Medical Cost Containment

Control Costs Before They Escalate

Point C approaches cost containment with a more coordinated strategy. We help employers manage their healthcare spend deliberately while supporting greater alignment across the plan.

Dot-pattern graphic illustrating claims selected for review
Smiling man in front of Point C branding on a gold background.

Not every administrator approaches claim review the same way.

For employers evaluating partners, the difference often comes down to whether the TPA is simply moving claims through the system or actively helping manage the plan.

Traditional TPA

  • Focuses primarily on claim processing.
  • Pays many claims as submitted unless an issue is obvious.
  • Extends limited scrutiny of high-dollar claims.
  • Offers less support during renewal planning.
  • Provides fewer tools and insights to guide client discussions.
  • Creates service experience that feels more reactive and transactional.

Point C

  • Integrates claim processing with payment integrity review.
  • Flags claims for deeper review based on thresholds and billing indicators.
  • Applies targeted high-dollar claim review and repricing strategies.
  • Looks for opportunities before or during payment.
  • Helps reduce avoidable spend at the point of adjudication.
  • Builds cost containment into plan administration.
Coworkers reviewing cost containment options.

For many employers and brokers, this is where the evaluation changes.

The question is no longer whether claims are being processed, but whether the plan has the right level of oversight for what gets paid.

Discover the Point C Difference
Solutions

Point C focuses on what drives the claim in the first place.

Care Management

Engage members earlier to address high-risk conditions before they become higher-cost claims with:

  • Nurse-led outreach during critical moments of care
  • Support for complex diagnoses and treatment plans
  • Improved follow-through and care coordination
  • Intervention before conditions escalate into catastrophic claims

PBM Analysis and Oversight

Identify pharmacy cost drivers and opportunities for greater transparency with:

  • Evaluation of PBM contract terms and rebate structures
  • Identification of cost inefficiencies and pricing gaps
  • Ongoing monitoring of pharmacy trends
  • Alignment between pharmacy strategy and overall plan performance

Utilization Management (URAC Accredited)

Ensure care is appropriate, necessary, and aligned with evidence-based standards with:

  • Earlier identification of eligible high-cost claims.
  • Alternative funding pathways when appropriate.
  • Member support throughout the process.
  • Greater visibility into specialty drug costs.

What Gets Billed and What Should Be Paid Are Not Always the Same

Medical costs can also rise when claims are billed incorrectly, priced inconsistently, or paid without the level of review a self-funded plan requires.

Point C integrates payment integrity, medical claim repricing, and high-dollar claim review so employers can actively manage self-funded medical spend.

Smiling man in front of Point C branding on a yellow background.
Solutions

A Stronger Approach to Cost Containment Starts Earlier

Point C creates a different kind of value, not just by reviewing what has already happened, but by helping reduce the circumstances that could lead to unnecessary spend in the first place.

Consumer Driven Products Care Management Pharmacy Solutions

Frequently Asked Questions

What is medical cost containment in a self-funded health plan?

Medical cost containment is the set of strategies used to reduce unnecessary medical spend in a self-funded health plan. It often includes payment integrity review, medical claim repricing, high-dollar claim review, and identification of billing issues that affect what the plan pays.

What is payment integrity in health plan administration?

Payment integrity is the review process used to help ensure claims are billed correctly and paid appropriately according to plan terms. It focuses on claims accuracy, pricing review, and avoidance of improper payments.

How does medical claim repricing work?

Medical claim repricing works by reviewing a billed claim and adjusting the payment amount when a different allowed amount is supported by the applicable methodology, plan terms, or claim findings.