Changing the Value Equation in Healthcare

4C Health Solutions believes self-insured employers deserve more from their healthcare plan. 4C works with employers to halt the trend of rising costs and eroding value in healthcare by empowering employers to gain real access, true insight, and proactive control over their claims data—independent of any third party.

4C delivers self-insured employers the only direct path to measurable value.

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Optimizing All of Healthcare’s Major Cost Drivers

Eliminate Fraud, Waste, and Abuse

A C-Suite executive wouldn’t keep his job if he knowingly allowed costs to increase 10% without accountability. Yet up to 10% of healthcare spend, or $200 billion, is lost to fraud each year, with only $15 billion reclaimed since 2009.

4C breaks the destructive pattern of healthcare fraud, waste, and abuse by providing self-insured employers an unprecedented level of insight into their claims data, along with the ability to affect change co-adjudication, pre-payment. That means employers can flag potentially fraudulent claims when they are made and preempt payment before funds become nearly irrecoverable.

How much are wasted or fraudulent claims costing your business today?

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spendingIn the U.S. up to 10% of healthcare spend, or $200 billion, is lost to fraud each year.

Datameer

Reduce Network Costs

Real costs exceeding projections are sure to earn a testy call from the CFO. What if the CFO knew that out of network treatment bills are 118% to 1,382% higher than what the federal Medicare system is billed.

4C helps employers identify and embrace opportunities for meaningful network improvements by understanding how out of network care is affecting their costs today, tracking their network costs against going market rates, and gauging provider popularity and performance. As a result, employers can take targeted steps to optimize network design by eliminating low-performing providers and bringing in those with superior accountability and outcomes.

How effective is your current network design, and how can you better optimize it for lower costs and greater value?

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treatmentOut of network treatment bills are 118% to 1,382% higher than what the federal Medicare system is billed.

America’s Health Insurance Plans

Enhance Disease Management

Boards and CEOs continually seek to define key cost drivers and implement controls, recognizing the bottom line impact on quarterly results. Why then are the 90% of healthcare costs associated with controllable chronic conditions routinely ignored.

The majority of medical costs are attributable to chronic conditions and diseases that must be continually managed by the members they affect. The more a chronic condition advances, the greater its negative impact on member quality of life and plan costs. 4C provides employers the meaningful insights needed to identify and make timely interventions that improve member adherence and enact disease management programs tailored to the needs of their network.

How can you make timely interventions to prevent avoidable, disease-associated costs?

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spending 90% of healthcare costs are associated with chronic conditions that are often controllable.

Center for Disease Control and Prevention

Improve Member Wellness

Key data in areas like finance and supply chain play a critical role in delivering information used by key decision makers. But what about employee wellness? With 93% of surveyed business leaders stating employee health has a significant influence on productivity, it’s clear that healthcare has big bottom line implications for your business.

Happy employees are high performing employees. By enabling employers to uncover timely trends and needs within their populations, 4C empowers them to design targeted wellness programs focused on enhancing health and quality of life for workers and their families. As a result, employers can facilitate a high-performing culture of wellness—all while reducing healthcare costs.

Are you empowered to design programs that support employee wellbeing and productivity?

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treatment93% of surveyed business leaders said employee health has a significant influence on productivity.

Health Enhancement Research Organization

Uphold Compliance

It’s well known that fraud, waste, and abuse within an employee retirement plans is illegal, as governed by ERISA, exposing corporate fiduciaries to personal liability for financial and legal penalties. Few fiduciaries realize the same level of risk exposure exists via employee health plans.

It’s more than an employer’s right to know what’s happening with their claims data. It’s also their fiduciary responsibility under ERISA law. By providing real-time assurance that benefits are being managed properly and documenting compliance every step of the way, 4C enables employers to ensure conformity with ERISA and strengthen their roles as corporate fiduciaries—all while protecting members, corporate reputation, and the bottom line.

Are you upholding your fiduciary responsibility under ERISA?

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spendingCorporate fiduciaries can be held personally liable for financial and legal penalties under ERISA.

From Our Blog

 

March 20, 2019

The Informed Customer is Always Right

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March 15, 2019

4C Health Solutions: Employer-Centered Focus on Health Care Costs Drives New Website

Twitter

The accused "concocted an elaborate scheme to exploit the U.S. health care system by targeting Medicare beneficiaries, paying doctors for prescriptions, paying kickbacks and bribes..." #healthcare #fraud #medicare https://t.co/ePqtKMhnTY

The 'black box' has enabled the health payment ecosystem status quo to thrive, creating an environment of confusion and restriction with little to no room for improvement. #healthcare #costs #insights #transparency https://t.co/f9V0k1Q7yb

"Employers continued to see moderate health benefit cost growth of 3.6% in 2018, but projections of a 4.4% hike this year would be above the consumer price index and employees' earnings growth, a new Mercer survey warns." #healthcare #employer #insights https://t.co/lCcJUtLsFj

4C Health Solutions is excited to announce the launch of its newly redesigned website. #healthcare #costs #transparency #insights #employers https://t.co/fUf32fMPoN

“Patients are becoming wiser consumers, and much more empowered consumers..." #healthcare #artificialintelligence #costs #insights https://t.co/KtzsjARvXu