health plans. Let us show you how these tools can help stabilize your healthcare costs.
Step :1 Customize a Plan
Step 2: Health Risk Assessment Tools
Sept 3: Risk Management Planning
Step 4: Value Based Insurance Planning (VBID)
Step 5: Incentives
Step 6: Wellness Coaching
Step 7: Participant Compliance & Accountability
Step 8: Outcome Reporting
Avoiding hospitalizations is what strong and effective medical management is all about. Hospitalizations represent an estimated 35-40% of all claims. By reducing the number of hospitalizations your plan experiences, you reduce the overall cost to your plan.
NurseMonitor, provided by Critique, is a leading approach to effective case management and outreach health improvements. Through nurse coaching, NurseMonitor can help prevent or shorten inpatient hospital stays, prevent flare-ups of conditions that can require hospitalization, and reduce the number of expensive doctor's visits or trips to the emergency room.
Cost Comparisons
Below is a comparison of plan costs for two national and two regional medical management companies, along side Critique's.
Costs are measured by
- Average days per stay
- Days per 1,000 participants
- Admission per 1,000 participants
Because NurseMonitor allows you to reduce the number of admissions per 1,000 participants, the overall cost of hospitalizations to the plan is less than with other medical management companies.
Adding Critique's Utilization Review to PPO Savings Gives Lowest Total Cost
| Days Per Admission | 2.87 | 3.4 | 3.32 | 3.4 | 3.1 |
| Admissions per 1,000 | 35.98 | 79.4 | 62.61 | 95 | 51.8 |
| Days per 1,000 | 103.26 | 269.96 | 242.9 | 326 | 160.58 |
| Inpatient Cost per 1,000 | $463,475 | $1,211,580 | $1,090,135 | $1,463,088 | $720,683 |
Please note: Average Days per Admission, Days per 1,000 participants and; Admissions per 1,000 participants are statistics commonly published by claims payers. The number of admissions easily indicates the effectiveness of their medical management programs. Assumptions: 1) 1,000 participants, 2) $4,488 per day of hospitalization average.
Prescription Benefit Management
MBA routinely compares financial outcomes of different Prescription Benefit Mangers (PBM), and has chosen the lowest total cost solution as our preferred PBM based on
- lowest total cost,
- effective drug therapy management programs,
- breadth of network,
- quality of service, and
- user-friendly member programs.
Provider Network Layering
MBA takes the multi-level approach to PPO coverage: we utilize a primary PPO, one or more secondary PPO options, and claims discount negotiators.
Secondary PPO contracts are set up based on a percentage of savings, and paid only when discounts are given.
To ensure that you receive the highest available discount, MBA's claims payment system has an auto-routing function that allows the established PPO layering structure to be set up with the primary PPO and secondary PPO networks. When discounts are not available under the specified PPO listing, MBA sends the claim to discount negotiating specialists to obtain a discount for you. This automated function keeps the claims re-pricing flowing smoothly.
