There are 7 item(s) tagged with the keyword "Utilization".
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- Session 8: A Look at PwC Health Research Institute's 2020 Medical Cost Trend Report
The Advanced Plan for Health team regularly scans the health market for trends, analysis and insight. In our research, we found The PwC HRI Medical Cost Trend: Behind the Numbers 2020 report to be full of valuable healthcare market information and thought our readers would benefit from the report findings. We decided to condense and present the PwC HRI report in a bi-weekly blog series to highlight what we found to be most pertinent to our readers and to better understand factors that could potentially affect the 2020 medical cost trend. Session #8 Employers will help their employees maximize their benefit packages.
- Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization
With higher and higher ER bills coming in to the plan and members, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to their employees and members about which conditions can be handled by more convenient and lower cost sites of care such as a nurse advice line, telehealth (which often also covers behavioral health), on-site or retail clinic or urgent care. They’re also sharing details on how to reach these resources, and how much lower out-of-pocket costs will be to members who utilize them versus the ER. Keeping this information top of mind when it’s needed is the key to effective communications in this area.
- Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)
Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health
Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).
In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.
- Data: Your Secret Weapon
So, where are your hidden health-related cost centers? The same places they’ve always been: In plain sight. But for the lack of data transparency and integration of data tools and services, they remain elusive to spot. To uncover these cost centers, consider partnering with an analytics firm that not only can access data sets from everywhere patients access healthcare, but also combine them to create nuanced action lists.
- 6 Costly Healthcare Myths
The healthcare system can be a confusing place for someone who is well, let alone someone who is sick and in need of help. Oftentimes, health plan members do not know their benefits and can seek care in the wrong place; like the ER when the problem is not urgent, or outside their network, which means they may incur an expensive and unexpected bill. This confusion can cause delays in treatment and less than desirable outcomes; as well as an increase of cost to everyone involved--from the patient to the health plan itself.
- By Barbara Rutkowski - Vice President, Clinical Operations
- Weighing Wellness with Poindexter
In the advent of Big Data and Predictive Analytics, a time when it is becoming more expensive to remain neutral in regards to company health improvement, 60% of corporations are attempting to implement effective, cost reductive wellness programs. Does this mean all 60% percent of these companies are experiencing improved ROI and a lower bottom line? Perhaps the easiest way to answer that question is to ask another; does everyone fulfill their New Years’ resolution?
- Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations
Dr. Rutkowski is a Medical Management Professional with more than twenty years of experience in operations, integrated medical management for Medicare and self-insured employers, hospital and managed care quality, and employee development.
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