mdstrat.compredictmdstratcom - AMS

-- -- Focused Solutions Provider Network Contracting Large Case Management & Medical Management Stop Loss & Underwriting Fraud Waste & Abuse Payment Integrity & Claims Negotiation Products The Predict Suite PredictRx PredictDx ImplantDx Predict FACS Predict Profiler Resources Webinars & Videos AMS Conference Videos Podcast -- Documents & Case Studies Membership Benefits Privacy Policy About AMS Why Choose AMS Vision & Purpose Who We Are What We Do Who We Serve Leadership Board of Directors -- Blog Contact MEMBER PORTAL CLOSE Knowledge is power. What can you do with the power of true cost transparency? Set up a demo and see for yourself. Submit Strategic Intelligence Software for clarity INTO COMPLEX CLAIMS Intelligence. Transparency. Speed. These are crucial when trying to manage high cost healthcare claims. -- AMS solves affordability of care issues with a targeted focus on Specialty Pharmaceuticals, Catastrophic Diagnoses and Medical Implants. AMS’ Predict Suite combines technology, clinical expertise, financial insight and data science into an easy to deploy, subscription-based service that brings strategic intelligence and risk mitigation to high cost claims issues. Simply put: Knowledge is Power. Schedule a Demo The Predict Suite Delivering crucial Cost and Clinical Insight into: Provider Network Contracting Drive value-based contracting initiatives with unsurpassed data and detail and contract from a position of true light Learn More Large Case Management/Medical Management Increase efficiency with existing resources, reduce the need for additional nurses, and zero in on the most costly and opportunistic claims (clinical and financial) Learn More Stop Loss/Underwriting The industry gold standard delivers increased accuracy, productivity and unsurpassed ease of use to reduce loss ratios and research time. Don’t forget about the “lasers”! Learn More Fraud Waste & Abuse Quickly boost and support the current team to leverage existing resources with laser focused information Learn More Payment Integrity & Claim Negotiations Implement the ‘Sentinel Effect’ by letting aggressive providers know you are watching and armed with clinical and financial data Learn More Strategic Intelligence Gap Easily administer implant contract overpayments to avoid hassling providers, reduce administrative burdens and expand loss control opportunities Learn More -- The Predict Suite At Work Delivering crucial Cost and Clinical Insight into: -- Provider Network Contracting Drive value-based contracting initiatives with unsurpassed data and detail and contract from a position of true light Learn More > Large Case Management/Medical Management Increase efficiency with existing resources, reduce the need for additional nurses, and zero in on the most costly and opportunistic claims (clinical and financial) Learn More > Stop Loss/Underwriting The industry gold standard delivers increased accuracy, productivity and unsurpassed ease of use to reduce loss ratios and research time. Don’t forget about the “lasers”! Learn More > Fraud Waste & Abuse Quickly boost and support the current team to leverage existing resources with laser focused information Learn More > Payment Integrity & Claim Negotiations Implement the ‘Sentinel Effect’ by letting aggressive providers know you are watching and armed with clinical and financial data Learn More > Strategic Intelligence Gap Easily administer implant contract overpayments to avoid hassling providers, reduce administrative burdens and expand loss control opportunities Learn More > AMS delivers crucial Cost and Clinical Insight into: Specialty Drugs Medical Implants Catastrophic Diagnoses Specialty Drugs In 2018, the $318 billion in specialty medicines represented 41% of developed market spending, up from $172 billion in 2013. In 2017, 90% of the prescription drug volume in the U.S. were generic and accounted for just 23% of total drug costs. Yet specialty drugs composed just 1.9% of total prescription volume but accounted for 37% of spend. Prescription benefits prices don’t have to be a hard pill to swallow. Visit PredictRx Medical Implants The global market for Medical Device Technologies reached nearly $521.2 billion in 2017 and should reach $674.5 billion by 2022, at a compound annual groth rate (CAGR) of 5.3% for the period of 2017-2022. The US spends more than $150 billion – 6% of total medical costs – a year on medical devices. Visit ImplantDx Catastrophic Diagnoses Catastrophic diagnoses which result in multi-million-dollar claims affect 6% of health plan members but make up 47% of the claims dollar spent. In the last five to seven years, a cataclysmic shift in the cost of care has resulted in a huge increase in both severoty and frequency of catastrophic claims, mostly due to specialty drugs, transplants, and neonatal care. Visit PredictDx What You Can Expect Increased Productivity Transparency Medical Appropriateness Payment Integrity Risk Recognition Improved Loss Ratios Brooks Goodison President Diversified Group PredictRx provides our specialty pharmacy nurse case managers with real time, actionable data on what we should expect for reasonable costs for these expensive drugs. We are able to take prompt and effective action on the problem drugs to deliver positive ... READ MORE results for our clients saving them big dollars right away—a win for our customers and a win for our stop-loss partners. PredictDx offers bountiful context around large claimants which helps lower laser exposure or unreasonable increases in stop-loss premiums for our customers. It is also helpful when we are providing self funded quotes to prospects that are coming from a fully insured program where claim data is limited. PredictDx can help us paint a picture with that limited data regarding the risk. This helps us guide the underwriting process to a better outcome for all. Both PredictRx and PredictDx produce results that are dramatic and immediate. Michael P. Eagan Assistant Vice President Claims AccuRisk Solutions We had a case where an individual was receiving Gleevec. All medical and claim documentation showed a diagnosis of neoplasm of connective tissues. We reviewed the Gleevec material on PredictRx. Gleevec is not FDA approved for treatment of neoplasm of connective ... READ MORE tissue. Nor is it a notable off-label use. As a result, the charges were denied under the terms of the plan document. The total savings on this one case, thanks to PredictRx, over $100,000. Linda Marsden Managing Director Client Administrative Services HRMP, LLC PredictDx and PredictRx answer questions every analyst has. What are average costs? What future claims can we expect? Are services or prescriptions experimental or investigational? Underwriters and claims analysts can go to one ... READ MORE place and get current, clear, concise and accurate claims and prescription drug information. It is by far the best reference tool of its type available. Knowledge is power. Partner with AMS and gain the industry cost transparency you've been waiting for. Schedule a Demo Focused Solutions Provider Network Contracting Large Case Management & Medical Management Stop Loss & Underwriting Fraud Waste & Abuse Payment Integrity & Claims Negotiation Products PredictRx PredictDx ImplantDx Predict FACS Predict Profiler Resources Videos & Never Events Assessing Catastrophic Claims Sample Reviews Guidelines Documents Membership Benefits Privacy Policy About AMS Blog Contact Advanced Medical Strategies | 855.224.9711...