Partner Overview:

A school district in Central California with approximately 3,500 employees partnered with PhysMetrics to provide a quality, cost-effective chiropractic benefit to employees and family members.

Environment:

PhysMetrics’ partner was experiencing rising healthcare costs across all medical disciplines. Suspecting excessive chiropractic costs as one of the contributing factors combined with the inability of their previous chiropractic vendor to provide accurate date for analysis, the partner was contemplating eliminating the chiropractic benefit completely. Knowing that chiropractic is a valuable and utilized benefit, the partner asked ChiroMetrics to examine the data and offer a solution to control cost, while providing a quality, medically-necessary benefit.

Solution:

PhysMetrics analyzed the chiropractic utilization and claims data to identify specific areas of abuse. PhysMetrics developed a network of chiropractors specifically for their partner, established a fee schedule to pay the doctors and implemented measure to keep chiropractors accountable without altering the existing benefit plan for the members. Additionally, the program promoted chiropractic care as an alternative to more expensive surgeries or treatment therapies to further reduce the cost of the total health care spending.

Results:

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

  • 48% reduction in chiropractic cost in Year 1 (Dollars)
  • Reversed upward trend of chiropractic spend
  • Eliminated abusive utilization patterns
  • 97% reduction in out-of-network utilization
  • 3.59-to-1 return on investment (ROI) in Year 1