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SEP 2020Get the latest from the best RBP advocates and auditors 

Industry Perspectives
Cynthia Swanson
Andrew Soha,
Vice President of Business Development

Member Education Key to Successful RBP Program

Education is the basis of a successful health benefits experience, especially when it comes to reference-based pricing (RBP). Creating a robust year-round education program that engages human resource (HR) teams and members leads to better healthcare choices and higher member satisfaction, positively affecting the plan’s financial performance.

According to a study by Guardian Life, 77% of companies rated employee engagement as a top priority. Communicating early and often institutes a strong educational foundation and ensures members feel support and peace of mind. The variety, quality, and ease of access to educational resources set the tone for the rest of the plan year and encourage members to learn and engage. Starting with our Pave the WayTM program, ClaimDOC begins building rapport with members and sparking trust in their health plan. We focus on teaching members how to successfully navigate their health plan and understand how to respond when things don’t go as planned.

RBP isn’t a program that members should just “set and forget.” What are we doing the other 300 plus days outside of open enrollment to help keep RBP fresh in member’s minds? A comprehensive year-round communication campaign is crucial for member success. Experience shows that members will wait until they need to use their benefits to learn about their coverage. Frequent, relevant updates, resources, and tools delivered across multiple channels ensure high engagement, better healthcare choices, and happier members.

Working closely with the group to understand how the members access information is also key. Every population is unique, so we pay close attention to each of their needs. By offering a variety of communication methods, such as a member advocacy team, mobile app, website, handouts, videos, and webinars, we ensure that all members have the opportunity to receive and review the necessary information to use their health plan.

The HR department plays a critical role, significantly impacting the success of an RBP program. The biggest mistake we see, after poor member education, is not involving HR and empowering them to convey the why and how behind the program. Members seek out the HR department for answers to benefits questions and concerns, and more commonly when changes occur. Their knowledge, understanding, and passion for the program can make or break it.

We’re here to give the HR team a break. At ClaimDOC, we provide full support from day one and focus on HR education as soon as the initial introduction. By setting the HR team up with educational resources, scheduled touch-base meetings, and an open communication line, we build a strong foundation before the plan becomes effective, arming them to craft the right message to their employees.

Member education is at the heart of any RBP program. Crafting a communication campaign that engages members early and often leads to better healthcare decisions and higher member satisfaction. Mix that in with an educated, empowered, and passionate HR team, and you’re well on your way to a successful RBP experience.

Client Savings

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. See the savings below and know that together we can make healthcare affordable.

1. Cleveland, OH

Eight-day hospital stay for treatment of intestinal obstruction due to cancer

High-Dollar Services:
  • EEGs: $53,444.00
  • ICU Room and Board: $20,376.00

Savings Summary:

Billed Charges: $117,138.40
ClaimDOC Allowed: $9,813.01
Plan Savings: $94,919.10
Reduction: 81%



2. Franklin, OH

Four-day hospital stay for treatment of back disorder and related spinal fusion surgery

High-Dollar Services:
  • Operating Room: $41,996.41
  • Room and Board: $17,711.88
  • Pharmacy: $13,633.30
Savings Summary:

Billed Charges: $321,691.21
ClaimDOC Allowed: $74,829.98
Plan Savings: $246,861.23
Reduction: 77%



3. Franklin, OH

Four-day hospital stay for treatment of complications related to tissue swelling post-surgery

High-Dollar Services:
  • Operating Room: $45,129.00
  • Medical/Surgical Supplies: $29,573.00
Savings Summary:

Billed Charges: $60,890.88
ClaimDOC Allowed: $14,241.19
Plan Savings: $46,649.69
Reduction: 77%



4. Indianapolis, IN

Seventeen-day hospital stay for treatment of severe infection of multiple sites

High-Dollar Services:
  • Cardiac Cath Lab: $57,018.00
  • Pharmacy: $30,543.90
  • Respiratory Services: $27,609.00
  • Room and Board ICU/CCU: $13,390.00
Savings Summary:

Billed Charges: $152,189.40
ClaimDOC Allowed: $38,540.34
Plan Savings: $113,367.68
Reduction: 75%



5. Exeter, NH

Thirteen-day hospital stay for treatment of a severe infection of the ankle and foot

High-Dollar Services:
  • Operating Room: $128,772.00
  • Room and Board ICU/CCU: $36,786.00
  • Cardiac Cath Lab: $11,897.00
Savings Summary:

Billed Charges: $221,217.30
ClaimDOC Allowed: $93,178.30
Plan Savings: $128,039.00
Reduction: 58%



Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.

Member Experience

Feedback from a Member

Having Emily as my Member Advocate to assist with my claim has been an amazing experience. She is someone who loves her job, and proactively stays in touch with her customers. ClaimDOC and me are lucky to have her.

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