Receiving a transplant with a good outcome has never been more important since life-time benefit limits have disappeared. INTERLINK has been refining its credentialing processes for 20 years, and is recognized as the most sophisticated transplant solution in the United States. Other networks rely solely on past outcome measures, but INTERLINK has created an innovative Predictive Modeling Program which identifies transplant teams predicted to produce the best outcome surgeries in the upcoming 6 – 12 months. Developing your own customized Programs of Excellence network is complimentary through Re-Solutions.
With the INTERLINK Transplant COE program, you get:
- Access to nearly 80 of the nation’s finest transplant centers and teams
- Average transplant episode savings of 55%
- Affordable Care Act adjusted benefit language
- Accurate and fast transplant claims processing
- Transplant specific education which includes monthly Medical Roundtable webinars, waived tuition for the AATMC™ program and free Quick Reference Guides
A plan authorized their consultant to work with INTERLINK to create a “narrowed” network, or “performance based” transplant network for their members. The network building criteria stated that the plan’s network would consist of the top 5 predicted outcome transplant teams for each solid organ type. The consultant provided the plan with all the outcome information needed to easily design a network built upon medical excellence. To drive members to their custom built network, the plan added Exclusive Provider Organization (EPO) network benefit language provided by INTERLINK into the plan document at renewal.
After only one month into the new benefit year, the first transplant case entered into the redesigned plan benefit. The plan’s TPA and case manager received a call from a transplant center seeking authorization to perform a heart transplant. The patient was not known to need such services, so the case manager began to gather information from the transplant center. Although the transplant center had a case rate contract with INTERLINK, their heart transplant program did not meet the minimum criteria to be included in the Transplant COE Network.
Many nurses would shop around and find the lowest contract for the service, but due to the EPO language and narrowed network, the patient went to the Mayo Clinic, Rochester for an evaluation. The Mayo Clinic was able to determine that the patient just needed to have their medications re-adjusted and would likely make a complete recovery without a transplant. Think about the ROI this provided to the plan and member!
Although transplant frequency remains stable, the costs, outcomes and the risks have not.
Contact Re-Solutions to design your custom, high-performance network today!