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Pricing Systems
Two patients in the same clinic. Same problem. Same symptoms. Different
doctors beget different treatment plans. Two different charges. Why?
Employers and payors want to know.
That fact is that while many healthcare providers boast a lot
about quality, few measure their performance either on clinical
outcomes and customer satisfaction.
As part of a comprehensive quality management program, Prizm
helps quality-minded healthcare companies, hospitals and physician
groups reduce treatment variation through written clinical protocols
and pathways that standardize the way each physician in a practice
triage treats patients. It's true that the benefit of a pathway
is in quality. But there is a bigger financial benefit as well.
By developing consistent treatment guidelines, Prizm can create
case rate packages that cover a month-long episode of care at
an attractive, predictable price for managed care.
Prizm, for example, has successfully contracted
with health insurance plans using Prizm's case rate methodologies.
Instead of getting reimbursed on a CPT-code basis, Prizm clients
can be reimbursed on an ICD-9 code basis. The approach is desirable
to managed care, because it addresses the quantity of units consumed.
For instance, even austere discounts merely reduce the price
for a physician office visit or a PT visit. However, such discounts
do not control the number of times that CPT code is billed. |
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Case rate packages are a win-win situation for the quality-oriented
provider and managed care payor. In this way, the provider is rewarded
for its efficiency rather than punished for it. That's because the
best providers will reduce the number of units provided to the best
case scenario.
Prizm's proprietary protocols enable a spine center
to sort back pain patients into price-predictable categories—without
X-rays, MRI or physician exam. Prizm invested over $50,000 on statistical
analyses that evaluated means and standard deviations for spine ICD-9s.
A spine center can price for an episode of care for physician visits,
diagnostics and therapy. Prizm has contracted successfully with a
variety of carriers. Without such tools, a spine center would be
economically punished for providing conservative care, because it
will have fewer CPTs to bill.
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