The rising cost of healthcare in the United States leaves consumers feeling helpless, but there are ways to gain control. John’s story is a great example.
John’s Story
John needed a full knee replacement and expected it to cost a fortune. According to his research, the typical cost of the surgery alone was $40,000 to $60,000 — not including physical therapy, post-surgery visits and potential complications.
Fortunately, John researched alternative providers that participated in a bundled service program he had heard about in his employee benefits meeting and was relieved — within 20 minutes of his house was a nationally recognized surgery center that participated in the bundled services program. A flat rate including the surgery and all post-operative care, including physical therapy was available and was considerably less than the cost of the surgery alone at providers that did not participate. John still had to meet his deductible, but a cash incentive from his employer for using bundled services would help offset his out-of-pocket expense.
Knowing exactly what the total cost of the surgery and all follow-up care would be, John scheduled his surgery immediately.
Why utilize a provider offering bundled services?
Bundled services allow patients to receive the best care while saving on medical costs. Rather than paying for each part of a large medical procedure separately (hospital stay, operation, post-operative therapy, follow-up office visits, etc.), bundled services provide all stages of medical care for a specific surgical procedure at a fixed price. Employees know upfront the total cost of getting all the care they need. Additionally, most bundled services are guaranteed for a predetermined time period (90 days on average). When services are provided in a bundle, the focus is on the outcome, rather than the different pieces along the way. A member is paying for a fixed shoulder or a replaced knee, rather than paying a fee for every service received. The goal of bundled payments is to increase quality and care coordination.
For employers, bundled services substantially lower out-of-pocket expenses, providing savings of up to 50% over standard contract rates. Since employers save significant amounts of money when a provider participating in a bundled service program is utilized, they can consider providing employees with benefits like cash incentives for taking advantage of these plans.
Benefits of HPS for Bundled Services
John is one of many employees with a Health Payment Systems (HPS) benefits plan that has saved money with bundled services.
Benefits of HPS bundled services include:
- Concierge program — Easy appointment scheduling (optional and included in many bundles)
- SuperEOB consolidated billing — Exclusive to HPS, this is a single, comprehensive, easy-to-understand monthly statement of all in-network providers’ bills and related claims, requiring only one payment, regardless of the number of providers seen
- Easy claims process — This process remains the same for the employer (all bundled costs flow through the third-party administrator and stop-loss carrier, contributing to the stop-loss insurance deductible and minimizing annual total out-of-pocket exposure)
- Ability to offer cash incentives — Employers working with HPS often use some of their cost-savings to offer incentives for employees who use bundled services
- Best cost and care outcome — With HPS, employers can provide employees with the best cost and care outcomes using bundled services (e.g., waiving the deductible and coinsurance)
With HPS, it’s possible to have bundled services that provide access to nationally recognized, high-quality providers, simplified billing and reduced healthcare costs. Contact us today to learn more!
HPS is a Milwaukee-based health care technology and services organization offering solutions to enhance the consumer billing and payments experience, while driving value to health care providers, health insurance companies and employers. HPS’ patented solutions include its comprehensive independent provider network in Wisconsin and a single consolidated statement of medical services for patients.
