Promoting health among members can help lower claims costs and improve overall health, reports the International Travel & Health Insurance Journal. Author David Healy outlines a few key findings as to how the international private medical insurance (IPMI) industry handles claims-related costs.
1. Active management
Insurance providers are taking an active role in helping patients manage complex medical issues. Insurers that have the means to do so are monitoring their patients' treatment plans to make sure they receive the appropriate amount of care, according to the International Travel & Health Insurance Journal.
For costly diabetic patients, insurers are keeping a watchful eye on their patients to ensure they don't miss appointments or forget to fill up prescriptions, FierceHealthPayer previously reported.
During the final stages of care, costs can add up. That's why Aetna's Compassionate Care Programme (CCP) informs patients and their family members on all options available for end-of-life care, hoping to make members comfortable and prepared. The CCP has significantly reduced the number of acute hospital stays and emergency room visits.
Many companies are jumping on board with wellness programs to get employees healthy and keep them healthy. The programs educate members about health and provide healthy strategies for their day-to-day lives--such as nutrition education, smoking cessation workshops and behavioral health sessions. By expanding or starting wellness programs, companies hope to cut medical costs by improving their employees' health.
3. Prospective claims reviews
Fraud is an important factor when determining claims-related costs. By analyzing claims during various stages of the payment cycle, insurers can make sure payments are reasonable and legitimate. States already have taken measures to avoid such risks. Massachusetts recouped $2 million in six months and avoided paying hundreds of thousands of dollars by using predictive modeling to fight fraud, FierceHealthPayer previously reported.
Detecting irregular claims from the get go will allow insurers to reduce claims costs over time, the International Travel & Health Insurance Journal noted.
- read the International Travel & Health Insurance Journal article
Engage moderate-risk members to lower costs
Insurers keep watchful eye on costly diabetic members
Wellness programs improve health, cut costs
Companies increasingly embrace wellness programs to cut costs
Predictive analytics catch fraudulent claims