HealthRedirectx? Launches Anew Under Leadership of Dr. Maria Todd

NEW FROM MARIA TODD

HealthRedirectx?, a new firm led by Dr Maria Todd, supports employer-funded healthcare benefits cost savings through patient redirection programs. Its ideal clients are self-funded employer health plan administrators and/or their existing TPAs.

TRANSPARENT, PREDICTABLE PRICING

The firm supports employers and TPAs with flat fee surgical case management and domestic (USA) health travel coordination. It also offers employers, union plan administrators and their TPAs assistance with due diligence including provider site inspections, credentialing, and transparent, bundled, elective surgical price negotiations. It does not market healthcare providers to employers and group health purchasers.

Upon client requests, HealthRedirectx? builds custom designed patient redirection programs as specified by its clients. Staffed by experienced case managers and health travel coordinators, the staff uses the world’s longest-established, best-in-class software for health plan participant redirection. Dr Todd was one of four original founding partners and its functionality designer.

HealthRedirectx? OFFERS A COMPELLING VALUE PROPOSITION TO EMPLOYERS, UNIONS, AND THEIR CONTRACTED TPAs

There's no need to change brokers, networks, TPAs or benefit advisors.

"No longer do smaller companies and unions have to pay more. Now they can act just like the PepsiCo, Walmart, Boeing, and other jumbo employers and craft unions, but at a scale that suits their unique elective surgery utilization needs," says Dr Maria Todd, HealthRedirectx? founding partner. "Moreover, employers and unions and their TPAs don't need a full replacement of their local care provider network. That still has value for emergencies and care where redirection is neither appropriate nor feasible."

Currently, the estimates of the number of US employers that have adopted patient redirection programs that involve travel within the USA include about 30% of the nation's 50 largest employers. These include the likes of PepsiCo, Walmart, Lowes, Boeing. In the public sector, the list includes many state and county governments. That number is up from 2015. The number of American companies electing to send plan participants outside the USA for care was already low and now with COVID even lower. Patients are terrified to be admitted to hospitals these days - no matter where the hospital is located. In addition, unions and their members are set on "buying American" not outsourcing health care to other countries.

Now, groups of 2-50 can use HealthRedirectx? as easily as groups with 30,000+ lives. Imagine saving $20,000 to $50,000 per case on orthopaedics, general surgery, heart, spine, gynecology, urology, eye surgery, ear nose and throat cases, and other elective surgeries. Small business groups of 2-50, The includes law, architectural, and accounting firms, small closely held companies, family-owned businesses, independent small to medium businesses with high deductible plans, level self-funded plans. To qualify, a business must self-fund its benefit plan and retain the freedom to choose in or out of network and the freedom to negotiate health care prices directly with providers. "Group size simply doesn't matter in our world," she explains. Todd explains that smaller groups no longer need to pay dues to healthcare purchasing coalitions or multiple employer welfare arrangements (MEWAs) as they did in the past.

"Since we aren't worried about PEPM network access fees, group size is irrelevant." Todd explained. Other networks don't want to do business with tiny groups because they make their money on the PEPM fees and then add 10-12-15% (or more) to the provider's charges without revealing the "double dip." Todd states that "Sometimes, our competitors also ask the provider for as much as 12-15% kickback on all redirected patient revenues - tantamount to a "triple dip". Doing that disincentivizes the providers from sharpening their pencils as much as they could.

Todd stated that she would not agree to be involved if any of those practices were a part of the business model. She also would not become involved if reference-based pricing was part of the business model. She believes she can negotiate better rates without it. "Reference-based pricing is neither new or equitable for all concerned. It's a comparative metric that commoditizes providers in terms of price. It doesn't reward good quality and good outcomes. It is a fad and an unsustainable race to the bottom. No facility or surgeon should accept such disrespect for their good service and value. RBP also forces many employers and unions to pay more than may be necessary. Why bother?"

HealthRedirectx? will take on all or part of the patient redirection program from first call to the conclusion of the episode of care. Rural and urban employers and unions with plan participants located anywhere in the USA, as well as expatriate workers stationed outside the USA benefit from the savings, quality, and case managed services coordination and tend to save up to 80% from what they pay when they access care through traditional network arrangements. And that savings is net, after the case management fee and the travel have been counted into the costs to use the patient redirection program.

