Facility Cost Containment
Inpatient & Outpatient Facility Costs
Our partner negotiates and pays cash for certain inpatient and outpatient facility charges. These claims are paid directly to a willing provider through a single case direct contract. All stakeholders see our methodology, and employees are guided through the process every step of the way:
- We obtain inpatient and outpatient facility claims data from the employer/advisor.
- An employer is provided with a Facility Cost Containment Savings Analysis that identifies the inpatient and outpatient facility payments paid, compared to the average cost reimbursed to that facility.
- Pricing Transparency is provided by The Rand Study "Nationwide Evaluation of Health Care Prices Paid by Private Health Plans".
- The Facility Cost Containment Shared Savings Modeler is used to determine the employer approved sharing formula.
- The employee provides direction on facility choice(s). We negotiate with the appropriate facilities.
- If facility and minimum savings requirements are met, the employee has final decision on engagement.