Health Rosetta : Is it a new kind of HMO for self-insured group?

[Monti_Ray]

Health Rosetta is claiming to reduce health care spending (but improving quality of care) for self-insured groups by applying innovative techniques. On their website (see below), it says 'what', but it does not say much of 'how'.

Is there anyone successful in applying Health Rosetta techniques? Please share your opinion.

From the website ( https://healthrosetta.org/learn/health-rosetta-vs-status-quo/ )

• Fair, fully transparent price to employer/individual at high quality centers who readily accept quality reporting such as Leapfrog.
• Providers able to set a price that works for them while avoiding claims/collections hassles and accompanying receivables.
• No charge for individual going to these providers. No EOBs, bills, etc. -- just a thank you note.
• Having resources to help you navigate the system that can draw on expertise for quality and cost including understanding benefits plans, best provider options, etc.
• Provide transparency and control over Pharmacy Benefit Manager (PBM) services
• Ensure members have relevant information to make informed choices
• Ensure clinical decisions are based solely on efficacy and ACTUAL cost
• Is a process that works on behalf of the purchaser’s best interests

Source : https://healthrosetta.org/learn/health-rosetta-vs-status-quo/

 

[leevena]

You are correct, not much to the details. 99% sure it is not an HMO. Believe it may be a set of strategies and tactics for the employer to use. Appears to be worthwhile, they have been up and running for a few years now.

 

[gregj]

Leevena's got it. This is a league of health strategy/policy advisers. Not sure how they monetize their ideas, but they do emit a fairly steady stream of analysis/commentary/etc that's worth paying attention to if you're in the group health benefits dodge.

Health Rosetta cofounder Dave Chase was not born to health benefits strategy (he's an ex-Microsoft bizdev(?) exec), but he's a fast learner & one of the most incisive writers on opportunities for innovation in health coverage you'll find. Tom Emerick, ex-Walmart benefits strategist, is Dave Chase but with an actual career in big-time group benefits strategy & execution behind his observations. Tim Thomas is nonpareil in his pharma benefits niche, and wellness program basher/"re-imaginizer" (yes, I made that word up) Al Lewis is...quirky, but right too often to ignore.

I don't know the others listed on their "about" page, but if these 4 associate with them, they're probably ok

 

[scagnt83]

After reading the website, it sure seems like a HMO setup to me. Lots of "feel good" words sprinkled in to make it sound like a new concept. But nothing new, just repackaged in a fancy wrapper. jmo based on their website.

 

[JosephDeacon]

It is not an HMO or an insurance product at all. Disclaimer, I am part of the Health Rosetta Group as of 2018. It is a group of advisors sharing proven practices to create health plans that deliver the highest quality medical care in the most cost-effective way possible, in a transparent environment. The Health Rosetta Group is influencing positive outcomes with employer groups all over the US. It’s basically an environment where everyone shares ideas amongst the group that are very forward thinking, and that are actually working as intended (and what is not).

Example: I am taking a current self-funded client away from the PPO model and implementing a reference-based pricing model after analyzing actual claim payment data at hospitals being utliIes by the group. This will likely cut their claims by at least 30%, which will save them at least $250K.

 

[Monti_Ray]

Excellent information.

How can a benefit broker join the Health Rosetta Group?

It seems the group already understands the pie is big, there is enough for everyone, and not afraid to share.

Monti
BestInsLeads.Com

It is not an HMO or an insurance product at all. Disclaimer, I am part of the Health Rosetta Group as of 2018. It is a group of advisors sharing proven practices to create health plans that deliver the highest quality medical care in the most cost-effective way possible, in a transparent environment. The Health Rosetta Group is influencing positive outcomes with employer groups all over the US. It’s basically an environment where everyone shares ideas amongst the group that are very forward thinking, and that are actually working as intended (and what is not).

Example: I am taking a current self-funded client away from the PPO model and implementing a reference-based pricing model after analyzing actual claim payment data at hospitals being utliIes by the group. This will likely cut their claims by at least 30%, which will save them at least $250K.

 

[leevena]

It is not an HMO or an insurance product at all. Disclaimer, I am part of the Health Rosetta Group as of 2018. It is a group of advisors sharing proven practices to create health plans that deliver the highest quality medical care in the most cost-effective way possible, in a transparent environment. The Health Rosetta Group is influencing positive outcomes with employer groups all over the US. It’s basically an environment where everyone shares ideas amongst the group that are very forward thinking, and that are actually working as intended (and what is not).

Example: I am taking a current self-funded client away from the PPO model and implementing a reference-based pricing model after analyzing actual claim payment data at hospitals being utliIes by the group. This will likely cut their claims by at least 30%, which will save them at least $250K.

We did the same with a 4,000 life group, reduced the claim spend by 46%.

 

[ABC]

Looks like the reference-based pricing model, of course it will save money if the medical providers will accept 125-150% over Medicare reimbursement.

 

[leevena]

Looks like the reference-based pricing model, of course it will save money if the medical providers will accept 125-150% over Medicare reimbursement.

We did a little more to it than changing the reimbursement amounts. By eliminating the “brand name network” and going to no network at all we assumed the responsibility for all management of care, which allowed for a more robust program. Belief is that a brand network needs to balance costs with the need to have a larger selection of providers, which leads to them trying not to upset the providers. Without a network we have reduced/eliminated this issue.

 

[ABC]

Lee, management of care? Is this scenario what does that consist of?