the alithias transparency platform healthcare consumerism @ work confidential, alithias, inc

Confidential, Alithias, Inc.

The Alithias Transparency Platform

Healthcare Consumerism @ Work

Alithias provides cloud based enterprise software that helps

self-insured employers and their employees save money.


• Milwaukee, Wisconsin based company• >20,000,000 claim records in SE Wisconsin• The only transparency platform:– Based on a program proven to reduce

healthcare costs– That can support PPO pricing, Direct Contracts,

Reference Based Prices and Medicare Plus plans– Incorporating quality data from the Wisconsin

Health Information Organization

The Alithias Platform

Some of our clients…

4

Alithias means…

Truth In Healthcare


Agenda

1. The Case for Transparency2. Transparency Platforms:

1. The Good2. The Bad3. The Ugly

3. What is “Quality?”4. Expected Utilization5. Making Transparency Work


The Case for Transparency

Employees are shouldering more healthcare costs

36% of employees are enrolled in HDHPs

$6,000 - $12,000 deductibles are common

• Case Study: CEO, St. Lucrative• Challenge: Increase revenue and profit in a competitive, flat

market• Few Options

1. Raise retail prices2. Become more efficient3. Generate more revenue from your current customers

• See more patients• Increase RVUs

– See more patients– Bill more

• Health systems act like any other for profit business





High Deductibles

Not understanding benefit coverage for preventative care

Delaying or not seeking care

78% of respondents said they would have made a different decision had they known the cost of care beforehand. Healthsparq survey, 2015


Transparency SolutionsThe Good, The Bad and The Ugly

Not all transparency solutions are equal


Solutions• Most major carriers

provide some type of transparency tool– Utilization = 3% - 5%– No customization– Can’t accommodate

direct contracts– Will not support

incentives or tiered networks


Customized to Client

Analytics SSO links to

benefits Direct

Contracts Incentive

Management Health literacy WHIO Quality

Data in WI Provider

information Utilization

Reporting Advocacy

Transparency Solutions: The Good


Transparency Solutions: The Bad

“Average” Prices

No Locations

No Networks

No Providers


“Total Hip Replacement”

“The Procedure Cost is the facility amount billed to Medicare for this procedure, as reported to the U.S. government. The data is publicly available from the Center for Medicare and Medicaid Services”

Transparency Solutions: The Ugly

Retail Amounts Mean Nothing

Facility Fee Only


• Correct coding to ensure proper billing is very complex• Most transparency platforms don’t consider provider

technique• Definitions of an “episode” differ, but should include

– Physician fee– Facility fee– Anesthesia– Lab– DME– Imaging

• Fixed, bundled prices are the only way to be certain you are receiving healthcare value.

The Alithias Platform


What About Quality?• National Hospital Ratings Systems Share Few

Common Scores And May Generate Confusion Instead Of Clarity - Health Affairs, May 2015

• National CMS Data: “Good, but…”– Metrics vs. Outcomes– No Provider specific– No ASC quality scores– Scores often incongruent with other quality evaluations


The Truth About Quality• CMS Quality Data are not correlated to the procedures

consumers are actually SHOPPING for.– Infection Rates: Before Jan. 1, only those infections in eligible

hospital's intensive care units showed up in the Medicare database through the Inpatient Quality Reporting (IQR) program on Hospital Compare.

– Mortality Rates based on: • Acute Myocardial Infarction • COPD • Heart Failure • Pneumonia • Stroke• CABG surgery


Quality Data Limitations

…which runs approximately two (2) years behind the current calendar year


The Truth About Quality

• How does an intensive care unit central line infection rate have anything to do Colonoscopies, Imaging or Orthopedic procedures?

• No one is checking a website when they are having a heart attack or searches for low cost stroke care.


Quality Scores and Reality

1) There are few standards for measuring quality

2) Comparisons across quality information providers is not helpful

3) If your local health system won’t provide basic quality information they are low quality

4) Procedure volume is the best surrogate

Alithias Reporting: 400 employee company(Market A)

Data are for demonstration purposes only


• Additional 2% - 8% of total medical spend– Depends on your local healthcare market– 35% of medical spend is for shoppable procedures– 30% - 50% average savings per procedure– 10% - 30% engagement or “behavior change to use

high value services”

• Effective Steerage– Serigraph

• Year 1 = 5% engagement• Year 6 = 70% engagement

Potential Savings from Transparency


Making Transparency Work• 6 Requirements

1. Access to data (Medical, Rx)2. Adjust plan design and incentives3. Frequent and regular communications4. Fixed, bundled prices are the only way to

provide perfect transparency 5. Care Navigation support provided by an

advocate, HR or Administrator6. A BROKER to hold service providers

accountable – something Zenefits can not do!


Results• Employees using the Alithias platform save an average of

$2,000 per procedure.

• Providers are more willing to contract directly or reduce their price in markets where transparency tools are used.

• Prices for certain procedures have dropped >30% in some markets due to consumer demand.

• Transparency is a great way to maximize the benefits of direct contracts or consumer driven plan design.

Alithias makes managing healthcare costs easy.

Ross Bjella 414 469 [email protected] www.alithias.com

mailto:[email protected]

the alithias transparency platform healthcare consumerism @ work confidential, alithias, inc

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