Solutions for Managed Care Providers

We offer a wide spectrum of products and services for managed care providers that help protect and improve the bottom line.

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.

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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.

Managed Care Liability Coverage needs to be solid and without exclusions if it is truly going to protect healthcare organizations, as well as their directors and management, from experiencing serious financial loss. While multi-district litigation and class action exposure have driven a hard insurance market, managed care organizations can protect themselves from the onslaught of lawsuits and evolving exposures by implementing sound risk management programs, identifying potential gaps in existing insurance coverage and understanding their potential. Working with a specialized team of managed care liability experts, Evergreen Re is now poised to offer managed care organizations the broadest reach to insurance markets in liability exposure, including Directors and Officers liability (D&O), and Errors & Omissions.

Directors & Officers Protection
The business practices and decisions of health care boards of directors are constantly under intense scrutiny from regulators and the public and they can easily become the target for litigations from employees, providers, customers, vendors, creditors, competitors as well as government agencies. While a managed care organization is at financial risk when a D&O claim is made, the personal assets of the organization’s management team are also at risk. D&O insurance can protect managers against personal liability. Key D&O exposure includes anticompetitive acts, shareholder liability and mismanagement.

Errors & Omissions Liability
Traditional D&O protection does not address the most important managed care exposure area – claims arising from the day-to-day management of the health care provided to members. E&O liability coverage protects organizations when allegations of management negligence are made, including the exposure area of vicarious liability, credentialing, peer review, provider selections, utilization review and claims processing. All managed care organizations – from large health plans to small medical groups performing credentialing or utilization review for managed care plans – should have E&O coverage.

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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 proprietary 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.