The Challenge

Commercial – Network-Based, Analytics-Based

To improve competitiveness, a regional provider-owned health plan needed assistance with:

  • Extending network access for its highly mobile membership
  • Containing out-of-network medical cost
  • Preserving its relationships and reputation with the local provider community

The Solution

MultiPlan structured a program combining national network access and provider-mindful reference-based pricing:

  • PHCS Network accessed selectively within the provider system’s service area
  • PHCS Network accessed nationally, outside the provider system’s home state
  • Data iSight pricing for claims not contracted by the system or MultiPlan

The Results

MultiPlan helped the system improve its competitive position while continuing to keep community at its core:

  • Savings generated on 98% of charges submitted
  • 65% of savings with plan member protections
  • 67% average reduction on claims not covered by networks
  • 99% provider acceptance of reference-based pricing results
Read the Case Study of how a regional provider-owned health plan saved with MultiPlan.