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

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

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.

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.

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.

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.