Mechanicsburg, Pa., brokerage and TPA Benefit Design Specialists has specialized in self-funded plans for years, and now the firm has taken its business to the next level with a medical management program. A little over 18 months ago, BDS launched Keep It Simple Surgery, or KISx.
Employees of participating groups can use the KISx Card to call BDS before any elective surgery and BDS will connect them with the best facility for them, aiming for a surgery center within 30-50 miles of their home. Employees are incentivized to participate in two ways. First, their co-pays and deductibles are waved for using KISx, and second, they receive a taxable financial bonus.
Now serving more than 15,000 employees at 19 BDS clients, the concept came about two years ago when TJ Morrison, BDS president, received a call from TPA CoreSource to attend a meeting with a large local outpatient surgery center, OSS Health. The facility was launching direct bundled pricing to employers and needed a conduit to deliver the concept to market, execute a seamless administration front for employers and their employees, and spread the word to area companies.
The proposed rates for procedures such as knee and hip replacements were as much as one-third the cost of traditional BUCA prices. “I thought, you really have something here, these are tremendous savings on these procedures,” says Morrison.
BDS has two sides of its business, a brokerage and a TPA. The company already did a fair amount of business with CoreSource on the TPA side. It was “a lightbulb moment” for Morrison to take the relationship further, but he was hesitant to get into the weeds with contracting providers into the network. Fortunately, while at a speaking engagement only two months after the initial meeting with OSS Health, he met a company called PriceMDs, which specializes in setting up provider networks.
Excited to move forward, Morrison thought, “It could be something really unique for us for going out and winning self-funded business.”
After spending roughly five months developing the legal documents and setting up a trademark for KISx, the program launched. It is now affiliated with 1,200 facilities nationwide that utilize more than 12,000 surgeons. Although Morrison says they’ve attempted to incorporate hospitals into the network, their “huge facility fee charges” and markups on hardware make it impossible. “It’s not that we don’t want to work with hospitals, it is just that they seem to fall short on being competitive with outpatient settings,” he says.
Although the program only works with self-funded business, a few of BDS’s self-funded clients are groups as small as 85 to 97 lives. KISx has gained a lot of traction in the blue-collar space, where the nature of the work leads to a lot of shoulder, knee, hip and back issues.
Whitney Morrison, an RN who is a trauma and ICU nurse by trade, now runs the KISx program. Patients contact her when they need imaging or outpatient procedures and she will set up the appointments for them and stay connected through post-op appointments. “I make the whole process easier for the patients and hold their hand to make sure they get the services that they need,” she says. “It’s a more personal touch because they have me. People generally trust nurses.”
Through its TPA side, BDS also markets KISx to other brokerages across the country. TJ Morrison has had more than 200 conversations with fellow advisers, TPAs and vendors about the program. “Everybody loves us,” he says. BDS is actively working with 11 broker partners and expects more to come in the next renewal cycle, he adds.
In speaking with employers about it, BDS will do an audit of their health plan to show the employer how much money they could be saving with KISx. They will take the company’s high claims report and create line items and charges for each service that a particular employee had done, adding up the cost for the facility, surgeon, anesthesia, hardware, everything, and then compare it to the average KISx program cost.
“Our program is so dirt cheap, that if I get one knee, one hip, one spinal fusion, it pays for the service three to four years over,” says Morrison.
As the benefits coordinator for the County of Dauphin, Melissa Bradley has worked with BDS for more than 10 years. The county’s 1,400 plan members have used KISx since Sept. 1, 2017. “It is an amazing program,” Bradley says.
KISx provides an average savings of 61% on the top 15 procedures performed in the U.S. “I love the concept of providing cost savings measures for both my company and our employees,” adds Bradley.
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