"Why wouldn't an employer currently footing bills for $30,000 to $50,000 for a single elective case not add a patient redirection program and pay $15-25K (or less) for:

• the fully inclusive, transparent and reliable, bundled surgery price that includes implants, surgeon fees, anesthesia fees, surgeon pre-op consult, and facility fees;
• the case management and travel coordination cost;
• airfare or mileage reimbursement for two people, hotel for two people, meals and incidentals for two people; and
• a single line item, bundled extracontractual claim invoice paid via ACH or check with no repricing costs", Todd adds.

HealthRedirectx? leverages Dr Todd’s established connections to more than twenty thousand US healthcare facilities and surgeons. Many already offer bundled priced value based healthcare. She brings her managed care contracting expertise, 25+ years of bundled price surgical case rate development and direct-with-employer contracting, her deep knowledge of ERISA fiduciary requirements, SPD modification know how, and 40+ years of combined surgical nursing, health travel and medical tourism, and healthcare business administration work experience.

LOCAL HEALTH SYSTEMS WONT NEGOTIATE?

Around the nation, many multi-hospital health systems have put the word out that they don't negotiate with employers or health plans and network organizers. This is especially true in certain states where the health system mistakenly believes that they "own" a marketplace. Not so! Not anymore.

"That's a pity. They will get the crumbs and emergency cases only," Todd explains. And as soon as the patient is medically stable and can manage the travel to a redirected treatment destination that's within a two hour flight radius, that patient will likely leave the market. Meanwhile, surgery that has been recommended and will be carried out as an outpatient case will travel. The closer the radius, the more likely it will be for patient redirection programs to be effective in saving money for both employer and plan participant. This upends the big health system's demands on the self-funded employers' health spend - almost overnight.

DIFFERENTIATION FROM COMPETITORS

Unlike its rival firms that tend to copy PPO network models, there are no monthly fees, PEPM network access fees, or opaque provider fee markups.

HOW FAST? HOW SOON?

Todd says, "If an employer or union called me on Monday with cases pending, we can have patients redirected within 5 business days of the initial inquiry, pretty much anywhere in the nation. SPD modifications are not necessary in many cases. If desired, their SPD can be modified with a short two to three sentences. In many cases their SPD may not need modification if a prior authorization program is already in place for elective surgery procedures. Patient redirection isn't a "new" benefit. It doesn't add costs, it reduces them. It doesn't add underwriting or other risks when launched correctly with all the proper infrastructure in place.

HealthRedirectx? has standard template contracts already drafted for use by employers and providers. "That cuts out the majority of the delay between employers and providers," Todd explained.

Another item that seems daunting to employers, unions, and TPAs are the initial setup of program operating policies and procedures. "These too, are already developed, tested, and ready for use", she explained.

"All that's really needed is the decision to start saving money and a company telephone extension answered remotely and transferred to our call center. For HIPAA compliance, the employer can be totally hands off beyond that."

WHICH PROVIDERS?

Todd states that if the employer has a particular surgery provider in mind, HealthRedirectx? will contact them, initiate the dialogue, obtain or negotiate pricing for predictable bundled case rates, handle site inspections of the health facility, hotels, and arrange all ground services, negotiate accommodation discounts or any other arrangements needed.

Todd adds, "The likelihood that the U.S. health facility and the area are already known to HealthRedirectx? is high. But if not, it isn't difficult or time consuming to add a new provider, new surgeons, or ground support, which is a comfort to most employers and unions. We don't sell what we have in a pre-built network. We're not here to "sell" you or market providers. Instead, we help you decide on the shortlisted preferred providers you want, where you want/need them, in the specialties you want/need. We also help you negotiate the best prices as the advocate of the employer/union/TPA and its plan participants."

Is the operation a solopreneur venture? "Not hardly." Todd says that case managers and travel coordinators are already on duty. She will direct operations to get off to a solid start. As she has done with all of her other companies, the company fills a needed niche in the market place, delivers results in the form of surgical cost savings and care coordination, and can scale as quickly as needed by adding more nurses and travel coordinators who know here and are ready to start on short notice. She proudly states, "HealthRedirectx? is a startup with zero debt riding like a monkey on its back." She explains, "When my companies can cash flow early and start and stay lean, greed is not necessary."

To learn more, please contact Dr. Maria Todd by calling 800.727.4160, toll free.