MedBen partners with AWAC^® to manage medical risks

Managing the 2-5% of a plan's members that account for as much as 80-90% of its costs remains a major challenge for most TPAs.  But HCC Life's valued client MedBen, a benefits administrator in Newark, Ohio, that manages more than 150 plans, is taking an aggressive approach.

MedBen is using AWAC^®, a medical management firm located in Augusta, Georgia, that relies on proprietary technology and a team of specialist physicians to identify potential problems and opportunities, then deliver quick, responsive physician-directed management and negotiating services to improve outcomes and contain costs.

"AWAC is one of the vendors we use to contain costs," HCC Life President Craig Kelbel said.  "We've had a successful relationship with them for about four years, and we promote them to the TPAs we serve."

In fact, MedBen learned of AWAC through HCC Life.  "HCC Life had used AWAC to manage several large cases in which we experienced dramatic savings, and that caught our interest," said MedBen President Doug Freeman.

After hearing more about the company at HCC Life's Partnership Summit in the spring of 2007, MedBen asked AWAC President and CEO Dr. Rick Richards to visit their corporate office.

"We liked Dr. Richards' presentation, especially the idea of having 100% of our claims screened, so we decided to take a deeper look at the company.  MedBen then sent a team of employees to the AWAC office for a fact-finding tour.  They were very impressed and came back convinced that AWAC could deliver what it promised," said Freeman.

Electronic Claims Surveillance and Physician-to-Physician Engagement
AWAC downloads MedBen's claims, prescriptions and precertification data nightly and compares this data to more than 60,000 physician-produced algorithms. "The integration of our systems went very smoothly," Freeman said.

This data is reviewed the next day by one of the company's 11 board-certified physicians. These physicians are backed by a team of more than 100 board-certified consultants representing virtually every medical specialty.

"We're very impressed with the physician management and the doctor-to-doctor involvement AWAC brings to the table. We've never been exposed to that kind of service before," says MedBen's Vice President of Claims Jim Weisent.

PPO Discounts?
Unlike PPOs, whose prices often appear to be inflated before discounting, AWAC negotiates prices on a true-cost basis. Further, clients can access the company's nationwide network of 4,600 contracted providers without paying PEPM access fees. Over the past 12 months, AWAC savings over and above other in-place discounts have averaged 43%.

Capture First-dollar Savings with Pre-certification and Utilization Reviews
AWAC's URAC-accredited precertification and utilization review service, iProcert™, electronically interfaces with HCC Life and has achieved our elite status. iProcert also electronically interfaces with AWAC, so physicians can quickly review data and predict the need for:

• Pre-negotiations for services
• Case management
• Early discharge planning
• In-patient or out-patient long term care
• Disease management
• Cost containment

Better Case Management, Increased Savings
AWAC's iCare™ program uses a multidisciplinary team approach to case management. AWAC physicians monitor claims and precerts daily, so they quickly identify insureds who may need assistance.  The AWAC team includes:

• AWAC physicians and board-certified physican consultants
• Pharm Ds
• Registered Nurses
• Advanced Practice/Masters Level Nurses
• Registered Pharmacists
• Nutritionists
• Social Workers
• Rehab Specialists
• Physical Therapist
• Occupational Therapist
• Prosthetists

Hard Dollar Savings with Proven Disease Management Programs
AWAC's disease management programs are setting the standard in improving care and reducing costs. Over the years, they have garnered the following savings:

• Dialysis: 63% savings
• Cardiology: 38% savings
• Hepatitis: 46% savings
• Oncology: 29% savings (almost all claims were from PPO providers)
• Neonatology: 21% savings (almost all claims were from PPO providers)
• Coding Reviews: 55% savings
• Specialty Medications/Injectables: 40% savings

Preempt Expensive Care with iHealth
AWAC's iHealth wellness program provides age and gender-specific wellness guidelines to all employees.  In addition, it performs a gap analysis on the claims data and notifies employees and dependents when preventative screenings are due. Using claims data and health risk questionnaires, it also identifies insureds with certain chronic problems. A team of physician-directed bilingual nurses then proactively coaches and monitors insureds with these problems.

Shape More Effective Plans with Detail Reporting
The comprehensive data gathered through claims surveillance is used to create customized iReports. These documents integrate information on each plan into one web-accessible report that provides an overview of each plan's spending as well as breakouts on a wide range of parameters. The reports tell TPAs and groups just where their money is going and lets them shape their plans more effectively.

And, for more accurate underwriting of existing group renewals and new group quotes, AWAC clients have found tremendous value in AWAC's Expanded Attending Physician Statements (EAPS). "At the end of the year, many of our clients renewed their stop loss contracts. The EAPS AWAC provided received lots of attention and helped control stop loss costs," said Weisent.

Predicting the Future is Too Late
Although AWAC can do predictive modeling, AWAC actually renders predictive modeling obsolete, since AWAC reviews the claims before they are paid, and then uses a physician-led multidisciplinary team to do something, taking actions to lower costs and improve outcome.

Turn Your TPA into a Health Risk Manager
For more information on AWAC, visit www.AWAC.md or call Director of Marketing Jan Wiggins at (706) 855-0830.