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Successful cost containment in Workers Compensation and Auto is based on achieving a few key results:

  • The best medical savings possible at any given time, without surrendering patient outcomes, provider relations, and market reputation;
  • Defensible savings; and re-pricing partners willing and able to deflect liability resulting from their work;
  • The lowest cost and complexity possible for achieving the goals above.

To achieve these goals, you need the ability to:

  • Implement your own choice of partners.
  • Have a direct relationship with your partners.
  • Negotiate directly and freely with your partners.
  • Implement and manage a large number of vendors
  • React to market and legislative conditions by:
    • Changing the routing of bills quickly, easily, and inexpensively.
    • Changing partners quickly, without impacting internal systems and processes.
  • Keep operations simple and cost low despite increasing the number of vendors available and the resulting more complex routing possibilities for bills.

In short, you need to build a solution that's tailored to your needs at any given moment, without putting an impossible burden on IT for vendor implementations and custom coding required to manage and route bills differently. 

Dr Bill Exchange provides these capabilities in the easy-to-implement, low cost and low risk manner you need.

What are your other options, and how do they compare to Dr Bill Exchange?

  • Internally-developed point-to-point transaction interfaces, plus custom software to handle the management and routing of bills each time changes to vendors or processes occur;
  • Major re-pricing or re-pricing software vendors that offer one-stop-shopping and a single connection to a limited and virtually static set of vendors chosen more for the intermediary’s revenue parameters than your performance needs;
  • Smaller bill review companies with highly manual processes that (necessarily) tend to do everything within their four walls.
  • Dr Bill Exchange.

So how do these stack up?

 

 

Point-to-Point Internal Solution

Major BR Intermediary

Smaller BR Service

Dr Bill Exchange
Choice of partnersFair to very good.  No business model limitations.  Limited by your own and your prospects' technology capacity.Poor.  You get what you get, and additions are difficult and slow, if possible at all.Poor.  You take the standard offering.

Excellent.  There is no limit;  vendors are attracted by other payers as well as you; very fast to add vendor if not already on the Exchange. 

Direct relationship with partnersExcellent.

Fair.  You have some access, but in the end the vendor has more at stake with the intermediary than any one payer. 

 

Good, in a limited sense, since they are doing the bulk, if not all, of the work directly.    Excellent.
Set terms directly with re-pricing partnersExcellent.

Not good.  Your intermediary has a large stake, since they are taking a percentage, and they control the relationship. 

 

Good, in a limited sense, since they are doing the bulk, if not all, of the work directly.    Excellent.  Dr Bill only contracts for the management and delivery of bills – the business relationship is the big contract.
Implement and manage more vendorsVery poor.  It is not practical to implement and manage bills from more than a handful of partners.

Not likely.  The intermediary’s revenue model offers disincentives to this.  Systems not built to support this, either. 

 

Not likely.  Lacks both capability and desire.Excellent.  Unlimited.  Powerful tools for bill management.  No implementations on your part at all.
Change bill routing quickly and inexpensively

Very poor.  It is not practical to frequently change bill routing among partners. 

 

Some offer limited, and complicated, changes among existing vendors.No, and usually nothing to change.Excellent.  Simple and powerful tools, with built-in rules.
Change partners quickly with low internal impactPoor.  A partner is often a partner for life, regardless of changing effectiveness.

Mixed.  Not bad among current vendors, if any alternatives are available.  If not, negotiating and implementing the addition of a vendor, will be slow,  but internal impact should be relatively low. 

 

Poor. Since you are often not getting access to an additional partner, the issue is often moot.Excellent.  Change your routing plans.  Add a custom rule if necessary.  Even if the vendor is currently not online, a few weeks with no cost to you.
Keep operations cost low while increasing sophisticationPoor.  Every vendor has different tranports and schedules.  Bill routing changes require lead time and expense.  More controls, emergency recovery capabilities, etc. are required.Fair.  Operations should be simpler.  But increasing sophistication at all is a battle.  And cost is certainly not low.Moot.  You are not buying sophistication here.

Excellent.  A single interface of your choosing.  You set your schedule.  We cover you and your partners on lost or duplicate files.  Reduced controls, excellent operational reporting and customer service. 

 

Overall Medical Savings ImpactInitially excellent but limited to key areas.  Over time, not predictable, but limited for full portfolio of bills.

Depending on the size of your organization, these may be considered ‘standard’ or ‘average’ at any given moment.  No real incentive to adapt and improve.

 

Varies widely at any given moment and for any mix of bills.  On average, probably not as strong over a wide geography as the bigger intermediaries. Excellent.  It is as good as you choose to make it, and easy and inexpensive to improve incrementally. You can react quickly to address potentially negative developments.
Overall Cost ImpactAfter expensive initial implementation, reasonably low for existing partners.  But still significant, and the cost of making changes is usually very high.Expensive. Very significant intermediary fees;  typically a base rate plus a significant cut of every vendors’ savings.These are usually manually intensive operations, which are expensive by nature.  Offset by offering largely core functions and not much more.

A low transaction fee, regardless of how many re-pricing vendors your bill might visit.  Starts significantly lower than other alternatives.  Will go down over time as Exchange volume increases.   

 

 

There really is no comparison.  Dr Bill Exchange has an unfair advantage – it was conceived and designed specifically to meet these goals (and create a level playing field for performance-oriented vendors of all sizes and types).  Its business model is designed to support all its members, payers and their vendor partners, harmoniously and economically.  Its use of sophisticated value chain implementation software architecture and design makes previously impossible solutions not just possible, but easy.  We also recognize that in the business of managing and delivering medical bills, all of this sophistication means nothing without the commitment to make every customer’s experience the best possible every day.

 
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Going to Boston?

... for the RIMS conference?  If so, we'd like to see you in person.  We will be in town on April 26th and 27th.  Call us at 800-827-0281 x902, or write us at info@drbillexchange.

Thanks For Visiting

We are the leading independent, open market service managing and moving medical bills and associated information between insurance payers and business partners such as re-pricing vendors, analytics vendors, and government.  We already work with some of the largest household-name insurers, PPOs, and specialty vendors in the U. S., delivering optimal medical savings, simplified processes,  better operational information, streamlined operations, improved customer service and expense savings.

Allow us to Show You

The Dr Bill Exchanges are modern and powerful tools used by medical bill payers and their re-pricing and analytics vendors.  Contact us soon to learn how you can get better control of your business and achieve the outcomes you want.  Write  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it  or call 800-827-0281 x902.

Random Note

Payer Benefit: Payer Flexibility

Dr Bill makes it easy for payers to assemble and operate a best-of-breed national re-pricing program.  And change it quickly and easily as legislation and landscape changes.  Don't get trapped into in one-size-fits-all, limited (and/or captive) partners.  Dr Bill is the only realistic open market, neutral third party solution available in medical bill re-pricing.

 

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