Public Entities

Take Back Control of Your Health Plan

Save On Annual Healthcare Costs

Because health plans are any public entity’s (or school district, fire department, public employee union, etc.) second largest expense, with absurd annual price increases, AMPS works with many public entities to save each an average of 5% to 25% annually on healthcare costs, while still providing their employee members with high-quality health care. These savings drop right to their bottom lines and/or reduce required employee contributions.

Public entities looking to take back control of their self-funded health plans work with AMPS on a three-step strategic plan over 2-3 years to gradually reduce health care costs while also minimizing employee disruption.

1

Audit Out-of-Network Claims

Audit Out-of-Network claims and reduce total plan costs by an average of 3%.

2

Medical Bill Review

Do ongoing Medical Bill Review on all hospital claims > $20,000 and reduce total plan costs by an average of 10% or $686/employee.*

 
3

Phase in Reference Based Reimbursement

Phase in Reference Based Reimbursement PPO replacement programs over 2-3 years and reduce total plan costs by an average of 25%, or $2,660/employee.*

4

Direct Provider Contracting

We can add critical providers to your benefits program and significantly decrease your Plan medical spending and member out-of-pocket costs.

*These savings numbers are based on 90+ municipality employee groups using AMPS OON, MBR, and RBR.

Employers Have a Fiduciary Responsibility

Employers need to start thinking aggressively about fiduciary responsibility. 25 years ago, an employer typically paid 99.5% of the overall cost of a healthcare plan. The employee contributed the other 4, 5, 10%. That's shifted dramatically. Now, an employee is contributing 25-30% and the employer is paying 70-75%.

In a self-funded healthcare plan with co-mingled employer and employee money governed by ERISA laws, an employer has the fiduciary responsibility to manage that healthcare pool in a responsible way. A fiduciary in an ERISA Plan must act in accordance with the Prudent Man Standard when determining what claims should be paid at what level. The failure or refusal to do so leads to the possibility of liability for the fiduciary.

Employers are most likely in breach of that fiduciary responsibility by how they currently allow funds to be paid out of their healthcare plans. When an employer knows that their PPO or TPA is not auditing a hospital bill before it's being paid, it’s a potential breach of fiduciary responsibility.

AMPS Driven Solutions

1

(OON) Out-Of-Network Solutions

AMPS offers multiple solutions to drive significant savings on out-of-network bills, including direct negotiations and reference based repricing.

2

(MBR) Medical Bill Review

AMPS Medical Directors perform line-by-line facility claim reviews to correct mistakes and ensure accurate and reasonable pricing. AMPS MBR clients save an average of $685/employee annually.

3

(RBR) Reference Based Reimbursement

Stop over paying and replace your PPO network! Our Care Connex program combines RBR, Healthcare Navigators, member advocacy, and primary care telemedicine to help you save 20% on health expenses while providing high quality benefits and care. AMPS RBR clients save an average of $2,600/employee annually.

4

(DPC) Direct Provider Contracting

We can add critical providers to your benefits program and significantly decrease your Plan medical spending and member out-of-pocket costs.

Introducing Care Connex

AMPS' RBR solution, Care Connex, offers employers and their employees direct provider contracts, member onboarding and education materials, Care Navigators, a real-time employer claims portal, and full fiduciary defense on any balanced billing.

Care Connex brings the pressures of the free market to the medical world. Employers set a certain dollar amount they will reimburse per procedure based on multiple data points (Medicare being one of many). Patients then connect with an AMPS Care Navigator to find a provider that will conduct the said procedure. Cost transparency is thus stimulated.

Still Have Questions? Contact an AMPS Client Representative