HealthSmart Launches SmartDecision Reference Based Pricing Solution

HealthSmart Launches SmartDecision Reference Based Pricing Solution

Release date: 7/17/2018

SmartDecision leverages multiple tools to direct members to lower cost, high quality providers

HealthSmart®, one of the nation’s largest independent third party administrators of health plans for self-funded employers, announced it has launched SmartDecision™, an innovative Reference Based Pricing (RBP) that provides high-touch concierge services for members.

SmartDecision leverages powerful pricing solutions with a concierge service desk to redirect members to the best care at affordable prices. HealthSmart’s Reference Based Pricing solution, powered by Zelis® Healthcare, delivers significant savings off hospital and facility billing. SmartDecision also includes HealthSmart’s proprietary MyDecision™ product, a bundled payment solution for elective procedures that reduces medical plan costs for employers with zero out-of-pocket for members. Additionally, SmartDecision offers directory tools to manage and control physician and ancillary costs, as well as transparency information on provider quality and pricing.

To help members and providers navigate their Reference Based Pricing choices, the SmartDecision Concierge Desk is a single point of contact to answer any questions related to benefits and coverage. The Concierge Team also helps direct care to the most cost-effective, high quality providers.

“While there are several reference based solutions available, we’ve taken the idea of cost containment to a new level,” said Tom Mafale, executive vice president and chief sales officer for HealthSmart. “Our RBP solution provides significant savings compared to what a PPO solution can offer, generally up to 60 to 70 percent of hospital and facility charges. Combining the RBP approach for hospital and facility charges with our proprietary MyDecision product and concierge services makes this a unique and effective approach to healthcare savings and quality.” Mafale added, “No one provides these inpatient and outpatient options like SmartDecision.”

HealthSmart says their concierge service specifically sets SmartDecision apart from other RBP solutions. “We developed this suite of solutions to provide the most opportunity for healthcare savings, but as with anything healthcare related, things can get complicated,” said Phil Christianson, CEO of HealthSmart. “Our concierge service makes the process simple by providing members and providers with a single point of contact for benefit questions and to direct members to high quality providers at a lower cost. It’s this high-touch, white glove service that makes this program really special and highly effective.”

HealthSmart has partnered with Zelis Healthcare, a market-leading healthcare technology company providing integrated healthcare cost management solutions, to power its Reference Based Pricing platform.

To learn more about SmartDecision, visit
About HealthSmart
HealthSmart is one of the largest independent third party administrators in the country and the premier provider of innovative, customizable and scalable healthcare and claims solutions for employers, brokers and payers. We partner with plan sponsors to provide key services needed to reduce healthcare costs and manage members with dignity and respect. HealthSmart is the one-stop source for health plan needs, including health plan benefit administration, pharmacy benefit management, provider networks, wellness and care management programs. We also provide comprehensive claims and administration services for property, casualty, and workers’ compensation. For more information, visit Follow HealthSmart on LinkedIn, Twitter and Facebook.

About Zelis Healthcare
Zelis Healthcare is a healthcare technology company and market-leading provider of integrated cost management and payments solutions including network analytics and design, network access and cost management, Reference Based Pricing, claims cost management and electronic payments to payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis Healthcare is backed by Parthenon Capital Partners.