REDIRECT MEMBERS TO PREFERRED PROVIDERS
Prices for medical services vary widely among health care providers. Yet research shows that higher prices do not correspond to better results.
MagnaCare offers several innovative programs that direct your members to lower-cost, high-quality providers. These redirection programs save money for your plan and members, while maintaining the same level of benefits.
Through the right programs and plan design, you can contain spiraling health care costs.
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 health care 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.
Reference Based Pricing
The amount billed by a health care 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 health care decisions.
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.
Savings per Infusion
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).
Centers of Excellence
MagnaCare has partnered with leading health systems to offer our clients Centers of Excellence 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.
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 health care costs while assuring your members high-quality health care.