Innovative contract payments
Our nation-leading Alternative Quality Contract is changing the way we work with doctors and hospitals. Based on global payments with incentives for quality care, it's not only controlling medical cost trend, but also improving quality when compared to providers who are paid on a fee-for-service basis. That means lower costs for you and your employees.
Network is everything. Ours has superior access, flexibility, and cost control across our product line. In fact, our leading-edge network and utilization management gives us a 6.8 percent savings on average over our competitors on per-member monthly costs1.
Integrated care management
We offer comprehensive, integrated care management programs that target complex health issues and risks, which may ultimately help reduce costs. Some highlights include:
- A primary nurse model, in which a primary nurse for each member serves as his/her champion in achieving healthier outcomes
- Proactive case management for members with complex medical and behavioral health conditions
- Strong emphasis on preventive health through comprehensive, consultative wellness programming
Data-driven wellness programs
Help employees make the connection between their lifestyle and long-term health. We start with a detailed assessment of your claims to identify the specific modifiable health risks of employees. Together, we develop strategies and goals for your company as a whole.
For many municipal members, pharmacy benefits play a key role in their overall health. An integrated pharmacy and medical benefit has been shown to reduce ER visits by 12% and reduce admission rates by 19% while improving medication compliance by as much as 12%2.
Our pharmacy management business model focuses on promoting clinically appropriate utilization, negotiating highly competitive discounts, and using the most cost-effective delivery channel whenever possible. For example, we exclusively manage our formulary and it is not dependent upon rebates or ancillary funding from pharmaceutical manufacturers, allowing us to aggressively promote generic drugs. Based on 2013 book of business data, we have found that every 1% change in generic fill rate produces a 3.6% reduction in gross spend. The current overall generic fill rate for our book of business is nearly 83%.
Lowering costs. Reducing fraud.
Learn more about how we're improving claim accuracy and preventing duplicate payments, billing abuse, and fraud with
Blue Claim Recovery Advantage.