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Ancillary Benefits Management

One seamless solution

Connects and integrates all ancillary medical vendors and services
Centralizes and improves the claims experience
Enhances cost containment capabilities
Ensures transparent and consistent pricing
Drives effective management of the entire ancillary service process
Enhances performance management through insightful analytics and key metrics

Motivation for a New ABM Model

Ancillary benefits account for over 40% of workers’ comp medical spend, but managing these products and services is often challenging due to:
A multitude of vendors to manage across various products and services
Variable pricing and little visibility into cost drivers
Lack of reliable data to measure performance and outcomes
Disparate systems and inconsistent processes for claims professionals
Heavy IT resource and procurement burden for payers
Waste caused by inappropriate services and over-utilized codes
Frequent changes in vendor ownership
Network coverage gaps
Service disruption and inconsistent quality of care

Ancillary Services, Simplified

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Healthesystems has designed a unique end-to-end technology and services solution, bringing all ancillary vendors together, to more effectively and efficiently:

1.

Connect

A single platform connects all vendors for an integrated, flexible, fully vetted and transparent supply chain network, along with the tools to efficiently manage the entire ancillary medical service cycle – from first referral to final billing.
2.

Manage

A single platform for claims professionals, built on a foundation of evidence-based clinical logic and transparent pricing information that drives consistency, automation, and right-time support into the claims process to help adjustors make decision that will ultimately reduce costs, increase efficiency, and improve health outcomes.
3.

Monitor

Performance management is made easy through our blend of self-service reporting and consultative insights on industry benchmarks, vendor comparisons, key metrics, and outlier activity that signals potential waste and abuse. These insights help inform strategy, drive continuous improvement, and contain costs.
4.

Adjust

A rigorous vendor assessment and ongoing monitoring process evaluates network vendors’ costs and clinical capabilities, allowing data-driven adjustments to advance strategic objectives for optimal performance, pricing, and outcomes.

Removing the Resource Burden

The procurement and implementation of the multitude of ancillary vendors and services involved in the care of injured workers places a tremendous burden on workers’ compensation claims organizations. Healthesystems simplifies this entire upfront effort by taking on the market analysis, vetting, and contracting of these vendors - as well as establishing technical real-time connectivity with them. Our ABM customers enjoy access to a number of quality vendor networks without the associated procurement or IT burden.
Durable Medical Equipment
Home Health
Electrotherapy
Translation
Transportation
Home & Vehicle Modifications
Physical Medicine
Orthotics & Prosthetics
Implants
Diagnostics

Learn more about how we evaluate and partner with ancillary vendors through our Connected Partner Program

Healthesystems’ ABM Program Advantages

Reduced total ancillary medical costs
Empowered and improved experience for front-line claims staff
Optimization of claims staff resources and time through smart automation capabilities
Lower operating overhead for managing and connecting vendors
Transparent, consistent, and effective pricing
Ability to easily change vendor mix and reduce risk of service disruption
Fewer appeals and bill resubmittals while ensuring all bills are accurate and appropriate
Safe, effective, and appropriate care
Easy performance management with data-driven insights and key metrics to inform strategy

ABM Resources


Diagnostics as a Defining Touchpoint in the Claims Journey

How the timing and accuracy of diagnostic testing can determine the course of a claim.

Dec 2022


Diagnostics As a Defining Touchpoint in the Claims Journey

Timing and accuracy of diagnostic test results can determine the course of an injured worker’s treatment plan and the claim

Winter 2022-23


Telemedicine Patterns of Use and Reimbursement

A WCRI report explores telemedicine utilization.

Jul 2022

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Request a demonstration of our ancillary benefits management technology and service solution today

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