Client-specific Summit ReSources solutions create value for clients by reducing the frequency and severity of catastrophic claims. These consultative care management services work toward maximizing clinical outcomes by employing evidence-based, cost-effective interventions. We are pleased to announce that total client savings for 2018 surpassed $30 million. Here’s how that total breaks down:
HOW IT WORKS: CLIENT CASE STUDY
Background: ReAssure is a cost-containment program designed to help Summit Re clients ensure their members receive the most appropriate care at a fair price. To accomplish this, claims that meet a cost threshold for individual members are submitted for review prior to payment. Clients electing to implement ReAssure may realize cost savings in three ways: 1) a premium discount from participating in the program, 2) savings on its first-dollar claim obligations based on audit findings, and 3) a higher coinsurance for reinsurance claims.
Client experience: A Summit Re client agreed to include the ReAssure program in its 2018 reinsurance treaty. The ReAssure program requires that all inpatient claims over $100,000 paid be referred to Summit Re’s preferred vendor for a bill review prior to payment. The bill review focuses on billing errors, unbundling, etc. If the bill review identifies potential savings and the client pays the claims based on the bill review recommendations, a higher coinsurance is paid (if the reinsurance deductible is exceeded). The bill review vendor fees many also be submitted as an eligible reinsurance claim expense (if the deductible is exceeded).
This client submitted a total of 265 bill reviews that included potential savings. The client paid the claims as recommended by the bill review vendor for a total net savings that surpassed expectations.*
*The ReAssure program bill review is anticipated to result in a net savings of 10% due to billing errors, unbundling, etc. This client realized a net savings of 21% and ultimately decided to lower the trigger threshold to send claims for review to $50,000 going forward.
THE BOTTOM LINE:
Summit Re worked collaboratively with this client’s claims department and the bill review vendor to set up processes to pend claims for pre-payment bill review and refer them to the bill review vendor. There were many interactions along the way as we refined workflow and communication to streamline and customize the process to meet the needs of our client. The overall ROI net savings realized exceeded expectations and Summit Re and the client anticipate even greater savings in 2019.