In this podcast, APH's Joy-McGee Cory discusses how employers can analyze employee benefits data to identify hidden medical expenses to save costs.
Health plans, employers and members are experiencing unexpected and very unpleasant surprises following certain complex surgical procedures, usually spine-related. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM)—and can sometimes reach into six figures!
During IONM, a technician or physician observes neural structures, such as nerves, the spinal cord and parts of the brain, to identify issues that could damage the nervous system. By noting any potential for damage in real time, corrective action can be taken during surgery.
When an employee of Hill Country Memorial Hospital developed chronic kidney disease, the not-for-profit hospital in Fredericksburg, Texas faced a whopping bill. Not only was an employee facing a lifetime of dialysis treatments three times a week, missed work hours and increased medical care, the 80-bed hospital had maxed out its $1 million premium for its employee health plan.
“It cost us quite a bit,” recalls Becky Laughlin, the current benefits manager, who was the benefits coordinator at Hill Country Memorial Hospital when the incident occurred.
After the episode, the HR and benefits team looked for a solution. They found one in data management provider Advanced Plan for Health, which oversees its employee medical care expenses generated by its third-party employee benefit administrator Web TPA. Using its Poindexter program, APH oversees the hospital’s employee medical expenses, looks for patterns of cost overruns, pharmaceutical pricing and possible drug seeking behavior, overuse of emergency room and urgent care facilities. It generates reports that are sent to employers on a weekly, monthly or quarterly basis.