Cost Management Strategies
BAS Medical Management
- Medical management of the benefit plan is an important aspect to controlling the cost of catastrophic claims. At BAS, our internal medical management team daily reviews members who have pre-certified care. From this review, the medical management team can determine the appropriate next steps, such as referral to case management, disease management, or other programs offered by the employer.
- The BAS medical management team may also determine a BAS Personal Assistant should be assigned to the member to provide support in navigating the health care system. The BAS Personal Assistant will then call the member to offer their services as the single BAS point of contact during the episode of treatment. The BAS medical management team is a key factor in identifying emerging catastrophic claims and providing direction for the member to access the best resources.
The Next Right Thing for Health Care Plans
- BAS has partnered with ELAP, a leader in fiduciary protection. We work together to shield our members by auditing claims riddled with exorbitant charges from healthcare facilities, and to provide legal defense if balance billing or a collection attempt occurs. ELAP becomes the co-fiduciary of the health plan in the event of balance billing or a collections attempt.
- ELAP is saving our clients an average of $150,000 per 100 employees the first year on our program or an average reduction in overall healthcare spend of 25% off the previous year (not trend, but actual spend).
- We modify the plan documents to ensure clarity in how the claim will be reimbursed and the plans responsibility. 120% of Medicare or 112% of cost, the greater of the two.
- Reference Based Pricing reimbursements average approximately 70% off the Facility billed charge.
Proactive Identifier (PI)
- Proactive Identifier (PI) is a large group solution for a middle-market self-insured group. PI provides a turn-key approach to using Advanced Analytics, data, and outreach to our members. This Fortune 500 solution provides small to middle market groups the tool for a more precise identification process, analysis, and insight into claims data. This leads to more targeted outreach.
- PI goes beyond the integration of medical and pharmacy claims data, and includes participant’s health assessment questionnaires, lab, and biometric values. This proactive approach incorporates predictive modeling, regression analysis, and employee engagement to reduce future claim costs.
- Unique to BAS, PI has the ability to integrate sophisticated data analysis, care management tools, and drive participation in health advocate programs. PI provides stronger plan management, and will ultimately prevent future spending.