Using Evidence-based Guidelines Produces Significant ROI for Health Plan

That healthcare costs are escalating is news to no one. That there are proven resources to help reduce costs—without compromising the quality of care—might surprise a number of insurers and employers.

Missouri-based Cox HealthPlans, like most insurers around the country, was searching for a way to ensure consistent, high-quality care to its 40,000 members while keeping the cost contained. The company turned to the Milliman Care Guidelines^® to help determine the best medical practices and set the most effective standards of care.

In the first year of instituting the Care Guidelines, Cox HealthPlans saved $159,000 by recognizing the appropriate level of care in inpatient and recovery care. In January, Cox HealthPlans added General Recovery Guidelines and Behavioral Health Guidelines products from Milliman Care Guidelines. One of the members of the nursing staff has a background in mental health issues, and he urged the need for the Behavioral Health Guidelines. In just the first few months of instituting that product, Cox HealthPlans realized a savings of nearly $200,000 in payments for medically unnecessary levels of care.

Click on the download link at right to learn how Cox HealthPlans reduced unnecessary costs without compromising quality of care.