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Improving care while
reducing spend

Health care costs are rising, and in order to stem the tide, we have to change the way health care is delivered.

In order to deliver high quality care while reducing the millions of dollars you spend on health care for your members, you need a strong strategy to bend your trend.

That means understanding where your members are on the health continuum, then giving them the tools and programs that will target their areas of need.

Managing your members’ health is imperative, and can result in cost savings that will help in your long-term success.  Healthier members and cost of care savings will lead to stronger reserves, not having to reduce benefit levels, and more money that can be directed towards other benefits. 

To more effectively manage care, we focus on two areas:
Effective collaboration with providers

The way we pay providers is changing.

It all works better when providers are paid for outcomes—not for the number of patients they see in a day.

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    You have access to the best network discounts in the industry.

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    We offer better-coordinated care, managing member frustration and connecting the dots, especially for chronic care members.

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    Your members will build strong relationships with their doctors. With Enhanced Personal Health Care (EPHC), members will have a primary care physician who will manage their care and connect them to a team of providers who work together to close gaps in care. When 2/3 of health care expenditures and 63% of inpatient admissions are for those with chronic conditions, those become very valuable relationships.

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    For procedures, EPHC docs, like all of our providers, can send patients to Blue Distinction Total Care centers for high quality care proven to generate better outcomes.

Integrated care at a lower cost

We know that many of our labor clients carve out programs and services. However, by integrating care—medical, Rx, dental, vision and other services—we’re seeing lower costs and better health outcomes. For instance, by linking Pharmacy, Dental and Vision coverage with Medical benefits, we see:

Faster identification and outreach.

  •   If a member hasn’t filled a prescription, had certain tests, or missed a dental cleaning, we can reach out to them sooner.

Meaningful engagement.

  •   We can identify and engage members who aren’t getting evidence-based care and create actionable insights.

Provider collaboration.

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    We encourage doctors to prescribe certain medications like generics and reward them for following evidence-based guidelines for medication therapy. In addition, we make it easy for vision doctors to access a patient’s medical records to determine whether or not a prescribed medication could be the cause of blurry vision or other vision-related problems.

Increased savings and improved outcomes. 

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    Medical + Pharmacy—$28pmpm average employer savings from integrating medical and pharmacy.

  •   Medical + Vision—people are 3x more likely to get an annual eye exam than annual physical, which enables early detection of chronic conditions like high blood pressure, high cholesterol or diabetes that wouldn't have been caught otherwise.
  •   Medical + Dental—74% lower medical costs for patients with chronic disease or pregnacy who treat their periodontal disease.
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