The Health Rosetta is a blueprint for high-performance health plans. Components upon which a transformative health plan is built are:
Transparent Open Networks
Traditional networks essentially guarantee that payments made to facilities are paid out at the highest level. This matters because your premiums are based in part upon these payments along with the health risk of your group. The good news is there is a solution to the most vexing problem healthcare has had -- pricing failure.
Fair, fully transparent price to employer/individual at high quality centers who readily accept quality reporting such as Leapfrog.
Providers able to set a price that works for them while avoiding claims/collections hassles and accompanying receivables.
No charge for individual going to these providers. No EOBs, bills, etc. -- just a thank you note.
Patient Stewardship
Can your employees ‘shop’ for healthcare prospectively? Do they have a place to turn for help? Health Rosetta plans embed this into the program, meaning your staff have increased support, understanding, and the ability to make the best choices within the healthcare ecosystem. Having resources to help you navigate the system that can draw on expertise for quality and cost including understanding benefits plans, best provider options, etc.
Value-Based Primary Care
High Net Promoter Scores
Quadruple Aim leading organizations
Ounce of prevention is worth a pound of cure
Same or next day appointments for issues not addressed via email/phone
Extensivist (for the sickest patients) has smaller panel allowing proactive care management & coordination.
Can reduce issues 40-90% and spending 20-50%
Active, Independent Plan Management
“Our health plan does all that….” is perhaps one of the most damaging mindsets that people have with respect to their health plans, and oftentimes the person saying this doesn't know it to be untrue. Independent health plans work with, not against you, in controlling your population and premiums.
Fully-compliant ERISA plans that protect companies from abuse
ERISA fiduciary oversight and review at least as strong as 401k oversight and management
Use TPA networks focused on high quality providers and geographic coverage
Transparent Pharmacy Benefits
Provide transparency and control over Pharmacy Benefit Manager (PBM) services
Ensure members have relevant information to make informed choices
Ensure clinical decisions are based solely on efficacy and ACTUAL cost
Is a process that works on behalf of the purchaser’s best interests
Major Specialty and Outlier Patients
Procedures
Second opinions at no charge for employee at world class Centers of Excellence facilities (e.g., Mayo & Cleveland clinics)
Unit cost often higher but lower complication rates & avoidance of unnecessary procedures drives strong ROI
Due to the infrequency of these procedures (transplants, neurological procedures, cardiac, spine and other six-figure or more procedures), this pairs well with Transparent Medical Networks for more common procedures.
Acute diseases
Access to evidence-based and disease-specific care navigation, pathways, and treatment protocols
Highly coordinated care with defined handoffs between care providers
Simple access to high-quality providers with demonstrable strong outcomes
Non-physician care team resources facilitate ongoing management and support
Transparent Advisor Relationships
Creates a 3-5 year plan
Brings transparency to where the money is going
Talks about their compensation and is willing to tie compensation to performance
Provides risk management to suit the needs of the business owner(s)
NEVER surprises with a “shock” renewal rate
Returns control over your costs to you
Bring the “benefit” of Benefits back to your business
Makes this a real attraction and retention tool
Understands improving benefits is the only way to lower costs
Provides detailed data driven analysis and actionable insight