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Why is there so much price variability in healthcare costs?

Many factors determine the cost of a given procedure and each individual’s therapy may be different. For example, two patients going in for the same procedure may have very different costs because one patient my require more anesthesia, lab tests or follow up care. Some physicians request more tests and some facilities charge more for their services. For examples, hospitals typically charge more for services than out patient clinics.

Why can’t I get this information somewhere else?

Acquiring this information from many different sources is expensive, time consuming and often difficult to do. We have found that some of the data available is incorrect, not customized to local hospitals or physicians and does not consider your company’s actual claim information.

What sets Alithias apart from other transparency information providers?

Alithias puts accurate price and quality information in the hands of the employee. There is no number to call and no waiting 7 – 10 days to receive a report. Since our data comes from physicians and the company’s own claim information, we know the information is the best available.

Is this a wellness program?

No. However, the Alithias program can help identify wellness needs and support any wellness initiatives.

What quality metrics do you capture?

We use multiple resources to provide users a well-rounded view of the quality of healthcare they should expect. At the hospital or health system level, broad quality measures, such as the institutions overall mortality rate, number of procedures performed, average length of stay for that procedure and complication rate are shown. The user can also see that institution’s scores as reported by the Center for Medicare and Medicaid Services (CMS) Hospital Quality survey. At the physician level, users can see verify a physician’s board certification, number of procedures performed and composite scores for quality and efficiency.

How do I know the quality measurements are accurate?

Quality metrics come from validated third party sources, such as the Department of Health and Human Services, actual claims data or from information provided by the physicians themselves. Comparative quality performance is established with data from nearly 4 million patients and over 200 million claims. Further, this data is “normalized” across all physicians, so that those physicians that treat larger numbers of difficult cases are accurately rated.

Where do you get your data?

Government agencies, third party information providers, claims administrators and our client’s actual claim information.

Is your data actual or projected?

Both. The data provided is based on actual healthcare claim information compiled from over 200 million claims. For some procedures where a client companies’ claims information is not sufficient to validate projected data, the projected data will be used. In some cases where there is either no or little data available, no information will be shown.

Is information available for all procedures?

No. While information is available for the most common procedures, not all procedures are shown. If you would like information about a procedure not shown in our database, contact your HR administrator.

Why aren’t anesthesia costs automatically calculated in the prices shown?

Anesthesia costs vary widely for each patient. We have chosen to show the range of anesthesia costs separately to provide the most accurate cost estimate. For example, some women request no anesthesia during childbirth while others may require it throughout their labor. For those procedures where anesthesia is not optional, those costs are included in the total estimated fee.

If my bill goes over the estimated cost, will I still receive the same rebate?

The rebate amount will stay the same regardless of the actual cost of your procedure. The estimated costs shown represent the range of costs a patient might expect for that procedure. However, actual costs may vary significantly based on your individual treatment needs. Cost is just one factor when making healthcare decisions. Where you choose to go for treatment is up to you. Your company is providing you both cost and quality information to help you make a decision that is right for you.

How do certain hospitals or facilities qualify for a rebate?

These providers were chosen because they offer the best combination of quality, cost and convenience for a given procedure. Many factors contribute to which facilities are eligible, including mortality, procedure volume, complication rate, overall quality ratings, average length of stay, and total procedure costs.

Is there a limit on the amount of rebates I can get in a year?

No. If you receive treatment at a rebate eligible facility, a rebate will be awarded. However, rebates are limited to the initial procedure and not subsequent procedures for the same condition within 12 months. For example, if you have a knee arthroscopy and receive a rebate, you can not apply for a rebate for an arthroscopy on the same knee for the next 12 months.

Why are rebates offered for some procedures and not others?

Your plan administrator chooses both the rebate amounts and which procedures will receive rebates. The procedures chosen and the rebate amount offered may depend on plan design, your company’s wellness needs or historic utilization patterns. The facilities chosen for rebate eligibility are selected because they offer the best combination of cost, quality, patient outcomes and convenience.

How do I receive my rebate?

After you receive care from a rebate eligible facility, simply bring the Explanation of Benefits (EOB) that is mailed to you from the plan to the [HR department]. Your company will [put the rebate amount into your HRA] [include the rebate amount in your next paycheck.]

Do I have to pay off my bill (co-pay/ deductible) before obtaining my rebate?

This will depend on your benefit plan design. Please ask your HR administrator.

Do I still need to call my insurance company to be sure they will cover my claim?

Your individual benefit plan may dictate which claims are covered. We recommend talking to your HR administrator or the insurance company prior to receiving care.

Are dental procedures included in this program?

No.

How can my company enroll in the Alithias program?

Enrolling in Alithias is simple. Call us at (855) 843 – 8783 and we will get the process started for you.

What does the program cost?

Program costs depend upon a variety of factors, including the number of employees enrolled, your company’s plan design, and the specific requirements of your TPA or Broker. In general, Alithias program costs are similar to other high value advocacy, transparency or wellness programs that are proven to reduce overall healthcare costs.

What creates a successful Alithias program?

Many factors contribute to the success of an individual program. Our definition of success is having fully informed employess actively engaged in making healthcare decisions. The benefit design of most high deductible health plans lacks two crucial elements: transparency with regard to price and quality, and a program that rewards employees for choosing from those providers that offer the best cost and quality.

Healthcare costs will only be controlled when employees are provided with the information and resources to engage in their healthcare decisions. We have found that the most successful programs have the following 5 things in common:

a) Executive commitment
b) Easily utilized tools
c) Accurate information
d) Aligned incentives
e) Effective communication

How does Alithias measure success?

Our success is measured by:

1) Reduced healthcare costs
2) Reduced premium increases
3) Reduced re-insurance premiums
4) Employee utilization of the program
5) Increased employee morale
6) Satisfied clients

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