NAVIGATE MEMBERS TO PREFERRED PROVIDERS
Prices for medical services vary widely among healthcare providers. Yet research shows that higher prices do not correspond to better results.
Often, members choose expensive or inappropriate care options because they don’t know any better. With the right guidance, members can find the best doctor or facility for their specific needs, receive more appropriate care, and save money by seeing the right provider in the right setting.
MagnaCare offers several innovative programs that direct your members to lower-cost, high-quality providers. These navigation programs save money for your plan and members, while maintaining the same level of benefits.
Navigation Programs
Through the right programs and plan design, you can contain spiraling healthcare costs.
Specialty Drug Infusions
Outpatient Surgery: e.g. colonoscopy
High Cost Radiology
Tiered Network
Lab & Genetic Testing
Center of Excellence
Tiered Benefit Design.
Our tiered benefit design divides the extensive MagnaCare PPO network into levels, or tiers, of in-network providers, with a cost disparity between them. When members use high-value providers, they reduce their cost-sharing and the plan can save up to 20% on healthcare costs.
Members can access any provider in the MagnaCare PPO network, but they will pay more if they go to more expensive providers. Tiered benefit design empowers your members to be wise consumers and drives savings through smarter benefit usage. You decide which providers to include in each tier, and we will design your benefits accordingly.
Reference Based Pricing.
The amount billed by a healthcare provider does not always reflect the true cost of services provided. In many cases, the bill is significantly higher than the market value of the treatment.
Reference based pricing (RBP) is a way to control the cost of expensive claims, such as hospital stays, surgeries, high-tech radiology, and other types of treatments that can significantly vary in price as well as outcome.
By establishing reference prices for expensive services ahead of time, members can receive high-quality care at lower cost. While a member can still choose to see a provider that is not part of the RBP arrangement, they would likely have to pay a larger portion of the bill out-of-pocket.
Through plan design that reduces – or even removes – cost-sharing for RBP-participating providers, members take a more active role in their healthcare decisions.
Site-of-service Relocation.
For recurring costly treatments such as specialty drug infusions, we save our clients tens of thousands of dollars per treatment by moving care from a hospital setting to a doctor’s office or home visits with a visiting nurse.
Case Study
A member was receiving a specialty infusion of Solaris every 2.5 weeks at a hospital. We moved the site of service to a nearby doctor’s office. The member appreciates the comfortable, warmer setting with the same doctor, and the Fund is saving $23,396 per infusion (every 2.5 weeks).
Center of Excellence Programs.
MagnaCare has partnered with leading health systems to offer our clients Center of Excellence programs with an all-inclusive, bundled payment.
Highly skilled specialists known for achieving superior outcomes perform high-cost specialty services, such as total joint replacement, cancer care, and transplants.
The lower, fixed, bundled price covers the entire episode of care, including the costs of the hospital, physicians, anesthesiologist, physical therapy, and any complications after discharge.
Case Study
Total Joint Replacement Center of Excellence: Partnership between MagnaCare and the Mount Sinai Health System.
Total Joint Replacement (TJR) is a very common, yet costly surgical procedure. However, with Mount Sinai’s TJR Center of Excellence, clients experience lower costs without sacrificing the quality of care delivered. The Mount Sinai program includes the best orthopedic surgeons and covers the total episode of care, including physical therapy and other programs 30 days post-procedure.
By directing members to Mount Sinai’s TJR all-inclusive bundled payment and care coordination program, MagnaCare lowers costs for the Fund/employer and eliminates surprise billing for the member.
The program achieves:
<1% readmission rate
<4% emergency room visit rate
15% lower than market rates
100% 10-star rating by members
Appointment-scheduling services make the right choice the easy choice.
For high-cost services such as high-tech radiology, genetic testing, and various outpatient services, Care Coordinators schedule all member appointments. This ensures that members receive the correct test or procedure at the best facility in terms of cost and quality.
Contact us to learn more about our innovative programs that lower your healthcare costs while assuring your members high-quality healthcare.
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