Prairie States Delivers 1.86 Percent Medical Trend in 2017

CHICAGO, June 18, 2018 (Newswire.com) - ​​​​Prairie States Enterprises, Inc., the Sheboygan, Wisconsin-based third party administrator, has announced that the self-funded clients they serve experienced annual medical cost inflation (or “trend”) of 1.86 percent in 2017. The industry average trend for PPO plans, meanwhile, was 7.5 percent, according to the latest Segal Consulting Trend Survey. Over the past three years, Prairie States clients saved $440,000 per 1,000 lives, compared to the national average. The analysis, conducted by an external, independent actuary, also shows cost inflation of a mere 2.3 percent for their customers’ health plans over the last ten years.

According to the Segal Survey, a factor influencing these continually increasing medical trends is a lack of plan management regarding where and what type of care is provided to members. To mitigate this problem, Prairie States takes a hands-on approach to case management, guiding patients through the entire episode of care, from simple primary care appointments to comprehensive care situations.

A third of our staff are nurses, working side by side with our claims department, in-house. There is never a hand-off to an outside vendor, so there's no loss of time or data. Combine that with excellent enterprise-wide connectivity and data, and we're managing both health outcomes and costs immediately, and more effectively.

Felicia Wilhelm RN, CEO

“Our integrated model plays a major part in this,” Prairie States’ founder and CEO, Felicia Wilhelm said of the trend numbers. “A third of our staff are nurses, working side by side with our claims department, in-house. There is never a hand-off to an outside vendor, so there’s no loss of time or data. Combine that with excellent enterprise-wide connectivity and data, and we’re managing both health outcomes and costs immediately, and more effectively.”

The survey also points out that there is an opportunity for health plans to focus on improving member health in order to reduce the risk of participants developing chronic diseases, thereby reducing long-term impact on the plan sponsor. Prairie States incorporates extensive wellness and education practices into every self-funded health plan and the results of such practices are supported by their increasingly lower medical trends. 

Discounted provider networks, bill audits performed by nurses, utilization and disease management and rigorous subrogation all play a part as well, Wilhelm said. “Financial accuracy is an important part of the story, too,” she added.  “At 99.86 percent, ours ours is on top, nationally. That makes a huge difference.”

About Prairie States

Prairie States Enterprises Inc. provides comprehensive health benefit plan administration services for self-funded organizations, offering in-house health management and wellness, benefits optimization, plan analysis and predictive modeling tools. Visit Prairie States’ website, prairieontheweb.com for more information or call Brett Wilkinson, VP - National Sales, at 800.232.2899 x5305.   

Media contact: Steve Graue
​Phone: 312.464.1888
Email: [email protected]

Source: Prairie States