Benefit 
Health Advisor
 

Improving

Healthcare


A commitment to the patient 


As care becomes increasingly more complex, utilization becomes more expensive, and adherence to

evidence-based medicine drops, the risk for inappropriate

and ineffective care

in some of the most

cost ly and complex

diseases is higher

than ever. 


Benefit Health Advisor is committed to improving the efficacy, safety, value, and appropriateness of care delivered by

seeking out the right

combination of

physician expertise

and sophisticated

technology in their

cost management

partners and

programs.

Claims Cost Management Strategies

Quality + Cost + Outcomes


By including a program in your benefits plan that focuses on the specific needs of the patient, you not only ensure all patients receive the correct treatment and appropriate quality of care, you also eliminate the unnecessary costs that provide little or no benefit to the patient. Benefit Health Advisor knows that a focus on improving outcomes will naturally result in safe, cost effective, quality care.



Overview of Programs


Comprehensive Oncology Care: This program provides a clinically accountable solution focused on promoting cost-effective, safe, and integrated care management for patients living with cancer. The cost of cancer-related care is about $366 billion and continues to rise every year. Engagement with patients and caregivers to provide support and identify resources that improve care is a good starting point to assist the more than 1.5 million new cancer cases that are diagnosed every year. Ongoing surveillance of claims for appropriate quality and cost of care includes prospective or retrospective review of treatment by a certified oncologist, peer-to-peer consultations as required, dedicated case managers, integrated care reports, cost containment strategies, and billing and coding review for errors, edits, and duplicates.


Comprehensive Kidney Care: This program focuses on patients affected by chronic kidney disease. More than 26 million people have CKD with millions others at elevated risk, representing over $59 billion in healthcare expenditures. The program includes identification of the risk population, clinical review of patient medical status and ordered treatment for alignment with national guidelines and prescribing standards, review of claims and ongoing surveillance for appropriate quality of care, billing and coding review, one-on-one health coaching, and physician review of claims, labs, and prescriptions.


Comprehensive Cardiovascular Care: This program focuses on patients affected by cardiovascular disease. Cardiovascular disease, including heart disease and stroke, account for more than one-third of all deaths in the United States and the costs of these diseases are estimated to be $444 billion. The program includes prospective review of patient medical status and proposed procedure, determination assistance of intervention, and clinical review to ensure alignment with the proper treatment, all helping to manage the costs related to heart disease.



Benefit Health Advisor has saved clients significantly by proactively finding ways to manage high cost claims. BHA’s commitment to quality, cost, and outcomes continues to serve clients well as we promote care management programs, direct negotiation with providers, and other unique and innovative approaches designed to reduce healthcare costs and improve quality and outcomes. This approach allows us to be accountable to the patient, provider, and plan.