We contract with clinics and hospitals to create customized networks of healthcare providers and facilities who have made a commitment to transforming healthcare. Under the current system, insurance carriers and large hospital corporations make decisions based primarily on profits. Our providers embrace a model that puts patient care first.

We’ve learned that when the health of the patient motivates decisions, the quality of the care delivered improves and overall claims costs are reduced. This mindset shift is a win-win for both the provider and the employer, since we steer employees to use our contracted facilities, driving solid business to their offices.

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Shared Reward Contracts in Practice

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Anderson Thornton consultants contracts with a group of clinics and hospitals who form a Clinically Integrated Network (CIN). An employer contracts with a Third Party Administrator (TPA) to administer their health plan. The TPA performs the functions you would expect an insurance carrier to provide, like paying claims, collecting premiums, and providing customer service. The CIN is installed as the preferred local network, sometimes in tandem with a larger national network for care outside the service area of the CIN. The employer’s plan is crafted to provide an incentive for employees to use the CIN. Employees and their families get excellent patient-centered care and, as claims are managed, the claim fund retains a surplus. At the end of the year, the CIN receives a portion of this surplus as payment for a job well done. Upon renewal, the group will likely receive a flat renewal or maybe even a rate reduction.

The plan is created so that if claims for any specific member exceed a predetermined threshold, then the employer’s liability for that claim stops and a reinsurance carrier pays the overage. If the claims for the whole group exceed the claim fund (meaning that claims management didn’t create a surplus), then reinsurance covers the difference.

Benefits of Shared Reward Contracts

Patient Care

  • Patients with chronic health conditions, who often create the most claims in a group health plan, are assigned providers to manage their conditions. Increased compliance encourages health care benefits for the patient and better, personalized care for the provider.
  • Providers are encouraged to provide smart and customized care, focusing on outcomes rather than simply provide services as quickly as possible.
  • Providers are encouraged to order the tests that are necessary, but discouraged from excessive testing for testing sake. This approach makes for a better care, focusing on the problem rather than following a checklist.
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Cost Savings

  • Employees pay less per visit, encouraging them to invest in wellness and preventive care.
  • Employer costs are reduced year-over-year as claims costs go down.
  • Networks are created based on proprietary data about provider quality, which helps to eliminate re-work and, therefore, to reduce costs.