THE PROBLEM

NETWORKS

Only five real networks exist in Michigan.  Each network is either owned by an insurance company, or large hospital system.  Networks were originally created to steer patients to providers who offer better outcomes at lower costs.  Now, with only five networks in Michigan and nearly 100% provider participation in each network, pricing negotiation has been lost.

Therefore, “repricing” rather than discounting is the new norm with Big Hospitals owning the top line chargemaster… and the conversation.  In many cases, rates for facility charges are repriced (after inflating the chargemaster) to accomplish a “trended” rate increase.  Leaving you (the payor) with a poorly negotiated net cost, and the network earning a rip for the backroom deal.

LOXLEY SOLUTION: 

Sympl Care Marketplace 

BIG INSURANCE

BIG HOSPITALS

Rx BENEFT MANAGERS (PBMs)