A large trauma hospital with more than 5,000 employees had on-site staff handling case management and patient advocacy. This legacy operations center handled internal case and utilization management for network-based care versus using the contracted third-party administrator (TPA). As a result, the facility struggled with employee concerns about privacy. The cost of this staff totaled more than $250,000 a year. That amount did not include other soft costs affiliated with full-time resources.
AIM was able to showcase the multiple efficiencies available when outsourcing case management. Through negotiations, it was decided that the TPA would assume the full set of case management services without any change in fee. AIM assumed the elevated claim and service calls via its internal member advocacy unit.
The hospital realized savings of more than $250,000 and reinvested these funds in other areas.
For more information contact your AIM representative at 1-866-284-4995.