{"id":682,"date":"2020-09-29T21:27:19","date_gmt":"2020-09-29T21:27:19","guid":{"rendered":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/?p=682"},"modified":"2022-08-04T17:05:52","modified_gmt":"2022-08-04T17:05:52","slug":"utilization-management-helps-self-funded-plans-contain-healthcare-costs","status":"publish","type":"post","link":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/utilization-management-helps-self-funded-plans-contain-healthcare-costs\/","title":{"rendered":"Utilization Management Helps Self-funded Plans Contain Healthcare Costs"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"600\" src=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2020\/09\/Contain-Healthcare-Costs.jpeg\" alt=\"Two surgeons operating on a patient while wearing yellow face masks\" class=\"wp-image-683\" srcset=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2020\/09\/Contain-Healthcare-Costs.jpeg 900w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2020\/09\/Contain-Healthcare-Costs-300x200.jpeg 300w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2020\/09\/Contain-Healthcare-Costs-768x512.jpeg 768w\" sizes=\"(max-width: 900px) 100vw, 900px\" \/><\/figure>\n\n\n\n<p class=\"leading\">From all projections, U.S. employers should expect their healthcare costs to rise in 2021. &nbsp;Self-insured and fully-insured plans could see their premiums increase between 5-6% according to projections by the consulting firm of Willis Towers Watson. &nbsp;Factors that will influence their premium increases include: the potential of new COVID-19 waves, the costs of a vaccine or therapeutic agents, and the effectiveness of policies deployed to mitigate the virus\u2019 spread.<\/p>\n\n\n\n<p>Self-funded plans could be especially hard hit by rising health care claims next year. &nbsp;Willis Towers Watson projected that self-funded plans could incur a 7 percent increase in health care claims in 2021 if many of their workers are hospitalized with COVID-19. &nbsp;There are options and tools that self-funded plan sponsors can use to help contain their healthcare costs in 2021. &nbsp;It\u2019s important that plan sponsors carefully weigh their options and take advantage of proven cost-containment tools such utilization management.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Options and Tools for Self-Funded Plans<\/h2>\n\n\n\n<p>For instance, self-funded plans can choose not to waive their members\u2019 cost-sharing for COVID-19 treatment inclusive of deductibles, co-insurance and co-pays for treating COVID-19. Electing to do so would be understandable given the severe economic impacts many businesses incurred as a result of mandated lockdowns. Weighing into their decision will be the costs associated with treating COVID-19. Willis Towers Watson\u2019s cost analysis provides a look at some of the costs associated with treating a COVID-19 patient. They include:<\/p>\n\n\n\n<ul><li>Approximately $250 for patients with mild cases<\/li><li>An estimated $2,500 for patients with moderate cases<\/li><li>Approximately $30,000 for patients with severe cases requiring inpatient hospital stays<\/li><li>Costs approaching $100,000 for catastrophic cases requiring intensive care<\/li><li>Other costs include COVID-19 tests ranging between $50 and $95 dollar per test, costs for test administration at $100 if performed in a doctor\u2019s office an up to $1,000 if performed in an emergency department depending on the geographic region, and additional care outside of an inpatient facility at an average cost of $4,000<\/li><\/ul>\n\n\n\n<p>Keeping these high costs in mind, many self-funded plans turn to experienced providers of utilization management to apply evidence-based criteria and guidelines.&nbsp; These guidelines determine the medical appropriateness of care and patient-setting factors, consider level of care determinants, and apply quality of care parameters. &nbsp;This holistic approach is designed to promote the optimum utilization of healthcare resources and promote maximum cost containment. &nbsp;Mitigating risks and helping to ensure compliance with regulatory mandates is also a key function of utilization management.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Choose Utilization Management Providers Wisely<\/h2>\n\n\n\n<p>Not all providers of Utilization Management services are alike. &nbsp;Self-funded plan sponsors should seek out providers with a proven track record serving a wide range of self-funded plans including those held by unions, trust funds, ERISA plans, state programs, businesses and associations. They should offer:<\/p>\n\n\n\n<ul><li>An experienced team of registered nurses and physicians overseeing comprehensive clinical services and settings<\/li><li>Service available on a 24-hour basis with the ability to \u201cwrap-around\u201d the utilization<\/li><li>Accredited to URAC standards<\/li><li>In compliance with Department of Labor standards for ERISA self-funded plans<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>From all projections, U.S. employers should expect their healthcare costs to rise in 2021. &nbsp;Self-insured and fully-insured plans could see their premiums increase between 5-6% according to projections by the consulting firm of Willis Towers Watson. &nbsp;Factors that will influence their premium increases include: the potential of new COVID-19 waves, the costs of a vaccine&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[14],"tags":[],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/682"}],"collection":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/comments?post=682"}],"version-history":[{"count":2,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/682\/revisions"}],"predecessor-version":[{"id":997,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/682\/revisions\/997"}],"wp:attachment":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/media?parent=682"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/categories?post=682"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/tags?post=682"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}