Reducing Costs by Removing Waste
- Managing variation to the 90th percentile. This could save self-funded employers $1,500 per knee and hip replacement case.
- Using MSK triage to appropriately referring patients with back pain to non-surgical treatment, e.g. physical therapy, chiropractic care (avoiding unnecessary surgery). This approach can generate an estimated $14,000 in savings per case.
- Incentivizing members to choose an outpatient setting over hospital for knee arthroplasty. This can save an average $21,000 per case.
Risk Stratification and Segmentation
Our risk stratification tools understand the clinical and financial risk in the member population by leveraging multiple data feeds, and multiple risk and utilization indicators.
By assigning a risk status to members with MSK conditions, and segmenting them into distinct groups of similar complexity and care needs, we identify the targeted interventions that maintain good care and help avoid their cost increase.
Over-utilization is avoided by eliminating unnecessary prescribing of services in low-risk members; concordantly, a valuable investment is being made for long-term gain in a more complex, high- risk population. It is the difference between optimizing utilization versus merely controlling it.
Population Health Management
Each member interaction with the healthcare system generates data. From these snapshots we are able to see the bigger picture of their healthcare journey.
Each snapshot is also an opportunity to intercept the member in real time when guidance is essential to improving the member’s outcome.
This systematic approach takes a data-driven view to prioritize interventions that improves outcomes for priority populations, and develops strategies to digitally enable end-to-end care journeys.
Smart Benefit Design
Get maximum flexibility in experimenting with benefit designs to align member and provider incentives.
The cost-sharing requirements imposed in most plans often do not reflect the true value of different treatment options. Our smart plan design aligns employee’s out-of-pocket costs with the value of the health services.
This approach improves utilization of high-value services and discourages the use of inappropriate, intensive surgical options.
We use cost and quality metrics to facilitate the identification of high-performing providers and facilities.
Our tiered network approach optimizes performance and savings and our network providers are reimbursed with payment models that promote high-quality and cost-effective care.
The value-based payment models reward providers for good outcomes and high quality, not medical errors, unnecessary procedures and other low-value care.
Sprite health brings form, discipline, and structure to plan administration processes by using easy-to-use, rapid and automated workflows for enrollment, eligibility, claim adjudication, and payments.
Our operations team is committed to delivering service excellence. Whether it is the processing of a claim or the handling of an incoming service phone call, we strive to exceed our performance standards.
- a single point of access for all MSK conditions
- on-demand virtual physical therapy integrated into their digitized lives
- help and advice to pick the right treatment first time
- an evidence-based, digital care program for chronic pain management that includes exercise therapy, behavioral support & education
- access to high-performing providers and Centers of Excellence (COEs) for surgical care at a pre-negotiated bundled rate
- pre/postoperative rehabilitation
- white-glove concierge service with full care coordination