Partner Overview:

A school district in Central California with approximately 10,000 employees partnered with PhysMetrics to provide a quality, cost-effective chiropractic benefit to employees and family members.

Environment:

PhysMetrics’ partner was experiencing significant rising chiropractic costs. The partner believed some of the rising costs were due to massage therapy abuse. They also wanted to know if their vendor at the time was doing anything to identify or combat that abuse. The partner was unable to get detailed regular reporting or an account manager to address their specific concerns. The partner asked PhysMetrics to revise how the benefit is administered without compromising member access to care.

Solution:

PhysMetrics analyzed the chiropractic claims and identified utilization patterns that were contributing to the rising costs. PhysMetrics then developed a comprehensive utilization management program, where PhysMetrics’ team of chiropractors reviewed treatment plans only for those services that were being abused, without altering the existing benefit plan for the members. PhysMetrics also established a detailed reporting system that demonstrates all of the services being performed on the partner’s behalf on a regular basis.

Results:

In a year-over-year analysis of chiropractic claims, PhysMetrics’ partner realized the following results:

  • 38% reduction in chiropractic cost in Year 1 (Dollars)
  • Reversed upward trend of chiropractic spend
  • Eliminated abusive utilization patterns
  • 93% reduction in out-of-network utilization
  • Facilitated further savings by tracking, reporting and addressing additional problem areas
  • 2.47-to-1 return on investment (ROI) in Year 1