Direct Contracting

Education, Engagement, and Transparency

Why Patient PAL Direct Contracting?

 

It’s time to take back control of the health care dollars that you are spending! When you self-fund your health plan, YOU are the insurance company. It is your money and responsibility to seek solutions that empower your organization to better manage the health claim expense that traditionally rises year after year as “status quo”! Patient PAL Direct Contracting can significantly reduce your healthcare costs by “partnering” with Hospitals and Hospital systems in the geographic areas serviced by your employees. This “Exclusive Provider Agreement” gives you ownership to your health plan that brings the Physicians and Hospitals together as a unit. They are the sole providers that have been given the opportunity to show their worth by better medically managing your employees and their families’ healthcare. Our integrated medical plan is a solution that provides improvement in the quality of care that is administered while securing cost containment measures that large carriers are unable to deliver.

Direct Contracting

Claims Negotiation

High Touch Concierge Service

  • Patient Centered Medical Home accredited providers are the goal

  • Price transparency and reductions
  • Middle men are removed
  • Directly linked to the preferred hospital system(s) and their providers
  • During Transition Stage, Patient PAL achieve immediate extra saving by reviewing and renegotiating pended 2018 claims:
    • Over $50,000 for In-Patient Hospital Stays
    • Over $10,000 for Out-Patient Services
    • All Out-of-Network Claims
  • 24/7/365 Access to Patient PAL Specialists
  • Personalized end-to-end care for all inpatient and outpatient procedures with 30 day follow up
  • Navigate to find the BEST Physician, Specialists, Hospital, and Facilities
  • Resolve issues with medical billings
  • 80+% outbound calling from Patient PAL Specialists to members

Remove Your Medical Insurance Carrier

Patient PAL Direct Contracting Services replace medical insurance carriers and includes

Provider Partner Establishment

Plan Design and creation

Claims Processing via TPA

Stop Loss Insurance Management

Analytics – Data and Benchmarking

 

Patient PAL Direct Contracting eliminates the need to contract with Medical Insurance Carriers. With this custom network option, Self Funded employer groups could see savings up to 40% on healthcare costs in your first year alone with Direct Hospital Contracting!  Patient PAL has the relationships with Hospital systems across the country and is the leader in this model. Patient PAL will provide the claims payment process, medical management and the plan document that will outline the benefits that will enhance your health care offering while producing diminished costs.

 

Education

Engagement

Transparency
  • Develop plan document
  • Facilitate and schedule open enrollment
  • Enroll patients with Primary Centered Medical Home Physician 
  • Patient disease Management review
  • Review contracts and payments process for ALL claims
  • Review Cost summaries and financial incentives 
  • Bid Stop Loss Premium