By Curtis Beharry
Vice President Evergreen Re Client Services

At Evergreen Re, we have always provided a great deal of assistance to our clients in the management of healthcare expenditures.  The success of these services has led us to the development of a more formal platform -- Pathways – to help complement and enhance our clients’ existing medical management programs.  Unlike other brokerage firms, Pathways provides aggressive cost-management strategies designed to help clients control risk and support quality outcomes.  These services include:

• Access to the Evergreen Re Pathway Transplant Program
  As the demand and cost of transplants continues to increase across the country Pathways Transplant Program offers our clients a combination of quality and cost effective care. The Pathways Transplant Program has access to 132 adult facilities with 461 programs and 86 pediatric facilities with 244 programs.
  
  
• Claims Repricing & Negotiations
  Evergreen Re offers access to network facilities – including scores of smaller, regional and specialty PPOs offering dramatic savings --  capable of meeting the health care needs of your members.  Our technology-enhanced ability to identify and work with partner PPO networks throughout the country, we can make affordable healthcare available to members who require care out of your service area at significantly improved discounts.
  
  
• Hospital Bill Audits
  Evergreen Re provides cost savings opportunities to identify bills for auditing or negotiations for In-Network, Out-of-Network and Out-of-Area hospital bill types. The process starts with a prescreening of a claim for a comprehensive review for auditing/negotiations for both PPO and non-PPO over the certain threshold amounts.
  
  For Medicare claims, the audit performed includes all claims that contain a straight DRG to see if the billed services are valid and acceptable.
  
  
• Neonatal Care Management
  The program offers NICU staffs advance clinical perspective that can help resolve complicated problems and decisions in the management of neonates. Functioning as a “Virtual NICU”, the program panel of board-certified neonatologists and neonatal nurses work in a collaborative manner with the NICU hospital staff and the health plan’s Medical Director to manage the complete plan of care to facilitate appropriate treatment and successful discharge. 
  
  
• Pharmacy Benefits Consulting
  Evergreen Rx’s managed pharmacy program is designed to help health plans, insurers and self-funded plan sponsors evaluate, analyze and implement proven measures to secure and maintain the most cost-effective, quality prescription drug benefit program currently available. 
  
  
• Social Security Advocacy
  Evergreen Re’s Pathways offers clients access to our expert disability advocates and attorneys who are dedicated to navigating the complex Social Security disability application process for your members with disabling conditions.

For more information about Pathways, please email me at cbeharry@evergreenre.com.