Health Plan Expenditures, Projected Savings Per Member Per Month (PMPM); MatheMEDics Charge Basis

We have analyzed figures from two large private health plans indicating that spending exceeds $8.30 per member per month (PMPM) on 11 diagnostic CPT codes alone. Assuming a conservative reduction of 15% in utilization plus administrative savings, MatheMEDics software and process redesign could save initially $1.30 PMPM. In a 100,000 member index plan, this translates into $125,000 savings per month. MatheMEDics charges are based on a nominal percentage of estimated savings for individual plans calculated on our analysis of your available data.

Moreover, we estimate that over 50% of all tests done in hospitals are unrelated to the patients' admitting and secondary diagnoses. Generally, inpatient diagnostic procedures are not reimbursable since most hospitals are paid on a negotiated global daily rate (per diem). MatheMEDics decision support software would help identify those procedures which could be performed electively on an outpatient basis and therefore would provide additional revenue stream to the hospital.

MatheMEDics software would also yield significant cost savings where the hospital either alone or as part of a Physician Hospital Organization (PHO) has capitated risk for imaging or other services. Here, the software could be used to identify situations for which imaging would be inappropriate. It is remarkable the extent to which resources of providers are needlessly wasted on services that have no value for patient outcome or well being. Furthermore, we have identified an enormous need for admitting and continued inpatient stay authorization software. Thus, MatheMEDics software and platforms translate into staggering savings for hospitals and PHO's.