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Cost Containment

A commitment to conserving plan assets

In a healthcare marketplace where costs and complexity grow daily, it is critical to identify and utilize all available cost-containment strategies. Beacon, either directly or through its relationships with trusted partners, works with the plan and its claims administrator to conserve plan assets through a variety of proven strategies. The following are examples of services Beacon can provide in conjunction with our stop-loss or on a stand-alone basis:

  • Out-of-network provider negotiations and re-pricing
  • Bill review & audit services
  • Physician review and peer-to-peer consultation
  • Access to National Centers of Excellence
  • Specialty Pharmacy/Oncology review and management
  • Customized Catastrophic Case Management Programs:
    • Dialysis management and specialty pharmacy programs
    • Transplant coordination
    • Neonatal case management

Dialysis and organ transplant cost containment programs

A benefit professional can help employers identify key areas where a single plan member with an expensive medical problem can wreak havoc on plan assets. Among the areas that Beacon can assist to address these issues are:

Carving Out Transplants

The number of organ transplants is rising; today, more than 100,000 people are registered on various organ donation lists. The cost of a transplant, including before and after care, can exceed $1 million. Arranging for separate insurance coverage for this low-incidence, high-severity risk is an economical way for an employer to protect the benefits budget from the unexpected. Having a fully-insured transplant policy can help:

  • Provide first dollar coverage
  • Avoid lasering
  • Protect stop-loss rates
  • Improve cash flow
  • Provide best in class medical services
Managing Dialysis Treatment

Like transplants, kidney disease that requires ongoing and expensive dialysis treatment is on the rise. People with CKD and ESRD usually require ongoing outpatient dialysis treatments. Dialysis costs continue to increase and can cause a serious financial burden to an employer’s health plan.

  • Estimates show that more than 10 percent of adults in the United States age 20 and older have some level of Chronic Kidney Disease
  • There are over 500,000 people with End Stage Renal Disease
  • Dialysis charges often exceed $50,000 per month and can cost as much as $1 million per year or more.
  • In 2011, 113,136 patients in the United States started treatment for ESRD
  • Approximately 1 of 3 adults with diabetes and 1 of 5 adults with high blood pressure have Chronic Kidney Disease

By contracting with dialysis management specialists, an employer can reduce costs — and in some cases, improve patient care. For example, in addition to being less costly than center treatment, home dialysis has been shown to increase the quality of life and improve longevity. Beacon also can arrange for drug discounts and challenge invoices that exceed usual and reasonable (U&R) charges. The U&R re-pricing program typically results in the greatest savings – current clients save an average of more than 60 percent off billed charges, including all program fees, and there is no upfront or fixed monthly costs.