U.S. MEDICAL BENEFITS TRANSPARENCY

Item # MBTY1 -Online Healthcare Provider Cost (& Quality) Transparency System                                                                                

This Online System Provides a Comparison of Healthcare Plan Provider Costs using the Employers’ Own Claims Database and if Available, own Provider Quality Metrics. It allows Plan Members to Locate the Most Efficient Providers. Average Claims Savings equal 7% to 14% when System Utilization is incentivized  

Item # MBTY2 – Concierge-Guided Healthcare Provider Cost and Quality Portal to Increase Plan Member Engagement Levels by Providing Specific- to-the-Member and Cost Effective Provider Pathways for Prescribed Treatments

 

Simply giving plan members access to the right provider knowledge is not enough to change patient behavior and create lasting change as evidenced by a less than 5% average activation rate for today’s healthcare cost and quality transparency portals. This member portal instead uses “context-guided technology” that is supported by the vendor’s expert, unbiased “Health Consultants” who get assigned to each employer and who guide plan members into making smarter healthcare decisions.  The portal system deploys advanced algorithms applied to 1 billion+ claims. Health Consultants, who understand the nuances of medical terminology, verify procedure (CPT) codes and take into account procedure order when estimating costs for complex procedures. They verify provider cost, availability, subspecialty, address, network status and patient experience so as to create personalized and portal-visible provider options for prescribed treatments. These options are specific for each member and result in a 25% activation rate with a 4 to 1 ROI. Optional portal system modules allowing members to establish a three year healthcare accountability plan and /or access an elite subset of high quality, lower-cost-care in-network providers together have been shown to increase portal activation rates to 40% with an 8 to 1 ROI 

 

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Item # MBTY3 – Physician-Developed, Wallet-Sized Electronic Medical Record                                                     

This Physician-developed, Audio-Visual EMR/PHR is Patient Maintained in a HIPAA-Compliant Credit Card Sized USB Flash Drive. Enables Physicians to record Voice Memos, scan in EKGs, house Lab Reports, Hospital Records, etc. plus attach X-ray Images. Also provides Web Links and Tutorials. Teaches Vital “Patient Skills” to expedite Diagnoses, Lower Medical Bills and Optimize Healthcare Overall

Item # MBTY4 – Employee Elective High Dollar Deductible Plan Benefits “Gap Filler”                                                                     

Some Employers are increasing Deductibles and Eliminating Ancillary Benefits just to save Basic Medical Benefits for Employees. This Employee Elective, High Dollar Deductible Plan Gap-Filler Program is Customizable by the Employer and can Include Tele-Health, Rx, Dental, Vision and Other Programs. Arguably, this Approach is the Beginning of the Socialized Medicine “Top Up” or “Wrap Around” Coverage” for the US under PPACA

Item # MBTY5 – Healthcare Plan Employee Annual Planner

This Hard Copy Healthcare Plan Work Book and EOB/Invoice Organizer has been designed by Head of Employee Benefits for a State Government. Its helps Employees to Optimize Utilization of Health Plan Services by Better Understanding how their Healthcare Plan is working throughout the Year  

 

Item# MBTY6 - Vendor Independent Employer / Employee Enrollment and Data Management System for Moving to a Defined Contribution Benefits Model

Employers may wish to move to a defined contribution benefits model within their current healthcare plan and other benefits programs, but may lack an effective platform for doing so. This state-of-the-art system provides an educational and decision-support-based benefits shopping portal containing personalized benefit information specific to the employer and its employees and is supported by a US-staffed , high quality customer care center. Within the system, employer determined-as-to-dollar amount credits are fully integrated and can be used by employees to price, compare, model, purchase and enroll in existing and/or newly-desired benefit programs on a vendor neutral basis. Desired benefits not paid for using the employer-provided dollar credits are deducted from the employee's pay via a payroll vendor interface. The system includes real-time reporting, ACA style eligibility tracking, premium reporting, and access to key enrollment plan information

 

Item # MBTY7 – Web-Based Centers of Excellence Type Tool to Help Employees Access the most Efficient and Highest Quality Physician Providers for their Own Severity-Adjusted, Chronic Illness Diagnosis

 

Employers had heretofore deployed a Centers of Excellence model only for episodic care which represents 20/25% of total healthcare claims leaving the reamining 70/75% for the PPO to control under a simplistic discounted fee-for-service model. This independent service provider instead deploys proprietary (yet customizable-to-your-needs) algorithms to identify quality/efficiency of health providers by severity adjusted diagnosis. Under the model, the employer’s healthcare plan claims data and national healthcare databases are used to rank physicians in terms of both proficiency (i.e. quality) and severity adjusted  efficiency (i.e. price/cost/resource consumption) which when juxtaposed, create a source for generating optimal physician referral options by disease-specific ranking. Robust management reporting capabilities (60+ standardized reports plus ones customized to your liking) cover both bundled episodic procedures and some 250+ chronic illnesses. A savings worksheet for employers can predict savings and ROI using a proprietary referral optimization solution, empowering employees to select providers based on quality and efficiency. Savings range from 25% and up with an ROI >8:1

 

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Item # MBTY8 – Centralized and Portable, Employee-Maintained Personal Health Record (PHR) To Facilitate Interoperability of Medical Information Among All Parties In Need of Such Information

 

 

Employees and family members may see multiple providers resulting in their having multiple prescriptions, procedures, medical tests, etc. Such information is typically stored within each providers closed date base and provided to plan members piecemeal by each provider such that a consolidated personal / family record is never available. This 18-months-in-the-development,  HIPAA-secure and  24 hour-call –center-supported  web portal walks employees through entering  their own (and their family member as desired) information from multiple provider and other sources so as to maintain a centralized PHR. Such health information includes but is not limited to clinical histories, allergies,

prescriptions, unlimited documents, etc. Stored information can be printed off prior to or viewed on a PDA at time of, a provider visit so as to facilitate the providers’ on-site, laborious and paper-based “fill-out-the -forms “ritual. Results include elimination / reductions in duplicate testing, unnecessary doctor visits and absenteeism.  The portal also reduces time spent during working hours addressing caregiving responsibilities, tracking down medical records and managing health issues.  

 

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