An Integrated Approach Helps Reduce the Cost of Care

To help clients encourage healthier behavior, drive better outcomes and reduce the overall cost of care, Benefit Plan Administrators leverages information to integrate the following resources and capabilities…

Finally True National PPO Network Access for Smaller Groups

As a result of our relationship with IHRM and the TriZetto Premier Partnership Program, BPA is able to access the GWH-CIGNA National PPO Network. While national health plans and our nation’s largest employer groups have traditionally enjoyed very deep discounts from large carrier networks, these discounts have seldom been made available to smaller groups – those with 100 to 500 members or more.

A unique partnership between Cigna and TriZetto has made it possible for Benefit Plan Administrators to access this true national PPO network and pass the discounts along to our clients. As a result of the network and its integrated cost management measures, we are experiencing more aggressive stop loss insurance markets, creating lower overall costs.

The GWH-CIGNA PPO Network has contracted with more than 600,000 doctors, hospitals and specialists nationwide. By integrating CIGNA facility contracts, national lab contracts and selected health care professionals, average available discounts have recently been in the area of 45 percent.

AHDI Helps Us Identify the Factors Driving Costs Higher

American Health Data Institute (AHDI) is a data warehouse and targeted utilization management partner that combines all the necessary elements for controlling healthcare costs from both the demand and supply side of the healthcare equation. AHDI utilizes information provided by the employer including medical claims data, eligibility records and pharmacy as the source data. The AHDI data warehouse utilizes very sophisticated software to analyze the variances, cost drivers, cost trends and other significant clinical and financial factors that influence the costs of a health plan. Ordinary claims data is transformed into powerful, actionable intelligence.

By accessing the following solutions, AHDI helps BPA identify excess healthcare costs driven by illness burden, provider cost variances, practice patterns and demographic challenges.

• Health Risk Assessment Tool: Key Care Guide
• Chronic Disease Management Program
• Predictive Modeling and Risk Stratification
• A comprehensive clinical and financial reporting package

Benefit Informatics Helps Us Evaluate Plan Performance

As an IHRM member administrator, BPA integrates Benefit Analyzer® technology from Benefit Informatics to evaluate the performance of employer sponsored health plans and benchmark results to industry norms. The Benefit Planner™ service from Benefit Informatics helps us evaluate multiple benefit plan scenarios going forward.

With more than 80% of overall health benefit costs attributed to utilization of health care services, the ability to obtain current claims data and evaluate plan performance on an ongoing basis is critical. These integrated capabilities make the latest utilization information easily accessible. Employers can evaluate plan design alternatives, care management strategies and targeted wellness programs – all designed to help our self-funded clients control costs without cutting benefits.