DENVER--(BUSINESS WIRE)-- BridgeHealth Medical, Inc. today announces the launch of Early Indicators, a revolutionary product that allows employers to identify through a HIPAA-compliant data transfer those plan members who are on the path to major surgery and will benefit from early detection, action steps that allow for education about the surgery, and the utilization of quality provider options. As the nation’s premier provider of Surgery Benefit Management (SBM), including medical travel services to high quality surgical Centers of Excellence (COE) at significantly lower prices, BridgeHealth again takes the SBM lead in controlling costs for major surgeries related to cardiac, orthopedic, spine, vascular and cancer care, thereby reducing financial risk for employer organizations of all sizes.
“When employers complain about the high costs of surgery and related expenses, with the recurring theme ‘I didn’t see it coming!’ – we can now empower them with a solution for anticipating these costs and taking action,” says Victor Lazzaro, CEO of BridgeHealth, noting that the U.S. Department of Health and Human Services reports that surgical costs represent by far the largest component of U.S. healthcare spending at approximately $700 billion, or 31 percent of the $2.3 trillion U.S. annual medical spend. “Even more troubling is a report from The Rand Corporation and Dr. John Wennberg at Dartmouth which document that as much as 30 percent of surgical procedures are medically unnecessary.”
Early Indicators uses a specific, limited extract of a group’s current claims data—along with a highly sophisticated, proprietary predictive model — to accurately categorize plan members into various probability groups, identifying and stratifying the likelihood of required surgeries. These identified groups are then addressed with specific initiatives for each probability tier so that both the health plan and its members benefit from early identification and intervention.
“The cost of unnecessary surgery is highly problematic to employers,” adds Lazzaro, citing a study from The Thomson Reuters Healthcare Analytics team which estimates that approximately $30 billion is spent annually by commercial health plans for overused procedures including coronary artery bypass graft, percutaneous coronary intervention, hip and knee replacement, Cesarean section, hysterectomy, transurethral resection of the prostate, disk surgery and spinal fusion, and implantable defibrillators. “If even one third of these procedures is unnecessary, the study would suggest waste of $10 billion, and that’s simply unacceptable.”
Lazzaro explains that The Thomson Reuters MarketScan Database includes claims data for almost 18 million people -- representative of the healthcare experiences of employees of the largest U.S. employers -- and provides significant evidence in this category of healthcare waste. The results were then applied to estimate the cost for these procedures for the entire commercially insured population.
“We designed Early Indicators to address this persistent challenge, and work closely with a plan administrator to define, gather and receive member data -- claims, diagnoses, pharmacy -- from the health plan on a frequent basis,” says Lazzaro. “BridgeHealth then parses the data to identify and stratify members who are on the path to major surgery before the surgery takes place and its related costs are incurred. A summary of the findings is given back to the plan administrator with identified members and an agreed-upon action plan for follow-up.”
In partnership with the administrator’s medical and case management functions, BridgeHealth appropriately reaches out to plan members with education, advocacy and options for potential surgery. Results of the Early Indicators program are returned to both the plan administrator and sponsor on a monthly and quarterly basis, respectively.
“We are already generating wide receptivity for this groundbreaking product that can deliver material results to employers,” says Lazzaro. “Forewarned is fore-armed, and this new approach offers a much-needed boost to beleaguered bottom lines.”
About BridgeHealth Medical
BridgeHealth Medical (BridgeHealth) is the premier provider of Surgery Benefit Management including medical travel services to high quality surgical centers of excellence at significantly lower prices, founded with a vision “to create a trusted bridge to the world of medical care.” BridgeHealth offers both US domestic and international networks and serves health plans, insurance carriers, employers, third party administrators, individuals accessing benefits via voluntary benefits plans, health and affinity card programs or Consumer Directed Health Care Plans (CDHP), and individual consumers seeking medical travel options. Visit www.BridgeHealthMedical.com.
CONTACT:
CPR for BridgeHealth Medical
Katelyn Petersen, 201-641-1911 x 18
[email protected]
KEYWORDS: United States North America Colorado
INDUSTRY KEYWORDS: Surgery Health Hospitals General Health Managed Care
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