Objective, Transparent, Defensible
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1 Data & Quality Driven Cost Containment: Objective, Transparent, Defensible Presented By: Scott Ray Chief Executive Officer Heath Potter Senior Vice President 1
2 HISTORY & FOUNDATION FOUNDED IN 2012 Independently Owned Team of Industry Experts INTEGRABLE & COMPREHENSIVE SOLUTION Specialty High Dollar Cases (Prospective) Cost Containment (Retrospective) SOLUTION BUILT ON QUALITY & DATA Objective, Transparent, Defensible Lowers Provider Controversy 2
3 RBP KEYS TO SUCCESS CUSTOMIZE YOUR SOLUTION No One Size Fits All Select a Reimbursement Methodology that Fits YOUR Market EXPLOIT CONTRACTING OPPORTUNITIES Overlay a Specialty Care Network for Complex Care Direct Contract with High Volume Providers LEVERAGE TECHNOLOGY Increase Cost & Quality Transparency Contract from a Position of Knowledge PROACTIVE DISPUTE RESOLUTION Settle Cases with Difficult Providers Self Fund Your Legal Utilize Local Legal Counsel When Necessary 3
4 CUSTOMIZE YOUR SOLUTION WHAT WORKS? WHAT CAN BE IMPROVED? Identify Your Pain Points Consider Alternative Approaches WE SUPPORT MULTIPLE REIMBURSEMENT METHODS Facility Repricing on Medicare Multiple or Reasonable Value Physician Only Network or Complete Network Elimination WE INTEGRATE WITH YOUR PARTNERS 6 Degrees Adjusts to your TPA s Capabilities Medical Management, Pre-Cert, and Member Advocacy Programs Planned Surgery Programs etc. 4
5 EXPLOIT PROVIDER CONTRACTING 6 DEGREES SPECIALTY CARE SERVICES Transplant Network Extensive Complex Care Contracting and Claim Experience A Combined 40+ Years Staff Experience in COE Networks A Combined 30+ Years of Hospital Negotiating Experience EXPERTS IN HOSPITAL FINANCE 6 Degrees Understands how Hospitals Think about Pricing Facility Repricing on Medicare Multiple or Reasonable Value 5
6 LEVERAGE TECHNOLOGY 6
7 LEVERAGE TECHNOLOGY 7
8 MEDIVI DEMONSTRATION 8
9 MEDIVI DEMONSTRATION 9
10 MEDIVI DEMONSTRATION 10
11 MEDIVI DEMONSTRATION 11
12 MEDIVI DEMONSTRATION 12
13 VENDOR COST MODELING 13
14 PROACTIVE DISPUTE RESOLUTION FLEXIBILITY We Adjust Dispute Resolution Services to Match Plan Risk Tolerance We Adjust Appeal Support Depending on TPA Involvement ULTIMATE PLAN CONTROL 6 Degrees Experts Can Manage the Dispute Resolution Process Plan Involvement in Problem Cases is Encouraged LOCAL LEGAL COUNSEL We Strongly Believe in Legal Counsel Licensed in the Applicable Jurisdiction Counsel Works for the Plan, not the Plan s RBP Vendor = Control 14
15 SOLUTION STRATEGY SUCCESS SOLUTION RBP Narrow Networks Direct Contracts Large Claim Repricing OON Transplant, COE and Specialty Networks Custom To Plan and Market STRATEGY Transparent & Clear Analytics Through MediVI RBP and/or Benefit Driven Cost Containment Support & Modeling Tool SUCCESS Win & Retain Clients Reduce Medical Spend, Bridge The COE Gap, Reduce The Noise Objective Transparent Defensible Fair and Reasonable Fee Structure Significant Impact On Total Medical Spend Copyright Degrees Health, Inc. All Rights Reserved 15
16 Heath Potter, MBA Senior Vice President Ext. 102 Visit us at NW Compton Drive, Suite 208 Beaverton, OR (503)
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