Reducing medically unnecessary utilization
Take a customized approach to inappropriate care
Inappropriate care—in the wrong setting, of the wrong type, at the wrong time—accounts for 20% to 30% of U.S. health care spending. Most industries have taken steps to address the most conspicuous and common categories of overspending (for instance, by implementing pre-authorization for MRIs), but these tactics are too generic to make a material dent in spending by any one employer. Employers must target their own, unique pockets of waste to meaningfully reduce costs.
Most employers poorly positioned to pinpoint waste
Unfortunately, even the most progressive HR shops are ill-equipped to root out waste, as they (understandably) lack deep clinical expertise. At Employee Health Compass, we have an army of experts who draw on an extensive and ever-growing body of research to customize plans of attack. Our approach is effective because it is precise.
Unlock savings by isolating, overcoming weaknesses
Our clinical expertise drives results in three significant ways:
- We size the true opportunity for each member, searching for signs of excessive utilization as soon as we have a new member’s data. For example, we measure the prevalence of CT scans for a specific set of diagnoses that our staff radiologist identified as providing questionable clinical benefit.
- We use our clinical expertise to identify solutions, with the dual objectives of reducing costs and maintaining or enhancing quality of care. For example, our staff pharmacist frequently analyzes prescribing patterns across populations and physicians to determine which therapeutic equivalents a specific employer should promote.
- Our experts help implement solutions by building support for change among key stakeholders and representing the member’s interests in dealings with third-parties, such as pharmacy benefit managers and third-party administrators.
See how one member is benefitting from our clinical expertise
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