Value-Based Payments

A Value-Based Payment plan with Lucent Health cuts costs significantly in the first year and will help you contain cost growth long-term. This serves as the most aggressive health plan savings solution while promoting and improving member wellness.

Value-Based Payment is the only way to know the true cost for hospital services.

The Basics

This plan utilizes the practices of reference-based pricing to negotiate costs, delivering the steepest possible savings. Lucent's Value-Based Payments plan bundles the RBP approach with a concierge care offering to deliver a superior member experience. We walk hand-in-hand with the member, negotiating with providers and facilities, and helping the member navigate any questions or challenges they face as they receive care.

How it works

Medicare is the rate the government reimburses hospitals and is the best price a hospital offers for its services. National insurance companies however, typically reimburse inpatient and outpatient hospital claims at 2 or 3 times the cost of Medicare. This plan utilizes the practices of reference-based pricing to negotiate costs and get you much lower prices at 140-150% the cost of Medicare. For every claim dollar submitted for reimbursement, we have delivered $.70 in savings. That leaves the employer paying only $.30 per $1 submitted.

Our Care Process

  1. Provider orders procedure and requests approval for medical necessity.
  2. Lucent evaluates the procedure for medical necessity and conducts all precertification activities, coordination, and communications.
  3. Medical Treatment or services are received by the member or their family member.
  4. Lucent keeps the member informed. Lucent has a patient advocacy team for the member and his/her family in all aspects of pricing, scheduling, precertification, and case management as needed.
  5. Provider submits a bill for services to Lucent Health for payment.
  6. Lucent Health makes payment based upon pre-priced amount.
  7. Lucent Health issues an Explanation of Benefits (EOB) to the Member and to the provider.
Provider orders procedure and requests approval for medical necessity.
Lucent evaluates the procedure for medical necessity and conducts all precertification activities, coordination, and communications.
Medical Treatment or services are received by the member or their family member.
Lucent keeps the member informed. Lucent has a patient advocacy team for the member and his/her family in all aspects of pricing, scheduling, precertification, and case management as needed.
Provider submits a bill for services to Lucent Health for payment.
Lucent Health makes payment based upon pre-priced amount.
Lucent Health issues an Explanation of Benefits (EOB) to the Member and to the provider.

Addressing the Risks

As with any innovative healthcare solution in the current disruptive market, there is always the potential for challenges to arise. In the one percent of claims where a provider or facility does not honor a VBP discount, Lucent Health will negotiate on your behalf to settle the payment. You can take a step further and protect your members by adding a concierge care option to your plan.

Have Questions?

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