PATH Consulting

Insurance is driven by the “law of large numbers.” That means as healthcare purchasing groups become larger, they have a greater ability to provide health insurance to their employees in a way that both reduces costs and improves quality.

RMP’s subsidiary, PATH®—Purchasers Alliance for Transforming Healthcare—has developed a program that is superior to the traditional way of purchasing health insurance. It is specifically designed for large organizations that seek to increase their shareholder value by taking control of future healthcare costs.

PATH Services

• Identifying Self-Insurance Opportunities
• Insurance Premium Management Services
• Self-Insurance Success Consulting

What level of cost savings can a large organization expect with the help of PATH? Click here to find out.

PATH to Identifying Self-Insurance Opportunities
A critical question for healthcare purchasers at large organizations is whether they should self-insure or purchase insurance. The larger an organization, the more predictable their payments become for health benefits. By self-insuring a portion of the health benefits risk, an organization can obtain certain economic advantages including savings in administration, overhead, profit, and reserve costs.

PATH can help an organization apply the principles of risk management to its healthcare program, advising on the appropriate level of self-insurance, as well as helping to purchase insurance when needed. In this way, PATH helps drive dollars to the bottom line for our clients.

PATH to Insurance Premium Management
As an employer’s group size gets larger, it is entitled to certain financial data and medical claims reporting from insurance carriers. Using this financial summary information, PATH can help provide direct savings to both fully and self-insured organizations by:

• Verifying that the correct claims are used as the historical basis for premium determination.
• Testing assumptions used to set “incurred but not reported” (IBNR) claims that are factored into premiums.
• Reviewing trend/inflation factors used to set premiums.
• Verifying the stop-loss premium and recoveries that reduce expenses.
• Negotiating administrative and commission funding.
• Reviewing historical membership used to set base experience rates.
• Comparing the manual rate assumption for the benefit package chosen with alternative carriers.

PATH to Self-Insurance Success
Minimizing the amount of medical expenses withdrawn from self-insured funds is the key to self-insurance success. PATH helps our self-insured clients succeed by analyzing medical and pharmacy claims data, assessing the risk, and recommending appropriate ways to intervene. Such interventions will not only reduce costs, but also often result in improved patient care. These improvements include:

• Implementing disease-management intervention programs to improve quality and reduce costs.
• Identifying potentially high-cost conditions before they occur—such as high-risk pregnancies—and intervening to prevent adverse outcomes.
• Conducting large case analysis and concurrent management of high-cost conditions—such as diabetes, asthma, congestive heart failure, and depression—before they reach catastrophic levels.
• Reviewing pharmacy utilization data to identify such factors as high-volume and high-cost drug usage, individual physician’s use of antibiotics, beta-blockers usage for post-myocardial infarction patients, etc.
• Providing network analysis and physician profiling to identify efficient providers and address systemic problems, such as inappropriately high surgical rates.
• Conducting quality analysis using national measures and standards, such as HEDIS and Leapfrog.

PATH proposes to use this data retrospectively, concurrently, and prospectively to manage the risk and minimize loss. Click here to see a PATH Sample Report.

Find out how you can take control of future healthcare costs.