Adding cost containment programs to health plans help lower costs by identifying members with high-cost health care needs. We then work with members educating and steering them to network providers committed effective and efficient practices.
The Care Navigator program provides support to members to assist in navigating the complexity of healthcare and insurance. A Care Coordinator will provide members with the tools and resources to help manage their health.
Centers of Value
The NexUS Center of Value program works with specific facilities to provide medical services related to a range of treatments and procedures. These facilities have been identified in providing cost-efficient care. Members with comprehensive coverage have $0 out of pocket costs when receiving selected services at Centers of Value.
Members with a high deductible health plan must meet their deductible.
Behavioral Health Connect
The NexUS Behavioral Health Connect program is geared for high-cost, high-risk members for with behavioral health needs. The program works with specific facilities to provide behavioral health services through a capitative fee arrangement to members. Members have $0 out of pocket costs when receiving selected services at participating facilities.
PCN can provide utilization management that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis.
Referenced Based Pricing
As a cost containment strategy used for establishing optimal reimbursement rates for health care services, our Referenced Based Pricing solutions employers have saved more than 35% on average over a 5-year period.