Apr 09, 2024
Targeting High Spend Areas to Drive Down Cost
When patient populations are afflicted by similar ailments, Point C can work with specialists to reduce costs while maintaining high-quality care.
Case Study Overview
Musculoskeletal (MSK) diseases (muscles, ligaments, nerves,tendons, etc.) have steadily increased globally due to increased workplace pressure, improper posture, poor fitness, and varied health habits. The global MSK market is roughly $58 billion of spend and is growing at more than 5% annually, especially among older individuals.
The Challenge
A school district in western Wisconsin with an aging population faced significant cost increases annually due to its aging population. MSK claims had become the highest medical spend category, with annual spend upwards of $1.5M. Furthermore, members could select any provider for elective orthopedic procedures, which substantially varied the cost of the same procedure across different patients.
“By establishing a pre-authorization requirement and utilization review for orthopedic procedures, MSK spend decreased $750k in the first year…”
The Solution
BPA worked with the school district to build a self-funded plan focused on a cost containment strategy for MSK claims. Utilizing vendor MDDirect, district employees obtained pre-authorization for elective orthopedic procedures. MDDirect guided patients through an efficient and cost-effective treatment process, giving recommendations on care and preferred providers, with surgery only being used as a last resort.
Result
By establishing a pre-authorization requirement and utilization review for orthopedic procedures, MSK spend decreased $750k in the first year and moved from the 4th highest expense category to the 1st and saved the school district 50% on MSK claims over the prior year. Spend per patient dropped from $5,800 to just over $1,400 all while maintaining high-quality of care.