Massachusetts-based company responds to Affordable Care Act by addressing "catastrophic" diagnoses and their effect on self-insured businesses
LYNNFIELD, Mass., Sept. 11, 2013 /PRNewswire/ — The Affordable Care Act has dramatically increased the number of businesses who self-insure, creating a greater need for companies who provide stop-loss or reinsurance policies to look deeper into their long-term liabilities. For those types of insurance providers, catastrophic diagnoses represent risks that must be carefully understood and managed. Until now, when informed about a serious or "catastrophic" employee diagnosis, underwriters had to use educated guesswork and scanty data for calculating premiums, making estimated cost predictions, and setting reserves.
A new claims-prediction database, called PredictDx, created by Massachusetts-based Advanced Medical Strategies (AMS), provides informed decision-making and risk management to the industry. When using AMS' subscription-based, online reference guide, treatments, prognoses, estimated expected costs, and diagnosis codes are all listed for the payors, enabling them to make more accurate predictions of their future liabilities. Advanced Medical Strategies provides more than 125 different diagnoses in a lookup tool, indexed by age, state, treatment, clinical assessment and cost ranges, employing various average discounts seen. An online tool with both clinical and financial guidance like these has never before been compiled.
"This tool is invaluable not only to underwriters assessing claim costs and lasers, but also to analyze reserves, audit bills and compare bills for submitted claims," says Adria L. Garneau, Chief Claims Officer at Advanced Medical Strategies, a physician-led company that blends medical and financial expertise on healthcare costs and claims. "Underwriters will be able to make smarter judgments without hiring medical consultants. They are able to more aggressively bid on new business because they'll understand the typical course of treatment, its potential costs and expected outcomes. According to our calculations, subscribers could not only achieve significant savings in both claims and loss ratios but also become more accurate in their pricing."
The new database, available on an annual subscription basis, collects, classifies and interprets available medical and claims information from all 50 states and represents a decade of AMS' claims, medical review and underwriting history. It is updated annually or more often when new data comes in that warrants changes.
"With the PredictDx Database, reinsurers, stop-loss carriers, third party administrators and managing general underwriters no longer fear being blindsided by catastrophic claims," says Stacy Borans, MD, AMS' Co-Founder. "It's almost like a crystal ball for underwriting and claims professionals, laying out what is likely to happen and the typical associated costs." Dr. Borans further explains, "An additional valuable aspect to the tool is the clinical information provided regarding typical treatments. If a claim comes in for a diagnosis, an initial assessment can be completed internally with this tool to see if the treatments received are listed as standard in care therapies. If it isn't, that claim could be flagged for further review and analysis."
About Advanced Medical Strategies
Advanced Medical Strategies (www.mdstrat.com) is a Lynnfield, Massachusetts based, physician-led organization serving small to medium sized TPAs, Health Plans, HMOs, Worker's Compensation Payers, MGUs, Stop-Loss Carriers, Specialty Risk Insurers, Occupational Accident Insurers, A&H Insurers, and Self-Administered Group Health Plans. AMS provides: doctor-driven complimentary screens, independent medical reviews, deep savings opportunities through cost containment services, underwriting services, aggregate audits, MGU and TPA review services and plan document reviews.
For further information, contact John Wood at 603.772.1220 / 617.435.2091 or Email.
Media Contact: John Wood,
To The Point Marketing, Exeter, NH
617.435.2091 or Email