Evergreen
Re provides and administers managed care reinsurance programs
for health plans -- including Medicare and Medicaid plans -- in
more than 45 states. We also provide a wide spectrum of risk-reduction
products and services designed to protect your bottom line.
Reinsurance
As the largest
managed care reinsurance brokerage firm in the country, Evergreen
Re helps health plans and other managed care organizations throughout
the country protect their capital and cash flow from catastrophic
claims.
Working
closely with Reden & Anders, an actuarial and consulting
firm with the largest proprietary managed care database in the
country, we have developed a series of tools to help you find
the precise balance. Using some of the most comprehensive and
sophisticated data analysis models in the industry, we can help
you determine the right mix of reinsurance and capital to make
those important decisions. We then place custom-designed coverage
that helps you keep risks – and costs – under control.
We also
offer Shared Stop Loss, Treaty and Quota Share programs as well
as Captives and other Risk Retention Programs for managed care
organizations and providers.
For a free
analysis of your current reinsurance contract, please email
abischoff@evergreenre.com.
Top
Predictability
Tools
Optimal
Reinsurance Program™
This is one of our primary value propositions we use to help
us select the reinsurer or product that offers the best value
to the customer. The Optimal Reinsurance Program™ was developed
in conjunction with a leading, national managed care actuarial
firm. The components of this program include:
- Theoretical
Reinsurance Analysis™. With a thorough understanding
of the evolving nature of risk faced by health plans, the
purpose of this analysis is to enable health plans to optimize
the combination of capital and reinsurance (covered services
and retention) to achieve 95% confidence of maintaining their
current surplus level at the lowest total cost of protection.
- Coverage
Structure and Marketing. We don't simply provide information
to reinsurers, we package data in a proven format to maximize
insurer response and competitiveness. We then utilize our
broad access and significant leverage to help ensure our customers
get the most efficient coverage available.
- Net Cost
Analysis. Recognizing that gross premium expense is not nearly
as important as plan predictability and net cost of catastrophic
transfer, Evergreen Re developed this analysis to determine
the relative value of competing insurer (coverage) proposals.
- Optimal
Reinsurance Analysis. This analysis marries the results of
the Theoretical Reinsurance Analysis with the Net Cost Analysis
to point to the most efficient level of reinsurance. It enables
final decision-making around the health plan's "appetite"
for risk and surplus protection, including risk based capital
goals.
Top
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 Rx has saved health plans and other pharmacy benefit payors more than $199 million in pharmacy costs through our contracting expertise, market knowledge and buying leverage. More importantly, these savings do not come from either formulary change or benefit change, but strictly a result of more favorable contracting.
Evergreen Rx, AHIP’s Pharmacy Consultant Solutions Partner, uses proprietary tools designed by our pharmacy team to help save clients between $8.74 pmpm for fully marketing their Pharmacy Benefit Management (PBM) contract to more than $3 pmpm when we simply renegotiate an existing PBM contract.
Representing more than $2.4 billion in pharmacy spend, Evergreen Rx is uniquely poised to help clients evaluate their current PBM contract, compare it with other similar contracts, review contract compliance, billing errors and provide ongoing management to insure compliance.
Additionally, as art of the ongoing consulting management services, the Evergreen Rx professionals identify opportunities for savings through the constant movement of product in the industry – the introduction of new drugs and drug technologies, the movement of brand drugs to generic to over the counter.
| Evergreen Rx was ahead of the industry in advising and making operational the coverage of Prilosec OTC for our clients – saving one Medicaid health plan client $4 pmpm months before any of their competitors. |
High-Cost
Biologics & Pharmaceuticals
Typically
chronic disease patients make up less than 1% of your health
plan members, yet they represent 25-30% 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
Top
Managed
Care Provider Excess
Evergreen
Re can help your organization determine if you have the right
type and the appropriate level of provider excess loss coverage
at the lowest total net cost. As risk-bearing organizations
take on many of the responsibilities and risk from health plans,
our client services staff can help make sure you eliminate slow
payment of claims that threaten solvency and destroy cash flow.
Top
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.
Top
Managed
Care Professional Liability
In an increasingly
hard insurance market, with unrelenting exposure to litigation,
Evergreen Re can help you identify alternative solutions available,
including best managed care errors and omissions insurance as
well as liability insurance for the directors and officers of
healthcare and managed care organizations.
Top
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.
Top
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.
Top
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.
Top
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.
Top
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.
Health
Plans & Insurers
