4c health blog the prudent perspective

The Prudent Perspective

NETWORK COSTS

What You Don’t Know, Will Cost You

It’s something I hear near-daily: be it a private sector or a government run health plan, the cost of health care is crippling. Businesses routinely cite healthcare costs as the second largest expenditure and the single-largest cost driver while state governments bemoan Medicaid and Medicare as the single largest budget line item increase.

This past January, with great fanfare the Department of Justice announced the recovery of $2.5 billion dollars associated with fraud and improper claims from healthcare providers the prior fiscal year. The significance of $2.5 billion in recovered dollars is certainly notable, but the enthusiasm dims a bit when the other side of the equation is considered. Said differently, 2018 was a fantastic year to be in the business of healthcare fraud.

Last year our country’s total estimated healthcare spend was a record-breaking $3.5 trillion. According to the FBI, healthcare fraud, waste, and abuse is the fasting growing segment of white-collar crime, accounting for 10-15% of all healthcare spending. Using the FBI’s conservative estimated of 10%, there’s $350 billion in fraud, waste, and abuse—of which $348 billion wasn’t accounted for in 2018. There’s no business that would accept having only .7% of the dollars wrongly distributed, returned. Again, 2018 was a fantastic year to be in the business of healthcare fraud.

Shouldn’t healthcare be managed like any other business cost center? C-level executives have long-embraced the value of data-driven insights when considering cost drivers. Yet in healthcare—despite the vast data produced—employers are provided with minimal insights and few actionable tools to deal with key cost drivers.

4C Health Solutions has developed a fully-independent health spend platform, delivering industry-first visibility into the true cost of healthcare breaking down where every dollar has been spent.

What is your claims data telling you when it comes to:

  • The effectiveness of your payment integrity efforts
  • How effective is your plan design
  • What can be done to improve employee health
  • Is there a better way to prevent disease-related costs

Health vendors go through great lengths including contractual terms shielding payment and quality-related data. These common health vendor business practices reflect the misaligned incentives forcing employers to accept the status quo of ever-rising healthcare costs.

The current health spend ecosystem isn’t built to provide these answers. Fortunately, 4C knows how to take your health data, and deliver the answers to these questions and many more using our 4Clarity solution.

With great insight comes even greater power. What’s stopping you from having 4C help provide the true insight into how your plan is performing from every angle of the ecosystem, including members, providers, costs and outcomes—and the real power to enact change?

by  
February 22, 2019