Self Insured Employers

Self-insured employers find it easy to use Physmark’s PayerSoft to self-administer their employees’ healthcare delivery at drastically lower costs even while providing better care and access to members. Hospitals are usually self-insured and are in an excellent position to take advantage of PayerSoft’s administration features to service their employees healthcare delivery. Normal TPA charges that cost $9 per member per month can be reduced by several dollars.

State Employee Organizations

State Employees are usually offered fully funded or self-insured products to support their healthcare benefits. While most state employee benefit departments are loathe to accept claim processing responsibilities, many are keen to control enrollment, so as to maintain a clean record of eligibility and benefits of their employees. Web enrollment can reduce their operational costs and help maintain an accurate and current record of their employee’s eligibility and benefit status. Incorrect eligibility rolls can cost states millions of dollars in unnecessary payments of benefits.

Even when TPAs manage the disbursement of payments to providers, states realize that monitoring such payments using Physmark’s PayerSoft-BAS, even retrospectively, can be a powerful over-sight tool, to eliminate errors of over-payment.

But the real payoff will emerge only when medical and pharmacy costs are integrated in a data repository such as Physmark’s MediMart, to help analyze the total cost of care and implement solutions so as to avoid waste and instill responsibility amongst enrollees.

Data Mining Can Identify the “Low Hanging Fruits”

Our analysis of healthcare data of a school district helped unearth a counter-intuitive fact. Their PPO program was costing them several millions of dollars less than their managed care program that included a capitated physician. It turned out that there were no incentives for the capitated physician to withhold referrals on the managed care side, and so every minor problem was being referred to a specialist, costing the system a lot more money overall. On the PPO side meanwhile, a primary care doctor was being paid for every visit and so made the effort to treat a patient to the maximum before relinquishing them to a specialist.

Just by abandoning the managed care program the school district saved several millions of dollars. That is indeed a low hanging fruit.