Attention to Patient Care Integral to Saving Money with Reference-Based Pricing Plans
Oct 13, 2020
3 min read
Companies get used to the idea that the cost of health benefits goes up year after year, and many employers accept that they have to pay more while also maintaining quality benefits. But a closer look at how care is priced, and the plan options available, means employers don’t need to choose between a plan that saves money and one that provides superior care for members.
Reference-based pricing (RBP) plans were introduced in 2011 by larger companies experiencing the skyrocketing cost of health benefits. Research at that time of reimbursement rates for healthcare showed that the cost increases, year after year, weren’t necessary. Commercial plans were paying highly inflated rates, as much as 200% and 300% of what the government was paying, via Medicare reimbursement, for the same procedures.
RBP plans are priced with Medicare as a reference. The original plans were priced at 120% of Medicare, with extra costs to brokers and third-party administrators (TPAs) for fees. But the experience for members (patients and their families) wasn’t great. The fourth generation of RBP plans, known as value-based pricing (VBP) plans, have worked out the kinks. Lucent Health’s VBP plans feature attentive, compassionate care management programs, helping members stay healthy and supported—while also saving employers money.
In particular, VBP plans that pay careful attention to the healthcare status of employees can be the difference between a RBP that saves money and one that causes headaches and heartaches. What does paying careful attention mean? And how does it pay off?
Paying careful attention means reviewing data nightly, not monthly. Most commercial plans review data only every month. With self-insured employers and a partner like Lucent Health, data are reviewed nightly. What that means is that Lucent’s proprietary algorithms are applied to claims data and, assisted by artificial intelligence (AI), instances where a member might need help from a care team are flagged. Being able to reach out rapidly after a diagnosis means being able to surround that member with compassionate, experienced team members who can help.
Programs like large case management are in place to help members. Lucent Health’s large case management (LCM) services ensure members with catastrophic illness and injury cases receive the quality care they need and achieve the quality of life they want and need after a catastrophic illness or injury. LCM also ensures the appropriate healthcare resources are devoted to that care.
For members dealing with chronic conditions, focused care is also provided. For those who qualify for help with high-risk medical conditions, Lucent Health Chronic Care Management services focus on the most medically vulnerable members, who likely need ongoing support. Ongoing support of chronically ill members means fewer missed appointments, more compliance with physician orders and medications, and more knowledge of what families need to stay on their plan.
Concierge care is another way to be attentive to member needs. The Concierge Program is designed to be exclusively for direct member engagement, available to respond to plan member needs securely and confidentially, as they reach out via phone or mobile text messaging. The Care Support Team has direct access to internal Lucent Health Solutions resources to help resolve matters efficiently and effectively. Members are more satisfied with their plan, and they are better consumers of healthcare, when they are supported with concierge care.
So how does VBP with attentive compassionate care pay off? With real reductions of episodes of care, for one—and millions of dollars of savings.
To hear more about how three companies were able to generate meaningful, sustainable savings for their businesses, while ensuring that employees were taken care of, watch our Webinar: Lucent Health’s Concierge and Complex Care Management Powered by Narus Health.