Designing Employer-Centric Clinically Integrated MSK Network

Employer Centric Clinically Integrated Networks

It is no secret that employers are always demanding lower-cost healthcare options without any decline in quality.  A number of plans are experimenting with narrow, tailored, tiered and other types of health networks designed for employers to tap into for greater efficiency.  The basic idea behind designing such networks is to offer lower premiums by limiting the…

Five steps to control escalating costs of speciality drugs

Speciality drugs are derived from living cells, often infused or injected and often require supervision. The prices for speciality drugs are much higher than branded or generic drugs. For example in employer sponsored plans, speciality drugs usage is about 2-5%, yet they make up over 30% of the overall cost. In comparison, the generics are typically…

Mind the gap in your stop-loss contract

The prevalence of high-cost claims have gone up drastically along with the dollar value of those claims. The conditions resulting in claims greater than $1 million are more prevalent today due to advances in medical technology and improvements in life-extending care. According to Sun Life, the 1,979 self-funded employers it counted as customers at the end of…