Trend, value, and how we deliver

Every TPA will tell you they save their clients money while delivering great service. It’s a given. And it might even be true, for some of them. However, when you try to pin down specifics on that stellar service and savings, you might start to wonder just what it all means. What are the savings measured against? How can you judge service? How do we demonstrate that we’re delivering on both? The answer starts with trend.

What is trend?

Simply put, trend is the increase in the costs of claims over time. It is the amount of money our clients spend per person, year-over-year, and we are constantly working to find ways to reduce it. Now, there are many drivers behind increases in trend, such as the cost of prescription medicines, high-priced treatments for certain cancers, premature births, and growing populations with chronic conditions like diabetes. At Luminare Health, we track these drivers and find ways to reduce their impact for our clients.
 
The good news is that we’re very good at keeping our clients’ costs below trend. Over the past three years[1], we’ve managed to keep the medical trend cost for our clients at 1.3 percent, well below industry average of 6.5 percent. That translates to millions of dollars saved for our clients.
 

What we do

As a TPA, we work with clients to administer their self-funded health plan benefits, which can be an effective first step in reducing trend for many employers. Self-funding provides more control and transparency around health benefits spending, and removes the threat of an arbitrary blanket premium increase from a carrier each year. Instead, we work with employers to analyze their spend, their populations, and other factors to find out what is driving their costs---and how to keep them down.
 
One way to keep cost down is through accurate claims processing. We pay close attention to high-value claims, looking for ways to reduce charges. We take aggressive steps, beyond looking for duplicate charges and verifying member eligibility, including reviewing subrogation options, finding costly billing errors, and checking for inappropriate charges, even those hidden in a bundled procedures. All this high-touch scrutiny keeps our auto-adjudication rate around 65 percent, below the industry average, and yields an extra 15 percent in savings before network discounts[2].
 
We also explore ways to drive down costs through utilization and case management, or cutting-edge products like telemedicine, diabetes management, behavioral health support, and transparency and quality tools. For example, if a client has an aging population, we look at their data to see if investing in a diabetes management tool would make sense for the client.
 

What it means for stakeholders

For many reasons, employers today are hesitant to pass along costs to members. Through our work in identifying ways to control rising healthcare spending, we allow employers to continue to deliver competitive benefits for their health plan members. In turn, we’re helping to control member out-of-pocket costs as well, and providing them with increased value.
 
We’ve made great strides in the past three years to achieve these trend and NPS numbers, and we understand the need to keep working each day to find new ways to save our clients money while delivering improved value. Connect with us to find out how we can help you, too