Integrated Cost Management

Integrated Cost Management

Active monitoring and focused action to drive lower costs.

Use your data to control your claims costs.

Your claims data feeds an integrated cost management intelligence system that triggers interventions to help your employees get the right care at the right price.

Medical Cost Intelligence

ParetoHealth applies advanced analytics to your claims data so you can see and act on opportunities to reduce costs.

  • High Impact Intervention
    ParetoHealth care coordination partners monitor your claims data for signs of the potential for cancer, neonatal and other high-cost care needs, and intervene to connect employees to the health services providers who can deliver the best care at the lowest cost.
  • Data-Driven Playbooks
    Data analytics partners and ParetoHealth experts work together to create playbooks containing easy instructions on how you and your benefits consultant can optimize participation and programs to create the savings revealed in your claims data.

The path to greater value for your benefits spend.

Data, analysis and action create the measurable value of integrated cost management.
Clinical & Claims Data
Benefits Cost Intelligence
Intervention & Playbooks
Lower Claims Costs

Pharmacy Cost Intelligence

Put the brakes on runaway drug costs.

Pharmacy benefits can represent 25 to 30% of the cost of your program costs and prices continue to rise. ParetoHealth uses data-driven intelligence to reduce your pharmacy claims costs.

  • Formulary Management
    ParetoHealth formularies support low, medium and high drug cost control philosophies, and all are actively managed by ParetoHealth experts to take advantage of cost-saving developments in the pharmaceutical industry.
  • Pharmacy Benefits Management Advisory
    ParetoHealth experts negotiate pharmacy benefits manager (PBM) contracts and monitor PBM performance to ensure compliance with preferred pricing and rebate guarantees.
  • Specialty Drug Management
    ParetoHealth can carve specialty drugs out of your PBM contract and use advanced analyses of clinical value, appropriate use, and other factors to reduce claims for very high cost drugs.
  • Pharmacy Playbooks
    ParetoHealth experts monitor claims and create cost control playbooks you can use to reduce costs by replacing brand name drugs with generics, finding low cost therapies for high-cost medical conditions, ensuring drugs are claimed through the pharmacy benefit, and more.

Are your claims costs too high?

With $2.4B in healthcare benefits running through ParetoHealth, we know where the savings are.

Every dollar I save helps every other members, and every dollar they save helps me. We're all in this together.
BRIAN KRASIELWICZ
Director of Operations
RoysBoys Pizza