The Challenge

Commercial – Analytics-based

Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by:

  • Significantly improving savings for the employer and its members
  • Engaging important providers in the new process
  • Preserving the community’s provider-patient relationships

The Solution

Claritev strategically combined network access with reference-based pricing:

  • PHCS Network access to preserve existing member relationships with their healthcare professionals
  • Data iSight pricing to deliver fair, consistent and transparent pricing of hospital and other facility claims

The Results

Claritev’s revised solution delivers greater savings on more claims:

  • 10-point improvement in savings
  • 8-point increase in charges reduced
  • Guaranteed member protections on 62% of claims reduced, compared to 0% with Medicare-based pricing