relevant short deck
TRANSCRIPT
Powerful Solutions for Today’s Healthcare Marketplace
Who is Relevant Healthcare Cost Containment?
Relevant Healthcare Cost Containment (“Relevant Healthcare”) is the trade name of a privately held company known as Contain Holdings, LLC: a certified Minority Business Enterprise and Union Member organization
located in Chicago, IL. Relevant Healthcare focuses on high cost areas of Employee Healthcare benefits with a focus on various challenging and costly
disease states such as Dialysis, Oncology and Diabetes.
Who is Relevant Healthcare Cost Containment?
Our services benefit
Health Insurance Companies
Self-funded employers/Unions seeking to control healthcare costs
On-site medical clinics as value-add for their clients
TPAs needing to curb payments on high-dollar procedures
Workers' Compensation insurance carriers/TPAs looking to lower costs
Self-Pay (uninsured/High Deductible) patients seeking value
Brokers/Consultants looking to go the extra mile to save clients’ dollars
Relevant offers significant cost savings solutions
Consultative and unbundled structure
All products except our Pharmacy Price Transparency Tool and Medical Bill/Review & Audit are available to any payer for no cost
All other revenues are earned based upon the savings captured
Very little cost or risk associated with our programs
We can also perform complimentary cost savings analysis for any of our products.
Product Offerings
• National Advanced Radiology Network (MRI, CT, PET Scan)
• Dialysis and Oncology Cost Containment Solutions
• National High Performance Surgery Network
• Medical Bill Review & Audit, Negotiations, or UCR for High Dollar Claims
• National Laboratory Network
• Claims Editing: Fraud/Waste/Abuse Detection
• Pharmacy Price Transparency Tool
• Genesis Blood Glucose Monitor – real time electronic monitoring of daily diabetic test results
• Reference Based Pricing on Out of Network Claims
• Claims Overpayment Recovery
Product and Service Offering – Group Health
Radiology Benefit Management (MRI, CT, CTA, MRA, PET Scans)
On average, 10% of population has imaging test per year
National network of imaging centers- 36 in MN
All facilities NCQA certified and ACR accredited
No fees, no risk and immediate ROI
“Concierge Service” for members and treating physicians
Average savings ~30-50% below PPO rates
Product and Service Offering – Group Health (cont.)
Blood Glucose Monitor for DiabetesAccurately tests blood glucose levels
Uploads results to secure, online account
Easy access for patient, provider, case manager and/or family member
Allows easy clinical management – Helps keep patients out of E.R.
Monitors test strip usage and auto-reorders when needed
No cost outside of test strips
Devices are free – new device sent to patients annually
Case management is free
Access to reporting package is free
Product and Service Offering – Group Health (cont.)
Pharmacy Transparency ToolWeb-based tool
Educates, motivates and empowers employees to save out-of-pocket expenses on Rx
Proactively researches and delivers savings opportunities to members via:
Text message
For every $1 saved by the member, employer can save up to $6
Average savings ~22%/member; 44%/employer
Priced at PEPM
Product and Service Offering – Group Health (cont.)
Claims Settlement or Negotiation Services
UCR re-pricing/clinical review or direct provider negotiations
Focus on very high dollar claims:
Dialysis
Oncology
In-patient hospital claims
Savings ranges from 30% to as high as 90%.
Priced at % of savings.
Product and Service Offering – Group Health (cont.)
Surgery Benefit ManagementNetwork built with highest quality hospitals and ASCs (Top 25%)
Participating providers are assessed based on
Complications, infections, patient satisfaction surveys, re-admit rates, etc…
Fixed case rates cover entire episode of care (excluding outliers)
Member education and shared decision making
30-40% of surgeries could be avoided with less invasive, expensive treatments
Dedicated care coordinators work with members to help make informed decisions
Average savings ~ 50%
RHCC fees: Included in case rate
Product and Service Offering – Group Health (cont.)
National Lab Network
National lab network
Claims sent to RHCC for repricing
Place Lab Company logo on ID card
Average savings ~85% off billed charges
Priced at % of savings
Product and Service Offering – Group Health (cont.)
Clinical Editing-Fraud/Waste/Abuse Detection
Cloud-based system focuses on accurate billing and coding
Contains millions of edit combinations
Clinical edits are done in real time
Implementation is free and is as easy as downloading an “App”
Links to any claim system/data formats
Average “hit rate”: 10-20% of bills
Average savings on “hits”: 25-30% (~$300/bill)
Priced at % of savings
Product and Service Offering – Group Health (cont.)
Out-of-Network Reference Based Repricing (Medicare %+)Reprice OON claims to a multiple of Medicare rates
Drives greater savings than wrap networks
Services are available at lower fees than traditional wraps or negotiations
Providers understand Medicare vs UCR
Customized by
Group, geography, claim type, service provider, plan, etc…
Eventually will drive members back to the network
Average savings ~ 50% at 200% of Medicare
Priced at % of savings
Product and Service Offering – Group Health (cont.)
Claims Overpayment RecoveryAverage annual overpayment of any health plan is ~7% of total spend
Program involves analytics, reporting and identification of the overpayments, AND the recovery of those funds on behalf of the client
Conservative estimates on total recovery are 3-4% of total annual spend
Depending on the financial situation of the client, we offer 2 options:
Contingency
Prompt Pay Bidding
Product and Service Offering – Workers’ Compensation
Radiology Network
Surgery Network
DRG and general Bill Audit Services
Age of Injury Report (additional)
Assists adjuster to mitigate or deny questionable WC claim
Independent review of original diagnostic images and report by licensed radiologist
Helps determine if injury is chronic or related to work accident
Flat fee of $275