Community Partners
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Most PPOs have maintained a "status quo" mindset when it comes to containing costly catastrophic medical claims. Large claim provisions in hospital contracts reduce PPO discounts, despite the fact that inpatient bills often account for 85% to 90% of catastrophic claims and most of these claims occur in tertiary care hospitals. ppoNEXT is focusing on lowering inpatient hospital bills for very large claims.
The Community Partners and ppoNEXT solution offers a proprietary alliance between premier stop loss carriers and specially selected tertiary care hospital members of the ppoNEXT network. Using reimbursement schedules developed by the actuarial firm Milliman & Robertson, Community Partners hospitals re-structure their contracts to employ fixed, global per diem rates at levels designed to lower the cost of catastrophic claims.
The Community Partners network, packaged with ppoNEXT's National Access Product, promises to be a strong cost containment tool for self-funded plans.
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