Can Technology Help Employers Choose a Healthcare Plan?
It certainly can. One of the ways we help employers choose a healthcare plan for their employees is by using our proprietary software to determine what the real cost of covering each employee would be in a direct contracting scenario.
When we say real cost, we mean that we can show them exactly how much the healthcare being provided actually costs, vs. how much the provider is charging the employer. If the employer is self-insured, as many large companies are, we can use the data from the employees’ claims to determine this calculation because federal law grants ownership of claims information to the employer in those cases.
We use a case mix adjustment (CMA) to do this. Using a case mix adjustment, we can take the CMA value of a provider and adjust the average cost per patient at that provider, relative to the adjusted average cost for other providers. Once we have those numbers, we can take this claim data, break it down and case mix adjust all the claims. In other words, we can make a fair comparison and show an employer how much they have been paying for healthcare vs. how much the care actually costs – and of course, this information will tell them how much their healthcare costs can be reduced through direct contracting.
Additionally, our technology enables employers to see how much care their providers actually provide, so that they can make better healthcare decisions for the company. For example, one hospital may appear expensive to the employer but could turn out to actually be the most cost effective provider due to the severity of the care provided. With the technology we use, employers can see the numbers right in front of them, so that they know the right questions to ask.
To learn more about the technology that simplifies healthcare decisions for the employer, contact GM&A today. We will be glad to offer you a consultation to have your questions answered.