Creativity is the name of the game when it comes to reining in continually rising healthcare costs!
Designed using Reference Based Pricing (RBP) methodology, ACS CostPlus provides total price transparency and payment for medical services based on the largest healthcare pricing system in the United States—Medicare.
CostPlus uses Medicare allowable amounts as a basis of cost and adds a multiple to establish a reasonable level of reimbursement for all hospitals and providers. In fact, 20% or more of Primary Care Physicians already bill at or below this reasonable level. This method of establishing reimbursement levels results in substantial cost savings to employers!
The perfect complement to a self-funded or consumer directed heath plan design, ACS CostPlus allows employer groups to:
- Preserve a competitive health benefits package
- More effectively manage benefits package expenses
- Reduce overall costs and expand benefits to employees
- Halt the increasing rate of inflation in medical costs
- Level the playing field across providers
Additionally, with CostPlus:
- Members can choose any provider
- “Out-of-network” area a problem of the past
- Average provider discount off eligible charges is 64%
Reasonable Reimbursement: Set at 150% of Medicare.
Per Employee Per Month (PEPM) Pricing: Subscription model vs. our competitions % of Billed Charges.
- Offer both full-replacement model and Facility only (PHCS as Professional Network)
- Ability to customize solutions by location using RBP and Network options
- Unique HRA Reimbursement model available for negotiated amounts approved by Employer
Years of Experience: Led to Product Refinement, Staff Expertise, Geographic Preferences.
Education/Communication: Customized Launch Plan and ongoing campaign.
Stop-Loss Partnerships: RBP-friendly reinsurers that understand how to price the product for maximum savings and coverage.
ACS’ balance bill occurrence rate is .06% - significantly below the industry average of 2%. In the rare instance this does occur, an ACS Patient Advocate will be there every step of the way until the issue is resolved.
The Proof Is in the Numbers!
Hospital Sets Price
Fair Reference Point Set by Medicare
As illustrated, in a traditional PPO plan, hospitals set their own price for a particular service as the billed amount, say $75,000, and the Plan negotiates down from there.
With CostPlus, the price starts at a fair Reference Point and is negotiated up from there – leveling the playing field for the patient, the plan, and the provider.
Actual client experience -
move from ppo to acs costplus rbp
Actual ACS Client Experience (Banking Industry) – Paid Claims