Maria Todd can help you negotiate with self-funded employers, healthcare purchasing coalitions, association plans and labor unions. Read More
Self-funded employers and trade and labor unions account for 70% of the non-Medicare/non-Medicaid, third party payers. They contract for PPO “discounts” nationwide but on average, are paying roughly 2.6 times greater than what Medicare pays. Are you getting 2.6 times Medicare for your PPO reimbursements? While some pay less than Medicare and most pay far more, it varies by geography. It helps to know who pays what, to whom and where. That’s part of the insight Maria brings to hospitals, ASCs, physician groups, and integrated health delivery systems. This is a compelling argument for building a direct contracting strategy directly with the employer than through a TPA or PPO. You save them significant cash each month and still make more than through the PPO.
PPO networks charge access fees, a fixed cost of a group health plan, of $12-$20 pe/pm. On top of that they pay for claim repricing and claim processing to the TPA that ranges $2-3 per claim, and then an hourly rate for case management, disease management that is in the $125-$200 per hour range. Most hospital PHOs, MSOs, and IPAs, or ACOs, and Integrated health delivery systems can easily charge their discounted fees for service and bundled case rates coupled with a lower admin fee PE/PM than the PPO and save most self-funded groups a ton of cash!
AskMariaTodd to supply the plan administrator contact details for over 210,000 self funded employers and labor union health benefit plans, a fair and uncomplicated model contract template, and walk you through the process of contracting directly with employers and labor unions. After 2-3 of these deals, you’ll feel confident and have a portfolio of referenceable accounts that you can use to continue without her help.