As health care costs continue to rise and complex, catastrophic cases occur with more frequency, you need more than a network solution to address presenting cases that expose your benefit plan to runaway costs. You need a company that specializes in creating customized contracting solutions designed to reduce the financial risk associated with complex or catastrophic medical situations when patients receive care outside your current network. You need Mirador.
- The cost of health care rises at a rate of 10 percent or more per year.
- The number of cases greater than 1 million dollars has quadrupled.
- No one disease or type of health care service is solely responsible.
- Payors are relying on general purpose and specialty networks to manage the cost implications of these events.
- While effective, the complexity of these cases and the “migrational” nature of today’s well-informed health care consumer inevitably results in out-of-network utilization.
- Although infrequent, an out-of-network catastrophic case is financially devastating and can have a profound impact on your medical loss ratio.
Leukemia treatment that becomes an allogeneic transplant
A patient with a “surprise” diagnosis of leukemia needed a quick placement to a national cancer center. The case was referred to Mirador and a negotiation for chemotherapy services was initiated with a prominent cancer center that was not in network. The patient received seven months of chemotherapy treatments with total charges of
$195,000. Mirador negotiated a rate that saved the plan $40,000 and reduced its payable to $155,000 for these treatments.
During the course of treatment, the patient’s disease evolved to a point where the provider deemed an allogeneic hematopoietic stem cell transplant necessary. The patient was willing to proceed, but did not want to transfer her care to another center. Mirador negotiated, drafted and completed an agreement with the facility to obtain an all-inclusive case rate that packaged physician and hospital services for the transplant.
Billed charges for the transplant were $324,000. By application of the Mirador-negotiated rate, the plan only paid $184,000 for the transplant, saving $140,000. For the entire case, the plan’s savings, net of Mirador’s fees, were more than $150,000.
Call Re-Solutions to find out how Mirador’s services can be of service to you.