Hanlon Insurance Agency, LLC
A Policy of Mutual Trust & Respectâ„¢

Self-Funded Group Health

Bending the Healthcare Cost Curve

Ask any employer, “Do you believe that there is waste, abuse and fraud in the healthcare system?” and virtually all will agree that it exists. However, follow up that question with, “do you know how much exists within your health plan?and you’re likely to get a puzzled look.

While many self-funded employers are wringing their hands over the implementation of “Obamacare”, very few are taking on the real  and immediate opportunity to significantly reduce waste, fraud and abuse within existing self-funded plans.

Employers in the self-funded group health market can realize extraordinary and untapped opportunities to bend the cost curve, realizing a return on investment within 12 to 18 months.

Many efforts to bend the medical cost curve have failed or fallen far short of expectations. Wellness and Disease Management programs are not creating the returns on investment promised by vendors and, in many cases, actually increasing the cost of medical care unnecessarily.

Curbing Out-of-Control Healthcare Costs for Employers

Self-funding is not new, but a dramatically new development allows employers to increase their control over medical expenses. You have likely heard that we are living in a world of “Big Data.”

Technology exists today that has driven down the costs of data mining and data warehousing. In the past this was reserved for the Fortune 100 companies only. However, the leverage of Big Data is now available for the under 10,000 employee segment.

The opportunity for self-funded employers to capture 1-3% of their claims dollars already spent and at the same time incorporate performance priorities and expectations to reduce future healthcare spending  by as much as 10% is now available to the under 10,000 employee size due to these new developments.

Why Employers Need an Independent Resource to Audit Claim Payments

How would you like to conduct a claim audit on 100% of your medical bills? Due to the complexity of the system, it is not surprising that medical bills are paid incorrectly. When bills are paid incorrectly on behalf of the self-funded employer, that money comes right off their bottom line and is lost forever.

In the “old days” claim audits were conducted manually on a handful of selected files. Today most TPA’s audit a random sample of files. We have the capacity to electronically audit 100% of the bills. In addition to identifying incorrect claim payments, this technology will also recognize waste, abuse and fraud in the system.

Employers who rely on their insurance company or third-party administrator to audit a random sampling of their claims payment history are missing an opportunity for savings. A partial audit will likely miss:

  • Identification of ALL the ineligible beneficiaries
  • Inconsistencies between the plan benefits and the claim payments
  • Assignment of other payers, such as a government agency

What If You Could …

  • Reduce your healthcare spending within the next 12 to 18 months?
  • Become aware of resources and technology that could help you reduce your claim payments by up to 15 percent?
  • Identify waste, fraud and abuse in your healthcare coverage so you can make changes that will reduce their costs?
  • Find claims that should never have been paid?

We Can Get You There

Hanlon Insurance has aligned with a data and technology company who delivers this service to self-funded employers. In operation since 1985, this company successfully processes annually more than one billion dollars of paid claims data submitted in dozens of different formats and also processes special surveys for over one quarter-million covered members. Their philosophy is three fold:

  • Respect for existing procedures;
  • Emphasis on customization; and
  • Focus on solutions.

Call today for a complimentary consultation.