Elective procedures account for almost 45 percent of the dollars spent on healthcare today. Costs for these procedures can vary in cost from 300 to 1,200 percent across national networks. To help control costs, HealthSmart developed MyDecision™, an innovative plan savings approach to managing costs for elective procedures.
With MyDecision, members can get procedures done using a high quality, cost-effective network of providers. HealthSmart’s comprehensive bundled payment solution provides 30 to 40 percent incremental savings for elective procedures over what traditional PPO networks offer. This can have a significant impact on overall medical claim spend, as our clients see reductions of 4 to 7 percent.
How it works:
- We contract directly with high quality providers at aggressively priced bundled rates
- Our clinical team provides integrated utilization management to determine medical necessity
- Our real-time concierge outreach redirects members to the right providers that they can select
- We pay the providers and distribute savings to the members and the plan
The plan’s success is a combination of clinical oversight and member outreach. In 2017, Member Advocates delivered a 92 percent redirection success rate.
Types of covered services include orthopedic, general surgery, spinal and neurological, women's health, advanced imaging, endoscopic procedures and more.
Our Member Advocacy team
- Schedules members into high quality, bundled provider settings
- Explains how members can benefit from the approved surgery or service
- Supplies pre-service information to prepare the members for their procedures
- Delivers a concierge service to ensure positive member experiences
- Pay ZERO out of pocket for services included in the bundled price
- Have complete transparency into the price and quality of providers
- Receive targeted, real-time, personalized guidance from beginning to end
Take control of the high cost of elective procedures with MyDecision!