During Calendar year 2004 we saved our clients more than $236 Million through PPO discounts by ensuring that they partner with networks that feature strong access, contract savings and management of provider practices. We are a truly independent resource in evaluating PPO options, and have dedicated staff to network evaluation and management. One of the hallmarks of our independence is our guarantee that we will not provide inflated and misleading expectations of discounts.
Our focus on obtaining discounts includes three initiatives:
Our PPO Complete process is used to select "best in breed" local and regional networks for clients, as well as "wrap" networks that maximize the use of contracted providers. This includes over 110 different PPO contracts nationally. Selection criteria includes access, disruption, reported savings and the overall quality of a network's contracts.
We are one of the few TPAs nationally that has met the strict quality criteria to provide our clients access to networks owned by insurance companies like Nationwide Health Plans, Great West Life, Humana and Wellpoint (California).
We have built several proprietary networks for our clients through direct negotiation with providers. In each case those networks have been constructed based on a thorough understanding of the local healthcare environment and "best practice" in contracting. This includes placing providers at risk for delivering efficient care through case rates and per diem reimbursements.
Across our book-of-business 93.7% of services were received from contracted providers.
