Integrated Cost Management
We have a two-part mission at ParetoHealth: to make self-insurance possible for more employers and to help employers reduce the cost of healthcare. Cost containment is critical to our success in these two areas and has been one of our core differentiators since we began in 2011. In our early days, we instituted basic programs like health risk assessments, biometric screenings, and tobacco cessation to foster accountability and engagement across our growing membership. With each year of steady growth, we have welcomed new ideas, strategies, and solutions to address the increasingly complex healthcare ecosystem. The progression and evolution of our cost containment strategy and approach led to the 2020 launch of our exclusive Integrated Cost Management Platform (ICM), a pre-packaged suite of Fortune-100-level solutions and initiatives designed to effectively reduce the cost of healthcare while enhancing captive members’ benefit plans.
ICM has three main components: Integrations, Interventions, and Playbooks. Driven by actionable data and insights, these turnkey offerings help employers save money and connect their employees with high-quality, cost-effective care
ParetoHealth Integrations optimize the activation and engagement of point solutions with improved TPA and PBM connectivity. Focused on addressing targeted areas of risk like oncology, high-risk maternity, and surgeries, our integrated point solution partners help guide and advocate for employees as they navigate treatment, ensure the appropriateness of diagnoses and care plans, and preserve payment integrity and access to high-value care.
To help our captive members and consultants identify real-time savings opportunities, ParetoHealth analyzes claim data monthly for certain trigger diagnoses or events and provides the recommended course of action through our ParetoHealth Interventions. These trigger events give visibility to certain high-cost, low-frequency claims like End Stage Renal Disease (ESRD), where coordination of benefits activity can lead to significant reductions in cost for you.
In addition to Integrations and Interventions, Captive members enrolled in ICM have access to our ParetoHealth Playbooks, which offer a retrospective analysis of “missed opportunities” based on member-specific data points. Each Playbook includes a series of addressable “plays,” with supporting context to justify them as areas of focus. Then, we provide data specific to that Member that quantifies our findings alongside summary recommendations and connections to our suite of solutions and strategies. Simply put, Playbooks allow our Members to leverage their claims data and seize opportunities for savings.
There are three different types of playbooks: Participant Optimization, Medical Cost Intelligence, and Pharmacy Cost Intelligence.
Participant Optimization playbooks identify members who are Medicare eligible or COBRA and provide guidance to help them find better, more cost-effective options.
Medical Cost Intelligence playbooks include recommendations on site of care, mental/behavioral health analysis, benchmark reporting, and preventive care compliance.
Pharmacy Cost Intelligence playbooks include recommendations for formulary optimization, therapeutic interchange via brand-to-generic substitutions, and site-of-care steerage.
The three components of our ICM platform allow Members to take control of their healthcare spending. Members not only have access to data but also analysis and suggestions that allow them to make informed decisions on cost management, whether it be through switching from brand name to generic prescriptions or connecting with one of our integrated point solution partners to intervene on a specific claim.
To that end, cost management aids you in building a sustainable employer health plan, but we firmly believe that health care is not one size fits all. We offer options through our ICM platform that small and mid-sized employers would not have access to otherwise, but these are just options, not obligations. We encourage Members to work one-on-one with their consultants to personalize their benefits plan and develop a multi-year strategy to proactively tackle rising healthcare spend.