Case Study: Retaining important business

The Challenge

Commercial – Analytics-based

Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by:

• Significantly improving savings for the employer and its members
• Engaging important providers in the new process
• Preserving the community’s provider-patient relationships

The Solution

Claritev strategically combined network access with reference-based pricing:

• PHCS Network access to preserve existing member relationships with their healthcare professionals
• Data iSight pricing to deliver fair, consistent and transparent pricing of hospital and other facility claims

The Results

Claritev’s revised solution delivers greater savings on more claims:

• 10-point improvement in savings
• 8-point increase in charges reduced
• Guaranteed member protections on 62% of claims reduced, compared to 0% with Medicare-based pricingContent here