Quantify Health will lower the cost of healthcare by at least $150 per member per year

Works for health plans, TPAs, stop loss carriers, reinsurers, and self-funded employers

E.g., for an org with 100,000 members, we will save $15M/ year

 

Shared-savings model where the client keeps 70% of the savings and we get 30% – no other costs involved

Last year we delivered $160 million+ in savings (avg. 23% savings)

Contact us below to get started or email us at info@quantifyhealth.co

Thanks! We'll be in touch soon.

Selected clients (mobile).png

The Problem

  • Quantify Health addresses overcharging by providers in two key areas: High Cost Claims and Implants

  • High Cost Claims:

  • High Cost Claims (hospital claims with a payable of over $100,000) are the number 1 strategic healthcare priority for self-funded employers according to a Mercer survey

  • Hospitals are overcharging through several techniques, e.g., charging for 48 hours of ventilator usage in a 24 hour period, continuing to charge at the higher trauma ICU rate even after the patient has been moved to regular ICU, etc.

  • Medical Implants:

  • Medical Implants (e.g. artificial knees and hips, plates, screws, rods, pins, stents, pacemakers, etc.) typically represent half the cost of an average surgery

  • Hospitals and  surgery centers are overcharging through different techniques, e.g., by supplying a doctored invoice with inflated pricing, charging for more implants than were used, etc.

The Quantify Health Solution

  • Our proprietary process identifies overcharging from the provider and works with the third-party administrator (TPA) and provider to correct it and charge only the appropriate amount

  • We have different solutions for High Cost Claims and Implants, but they work in a similar way

  • This happens “pre-pay”, i.e., we identify the overbill before it’s paid out – so the employer/ payer only pays the correct amount

  • Contingent-based shared savings mode, where we charge you 30% of the actual realized savings based on the difference between the original allowed amount and the repriced amount

  • Last year we delivered total savings of over $160 million (average savings per claim of 23%)

  • Our solution works for self-funded employers, health plans, TPAs, stop-loss/ reinsurance carriers, captives, and worker’s comp carriers 

Financial Impact

  • Quantify Health will save the employer/ payer/ reinsurer over $150 per US employee per year

  • These are direct savings to the bottom lines of self-funded employers, health plans, reinsurers, and captives - and for TPAs can provide additional impact to their self-funded employer clients

Capture.PNG

Five key differentiators

  •  We deliver average savings of 23% on high cost claims and implants

  • Our reviews are performed by nurse practitioners and physicians with expertise in specific areas such as oncology, neonatal, transplants, etc.

  • Forensic review includes a deep analysis of medical records, which takes tens of hours

  • We build an incredibly detailed 5-20 page report with strong supporting medical evidence

  • Once the claim is paid, we proactively reach out to hospitals to address pushback/ appeals

Getting started

  • For TPAs/ health plans/ stop loss carriers: We start with a free preliminary analysis of 3-5 claims and then run the full forensic review to deliver strong savings

  • For employers: We start with an opportunity analysis by requesting the last 12 months of claims data (no PHI) and come back with the savings potential

  • We would both sign a BAA (happy to sign your format once we review it) and our contract (which can be canceled at any time with a 30-day notice)