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- Medical Tourism
- Medication Management Therapy
- Wellness Programs
- Captive Programs
- Data Analytical Audits
- Actuary Services
Medical Tourism
In the past few years, the most notable emergent sector in the healthcare industry is medical tourism. Each year an abundance of people partake in medical tourism. You might be asking yourself why they would consider doing this. There are several reasons.
- State of the art healthcare
- Better accessibility
- Significant cost savings
The Medical Tourism Association defines medical tourism as such: "Medical tourism occurs when people who live in one country, state, region, or city travel to another country, state, region, or city to receive medical, dental, or surgical care for either better quality, better availability, better access, or better pricing."
State of the Art Healthcare
Many people travel for better quality healthcare. Did you know that you can receive excellent medical care in countries like Costa Rica, Jordan, South Korea, and Thailand? These (and many other) countries have state of the art technology and highly experienced medical personnel.
Better Accessibility
In some countries certain medical procedures are unavailable, like stem cell treatments, the newest cancer therapies, noninvasive spine surgeries, organ transplants, medications, and much more. Due to this, patients often seek out the most reputable and experienced physicians and treatment centers outside of their country. For some, the wait for a new organ in their country would be a death sentence, so they go to countries like India or Thailand to get a very prompt organ transplant.
Significant Cost Savings
The cost of many procedures in other countries can make a savings of up to 90%. For example, heart bypass surgery costs around $144,400 in the United States, but it only costs about $25,000 in Costa Rica. This is for the same procedure and for the same (if not better) quality of medical care.
Medicaton Therapy Management
Medication Therapy Management is a partnership between three main parties: the pharmacist(s), doctor(s), and the patient. It promotes the safe and effective use of medications while helping the patient achieve the targeted effect from the medication therapy. It includes:
- Analysis
- Consultation
- Education
- And monitoring services by pharmacists.
This helps the patient get the best results from medications through:
- Enhancing understanding of medication therapy
- Increasing adherence to medications
- Controlling costs
- And preventing drug complications, conflicts, and interactions.
Improving the use of medications can improve patients' lives and help control the nation's rising healthcare costs. Consider these facts:
- 125,000 people die every year due to adverse events related to medications in hospitals.
- Misuse of medications results in $177 billion in medical costs
- For every $1 spent on prescription medications, over $2 is spent addressing resulting medical problems.
- 51% of Americans of all ages are on chronic medications.
Wellness Programs
Fight Back Against the Rising Cost of Health Insurance
Like many employers, you probably have been faced with the rising trend in health insurance cost. As a nation, we have seen 100% increase in premiums between 2000-2007. Inflation in the same period increased 24%, and wages saw a 21% increase.
How does one survive in today's economy? Many see the only option is to react to high renewal rates by either sharing the cost with the employees, or lowering the benefits (raising deductibles) offered, in order to maintain their bottom line.
This is not a long term solution.
Health insurance should be viewed as a long term investment, and not just an expense. Your benefits package will help recruit, retain and reward key employees. Reacting at renewal will always put you in the ring with one hand tied behind your back.
At Partners Insurance, we work with employers to develop a strategic plan, and actively manage their benefits. We are a full service, independent Benefits agency. Put Partners Insurance in your corner, and we can help you win the fight against rising health insurance costs!
Captive Programs
Many employers are faced with the rapidly growing cost of health insurance, second only to payroll. The average cost for family coverage is almost $13,000 a year. Larger employers are capable of taking control of their costs because most of them are self insured. Most mid-sized employers are fully insured and do not have the product options that their larger counterparts have available. They do not know what claims they have or where their premium dollars go. The lack of transparency prevents them from taking control of the cost of health insurance.
So how can mid-sized employers change what they are doing? They can form what is called a captive program. A captive can be formed by a group of employers in an effort to reduce the costs associated with providing health benefits to their employees. These employers can come from a wide variety of backgrounds including existing risk retention groups, trade associations, franchises, portfolio companion of private equity firms, and clients of an agency or broker. Employers have been using captive programs for workers compensation for years with high success.
Each captive can be customized with its own terms, rules of participation, and financial structure, and the typical captive program takes 3 - 6 months to create depending on multiple variables. Launching a captive usually requires a minimum of 3 employers with a total of 500 or more employees.
So what is the value of being in a captive? The concept behind a captive program is simple: provide medium sized employers with the advantages of self insurance while decreasing volatility. Participation in a captive program is a means to an end. The real objectives are transparency, control, stability, and profit. A captive program can help achieve these objectives.
Data Analytical Audits
Medical claims payments have become so complex that even the most advanced claims administrators face challenges paying claims correctly. According to a recent insurer report card, claims payment accuracy of national insurance companies ranged from 62% to 87%. Even the most advanced electronic medical claims processing system is no guarantee that your healthcare benefit claims are paid accurately.
Each year billions of dollars are wasted on incorrectly paid healthcare benefit claims. Benefit plan overpayments are estimated to exceed $80 billion per year. Medicare reported overpayments of $12 billion or 6.3% per year in total expenditures.
We can help your company find these savings. We typically detect between 2-7% in unnecessary expenses, which includes recoverable overpayments.
Our approach to claims payment verification reduces expenses, improves cash flow and identifies correctable patterns of errors. This ensures that your health benefit plan is operating at maximum efficiency. Escalating healthcare costs make it critical that all self-funded plans are regularly reviewed for accuracy and effectiveness.
Actuary Services
Our staff includes a credentialed actuary (FSA, MAAA) who has over 15 years experience working for various carriers. He is trained in both health and disability actuarial services, with significant familiarity consulting with employer groups on all aspects of their employee benefit programs. He has specific expertise in the following areas:
- Development of cost projections and funding rates for self insured plans
- Preparation of fully insured versus self funded "decision" illustrations
- Network discount analysis
- Pricing of medical and pharmacy plan designs (calculating relative values of different designs)
- Pricing of medical stop loss for captive insurance transactions
- Group disability renewal and reserve analysis
- HSA and HRA plan design development and pricing
For more information about our Broker Resources, please contact us!