Customer-centric insurance solutions
At Wellfleet, it’s our mission to deliver customer-centric insurance solutions with quality service and uncompromising ethics. That’s why we work tirelessly with our partners to identify high-quality, cost-effective service solutions. In fact, for the 2017-2018 school Year, our efforts across all programs saved a total of $147.1 million. Here’s how we’ve done it.
School year savings
It’s important that our members get the treatments they need with the providers they desire, whether that’s in- or out-of-network. Wellfleet works with PPOs to help ensure members get the best cost with their chosen in-network provider. For out-of-network providers, Wellfleet has been able to save members 80% of their total cost – meaning they only pay 20% out of pocket. In total, Wellfleet’s efforts saved $85.2 million for both in and out-of-network providers in the 2017-2018 school year.
We also help students save money by identifying solutions that align with their needs – like offering more than 40 antibiotics, dermatology and behavioral health medications with a $0 copay!
Through negotiating competitive pharmaceutical discounts and rebates with PBMs and holding them accountable to meet guarantees, Wellfleet’s Pharmacy program saved $51.2 million in drug costs. This savings is also attributable to formulary management strategies, including utilization management programs to ensure the appropriate use of medications.
Wellfleet’s Medical Management program strives to ensure patients are taking the right steps to recover fully and using cost-effective approaches to treatment. This program includes Oncology Case Management which empowers cancer patients to make informed decisions about how to care for themselves, helping to lower their chance of remission.
Another feature of our Medical Management is the Payment Guidelines program, which scrutinizes billing to ensure that what was ordered was appropriate for the type of claim. Through these efforts, Wellfleet saved members $5.1 million.
The Payment Integrity program is Wellfleet’s way of going the extra mile. By auditing providers, we safeguard our members from deceptive claims or billing errors. These protective efforts saved members $5.6 million!
Another great service we provide is Injectable redirection. This program saves member’s money by providing an alternative to getting expensive injectable drugs obtained from and often administered at hospitals. Wellfleet collaborates with the member and provider to transition the acquisition of the drug to a specialty pharmacy and the administration of the drug to a lower-cost setting, such as at an infusion center or at home. These efforts resulted in $6.5 million in savings.
Payment integrity findings
Integrity is important to us. That’s why we take a multifaceted approach to reviewing claims. Our Payment Integrity program saved over $5.6 million.
Through Claim Editing, we’ve built processes that detect coding errors for common occurrences. Further, we’re able to identify and separate items that hospitals incorrectly bundled which may have resulted in an overcharge. The systems we have in place for claim editing saved $2.4 million.
Our Payment Integrity program also includes Deception, Waste and Abuse investigation. Unfortunately, irregularities in claim data are quite common. That’s why we’re vigilant in our approach to investigation. Our efforts have saved $1 million and prevented unlawful claims.
Further, Bill Review is another element of Wellfleet’s payment integrity program that corrects mistakes in bills sent over from providers. Through correcting improper bills, Wellfleet has saved $2.1 million.
Continuing our mission
Our team works collectively to engage students in their health plans and empower them to lead healthier lives and become better consumers of healthcare. That’s why we’ll continue to ensure program features are developed with a cost-effective, member-first approach.