The days of healthcare price secrecy are over! Self-insured employers were disappointed that implementation of the Affordable Care Act (ACA) did little to address healthcare costs. Today, years later, price transparency provides a meaningful cost-reduction opportunity.
Employers can now obtain their claims data, inclusive of both provider identity and price. You can also obtain provider-specific price data from public sources. Teus Health will partner with you to obtain data; identify fraud, waste, and abuse (FWA) and overpricing; hold your administrator and network accountable; and reduce healthcare costs.
Read more about the savings potential in “The Converging Forces of Healthcare Price Transparency: Self-Insured Employers Will Lead the Way to Cost Reductions” and “The Dawn of Self-Insured Transparency: Shining Light onto Fraud, Waste, Abuse, and Overpricing”.
Are you underwhelmed by the quarterly and annual reports produced by your health insurance broker, provider network, TPA/ASO contractor, PBM, and wellness and care management vendors? We are. We work for you to find specific actionable hot spots of over-pricing, ineffective interventions, fraud, waste, and abuse – the things that cause you to spend more than you should.
Do you need help preparing a health policy analysis or responding to someone else’s analysis? We perform careful, documented analyses and clearly articulate the strengths and weaknesses of our findings, in the format that suits your needs.
Is risk adjustment a black box? We will help you unbox it! We are experts at risk adjustment, from the philosophical to the technical. We have rewritten the SAS risk adjustment scripts distributed by CMS into R.
Are you overwhelmed by the details of value-based contracts? Do the technical descriptions for member attribution models, incurred and paid claims, risk adjustment, and quality of care measurements make your eyes roll? Would it be helpful to have an actuary on your side when you engage in financial negotiations or audits with providers? Do you need an independent party to examine your or someone else’s data? Dr. Sawhney (actuary) and the Teus Health team are ready to help.