While there
are many savings realized through group programs, the continuous
advances in medical technology have increased the cost and frequency
of high-cost medical claims. Organizations are now looking for
ways to protect themselves from catastrophic and ever increasing
claim expenses through a variety of risk reduction products and
services.
Employer
Stop Loss
We help
self-funded employers, coalitions, insurers and funds determine
the most appropriate program to protect themselves against catastrophic
claims and unpredictable losses. Specific Stop Loss insurance
reimburses an employer for catastrophic claims incurred by a
plan participant above a specific deductible, while Aggregate
Stop Loss reimburses an employer for higher than anticipated
health care expenses incurred by all plan participants. We also
offer Shared Stop Loss, Treaty and Quota Share programs as well
as Captives and other Risk Retention Programs.
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Transplant
Management Programs
The volume
of solid organ and bone marrow transplants has doubled in the
past ten years, and the number of people on waiting lists has
tripled. With advances in medical technology and immunosuppressant
drugs, the rate of transplants is expected to increase significantly.
According to the Centers for Disease Control, the increasing
incidence of Hepatitis C alone is expected to increase demand
for liver transplants by 500 % by 2008.
Managed
Transplant Insurance
A
comprehensive carve-out program converts this unpredictable
and catastrophic risk to a flat monthly cost, allowing payors
to budget for claims evenly throughout the year. Additionally,
cash-flow advantages may occur as reinsurance recoveries from
transplant claims are eliminated. This is typically a first
dollar coverage with no deductible, but we can tailor the program
to meet individual needs, specific procedures, limitations,
out-of-network benefits and specific hospitals.
Transplant
Programs & Networks
With an average
claim cost of more than $300,000, the increased frequency of
transplants can quickly become a catastrophic expense for most
organizations. We can provide an innovative transplant program
that can help reduce costs, increase productivity and reduce
access fees. Our programs provide access to nationally-recognized
centers of excellence.
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Neonatal
Risk Programs
With the
cost of neonatal intensive care exceeding $8 billion a year,
we can help evaluate and secure emerging full or partial risk
transfer of catastrophic claims associated with premature infants.
Evergreen Re specialists can help identify best-class solutions,
from high-risk screenings to full case management, using an
analytical process to help you determine if the increase in
fiscal predictability that a neonatal product provides is cost
effective for your organization.
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Evergreen
Rx - Pharmacy Benefits Management Consulting
| Checking
Your Vital Signs |
|
With
all the innovative drugs, expensive pharmaceutical therapies
and new technologies available today, are you confident
your pharmacy costs won’t spiral out of control?
Is
someone auditing your pharmacy costs to make sure the
right people are getting the right drugs at the right
costs?
Is
your group getting back all the manufacturer’s discounts
that represent thousands of dollars to your bottom line?
|
If you answer
no to all or any of the above, you are not alone. Evergreen
Re can help you find a precise solution to help you control
pharmacy costs.Evergreen Rx PBM Process Guarantees Significant
Savings
Evergreen Rx, the pharmacy practice of Evergreen Re, uses propprietary
analytical tools designed by our pharmacy benefits practice
leader Ken Dowell to help clients evaluate their current Pharmacy
Benefit Management (PBM), compare it with other plans, as well
as review contract compliance and billing erros. This PBM vendor
management process can help clients save 8-13% of gross pharmacy
costs and has become a powerful negotiating tool at PBM renewal
time.
High-Cost
Biologics & Pharmaceuticals
Typically
chronic disease patients make up less than 1% of your health
plan members, yet they represent 25-30 percent of pharmacy costs.
With more than 100 biotech products currently available and
hundreds more in the pipeline, we have identified three areas
that payors can save money and protect their bottom line by
better management of these high-cost therapies:
- Lower
prices on biologics and injectible drugs
- Paying
only for the drugs used, with no over purchasing due to lot
requirements
- Early
intervention, adherence to therapy and prevention of complications
involving quality of patient care
- Last
year a health plan responsible for 85,000 lives realized a
savings of $640,150 or more than 27.7% of their chronic disease
pharmaceutical costs by using this specialty biologics and
injectible drugs program.
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Disease
Management
Evergreen
Re offers clients a special program designed to control costs
and manage Cardiac Disease, a health problem affecting 1 million
Americans, with 400,000 new cases every year.
With nearly
$107 billion spent on cancer treatment each year, we also offer
an Oncology Management program to assist you in increasing patient
satisfaction while helping to reduce unnecessary and redundant
costs.
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Advocacy
-- We Work For You
At Evergreen
Re we represent the interest of our clients first and foremost.
Whether your needs are for reinsurance or any of our other products
and services, we become your advocate and work with you to make
sure you have the right type and right level of coverage at
the lowest total net cost. Once we market your risk and place
your insurance, our goal is to make sure you thoroughly understand
your coverage, and use it to your advantage.
We not only
conduct a comprehensive installation and training program, but
will also help you prepare monthly reports, advocating your
position on difficult claims and following up with the insurer
to get your claims within 30-45 days, twice as fast as the industry
average of roughly 90 days. Bottom line, we provide clients
significant cash flow advantages resulting from timely reimbursements.
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Other
Solutions
Finite Reinsurance,
Treaty and Quota Share, Captives and Risk, Retention, Oncology
Management and Risk, Cardiovascular Disease Management, Specialty
Care Networks, Surety Bond, Client Advocacy Services, Claims and
Business Process Outsourcing, Claims Audits, Data Driven Services,
TPA Outsourcing, PPO and Indemnity Issuing Carrier, Subrogation
and other Third Party Liability, Fraud & Abuse Programs.
Business
Coalitions & Associations
