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 Group Health Analysis |
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 Example of findings #1
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A 40,000 employee self-insured corporation offered supplemental healthcare coverage to retired employees.
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The employer's Third Party Administrator (TPA) had the employer pay for claims which should have been sent to Medicare. Dynamic Health Strategies discovered that this client overpaid by $5.4 million dollars.
Our Solution: In concert with the Employer's Third Party Administrator, claims processing was re-engineered to insure appropriate claims were submitted for Medicare reimbursement.
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Example of findings #2
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Percentages of Outpatient Visits by Major Diagnostic Groups.
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Our Findings: Ears, Nose, Throat (ENT) diagnoses accounted for 49.7% of all outpatient visits—nearly 5 times the expected rate. The ENT visits could result from allergies and together accounted for 56%of the ENT visits.
Our Solution: Employee and Provider education on pro-active allergy identification and treatment resulted in significant decline of ENT outpatient costs.
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Example of findings #3
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Our Findings: identified flaws in an employer's prescription plan that allowed unlimited mail-in claims refills with a single copay.
Our Solution: Redesign benefits administration to eliminate unwarranted decrease in employee copay fees.
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Example of findings #4
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Our Findings: An employer's average cost of migraine incident was $945 vs. the community average of $165. Analysis revealed migraine treatments that were contrary to recommended protocols.
Our Solution: The client implemented a medical management program targeting migraines and headaches, with emphasis on recommended protocols.
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