Cost vs Charge

Pacific is the leader for a new era in cost management methodology. We are excited to offer a unique new claims evaluation process that maximizes savings in a manner that is transparent, defensible and repeatable.

Cost vs Charge

Pacific is excited to offer a unique new claims evaluation process that maximizes savings in a manner that is rational, transparent, defensible and repeatable. We call it Data iSight, powered by NCN. Clients call it "found money!" Data iSight is an industry disruptive technology that, at long last, can provide a scalable, impactful healthcare solution that the United States healthcare system desperately needs.

In the US today, as the Large Metro Areas graph highlights, the charges for medical services bears little resemblance to the actual cost to deliver services. Most healthcare reimbursements are based on negotiating reduced charges. Pacific's cost-based solutions ensure rational reimbursements to providers and fair charges to consumers. With healthcare costs rising to unprecedented, crisis levels, the need for control is imperative. View the Wall Street Journal article.

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Shining the Light On the Cost of Healthcare.

Pacific is a national leader in cost management for out-of-network claims. We use cost-based data and transparent reporting to maximize savings on healthcare claims. Pacific's technology solutions are powerful, data-driven tools, which achieve rational, cost-based reimbursements for healthcare payers throughout the United States. Our ground-breaking services aid in controlling costs on more than $2 billion of healthcare claims each year.

This revolutionary intelligence tool, Data iSight, empowers every patient, payer and provider to understand the real cost-of-care and determine rational reimbursement for medical services. Data iSight decodes the cost-of-care and uses that powerful information to keep healthcare charges under control.

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Unprecedented Savings

Every day, providers charge patients roughly three to four times the cost of care (see Los Angeles Metropolitan Hospitals graph). Payers then work with traditional cost-containment firms to negotiate savings as a percentage off charges-essentially raising costs over time. Data iSight is a better way. By utilizing publicly-available data, we evaluate claims and settle them from a "cost-up" approach, rather than the old "charge-down" method. The result is savings that can be double that of traditional methods - savings of up to 45%.

Now, for the first time in the industry, Data iSight can give payers, providers and patients access to the exact same information. This new, patent-pending reimbursement methodology ensures a variety of other benefits to all three parties as well:

  • Transparent Reporting to all parties facilitates open dialogue and builds trust.
  • Defensible Methods are based on solid data to validate settlements and streamline the negotiation process.
  • Repeatable Results provide consistency every time and prove the superiority of the solution.
  • Lower Cost means increased savings for payers and patients on claims of any size.
  • Efficient Turnaround means providers are not kept waiting by the process.

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Clarity For Payers/Employers, Patients and Providers

Benefits For Payers/Employers

  • Rational Savings: On average, Data iSight delivers 35-45% savings on inpatient claims, 50-60% savings on outpatient claims, and 40-50% savings on physician claims, which is more than twice that of traditional claims-repricing products on out-of-network claims.
  • Provider Acceptance: Defensible methodologies and full transparency virtually eliminate appeals and leads to an industry-high provider acceptance rate.
  • Easy to Use: Data iSight has a high adoption rate because it is user-friendly, with a quick learning curve.
  • Instantaneous Results: Automated processes deliver instantaneous results via secure websites.
  • 360° Access to Information: Payers, employers, patients and providers can access comprehensive information through secure websites that serve as educational tools for all parties.
  • Competitive Advantage: As a result of cost savings, payers and employers are able to offer more competitive benefits packages to consumers/employees.
  • Analytical Technology: Beyond just reimbursement tools, Data iSight is also offers a suite of analytical tools that benefit all departments of an organization - assisting in actuarial, case management, contracting, contract validation, and consumer plans.

Benefits For Patients

  • Realistic Savings: Patients enjoy lower out-of-pocket expenses and lower premiums.
  • Understand the System: Patients now have access to charge vs. cost data for the first time.
  • Empowered to Act: Patients are armed with information to have a voice in healthcare decisions.

Benefits For Providers

  • Competitive Advantage: Providers have access to comprehensive data that reveals performance against like facilities.
  • Rewarded for Efficiency: More efficient providers achieve a higher margin since reimbursement is determined by average cost to deliver services.
  • Administrative Advantage: With increased adoption of Data iSight, providers will rely less on multiple networks, thus reducing administrative workloads and expenses.

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