Our Product

A Better Health Plan Solution

ProVision Health

This plan is designed to offer employers and employees the best of both worlds: broad provider choice and lower healthcare costs.
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The Corporate Benefits Alliance is offering a hybrid health plan called ProVision, which combines the best elements of a PPO network plan with a reference-based pricing model. This plan allows the members to utilize the entire PPO network of doctors and hospitals on an in-network basis, yet restricts the hospital payments to 150% of Medicare, versus the standard average of 300%. Given that hospital claims account for approximately 70% of all health plan claims, this dramatically lowers the price of the health plan by limiting the amount it pays for in hospitalization. Prior to the creation of ProVision, PPO Networks and Reference Pricing were mutually exclusive.

ProVision marries one of the nation's largest Preferred Provider Organizations (PPO) networks with reference-based pricing (RBP) for facilities at 150%, presenting a novel approach to managing healthcare costs while maintaining access to a broad network of providers. This strategy offers several advantages for both the health plan and its insured members, as well as potentially impacting reinsurance costs favorably.

*Pap / MAP goes from deck

Cost Savings & Provider Access

ProVision Advantages for Health Plans and Plan Members

By setting payments to facilities at 150% of Medicare allowable charges, the plan ensures that payments are based on a standardized benchmark rather than the standard network discount, which averages 300% of Medicare.
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Combining RBP with a PPO network ensures members have access to a wide range of providers. This access is critical for member satisfaction and can help mitigate one of the common drawbacks of RBP alone—limited provider acceptance.

Our program's unique feature of achieving less than 1% balance billing from facilities, allows us to eliminate the balance bill risk to the member. ProVision indemnifies all plan members against ever having to pay a balance bill. This is a major advantage for member satisfaction and alleviates the primary concern with RBP strategies.

The cooperation of the PPO network means that your program isn't just imposing rates but working within a framework that providers have agreed to. This can lead to smoother provider relationships and potentially better care coordination and outcomes.

By ensuring that the worst-case scenario payment is the PPO contracted rate—not the chargemaster rate—ProVision offers predictability and financial stability for the health plan and its members. This can make budgeting for healthcare costs more manageable

Cost Savings Through Innovative Payment Model:

Network accept 150% of Medicare rate
Hospitalization cost cut in HALF
Avoids 300% Medicare network discount

PPO Network Access:

Largest Most Trusted PPO network
93% Net Promoter Score for members
Eliminates all drawbacks of RBP pricing

Eliminates Balance Billing Risk:

No balance billing
Members only responsibility is cost sharing outlined in plan

Negotiated Rates with PPO Cooperation:

PPO network cooperation
Adheres to provider framework
Enhances relationships, & patient outcomes

Predictability & Stability:

Worst-case payment: PPO rate
ProVision ensures price stability
Savings are sustainable in the long run

Healthcare Pricing Comparison

Impacts on Reinsurance Costs

ProVision's Impact on Reinsurance Costs and Client Savings
‍ProVision has led to favorable terms with stop-loss insurers, resulting in significant cost savings and flexibility for clients. Its proprietary claims adjudication platform substantially reduces the high cost of facilities claims. By addressing issues such as double billing and inappropriate claims, ProVision ensures the utmost cost containment and client value.

‍Reduction in Premiums
‍This proprietary model, coupled with strategic partnerships with key entities, has fostered substantial reductions in both individual and family premiums compared to traditional stop-loss models.

‍Minimized Fixed Costs and Maximized Variable Savings
‍ProVision effectively minimizes fixed costs while maximizing variable savings, particularly in the high dollar value of complex facility claims.

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Lower Claims Costs:

Effective cost management
Lower overall liability
Better long term risk portfolio

Increased Predictability

Max claims liability, network allowed amount v.s. billed charges
Simplifies risk modeling for reinsurers
Minimizes exposure to high dollar claims

Reduced Incidence of Large Claims:

Lower specific stop-loss premiums
Lower aggregate attachment points
Inherently lowers claim risk

In Summary

ProVision offers a compelling model for managing healthcare costs while maintaining the highest levels of access to care and provider satisfaction.

We accomplish this by offering:

Comprehensive Cost Management
ProVision offers an effective model that addresses key challenges in healthcare cost management by combining reference-based pricing with a robust Preferred Provider Organization (PPO) network, ensuring high access levels and provider satisfaction.
Innovative Plan Design
The program's unique design features, including the elimination of balance billing risks and the capping of worst-case payment scenarios, make it appealing to reinsurers due to the lower risk profile and increased cost predictability.
Advantaged Reinsurance Terms
Due to its innovative approach to managing healthcare costs, ProVision is attractive to reinsurers who value the reduced risk profile and enhanced predictability of costs.
Potential Blueprint for Future PPOs
Many consider ProVision's approach as a potential model for other PPOs aiming to strike a balance between cost containment and the provision of quality healthcare access.
Unique Position in the Market
Currently, ProVision is the only health plan in the country that successfully combines reference-based pricing outcomes with a well-known national PPO network, offering an unparalleled solution in the healthcare marketplace.
Sustainable Year Over Year Stability

Our Clients Say

"Switching to ProVision has been a game- changer for our company. The innovative plan design has significantly reduced our healthcare costs, and provided us with access to an excellent, national PPO network. Our employees have never been happier with their healthcare coverage, and it shows in their morale and productivity."
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Sam Wafaa

American Guard Services

"ProVision has redefined what we expect from a health plan. From exceptional customer service, to seamless, nationwide coverage, it's clear our needs have been prioritized. Our employees have noted how satisfied they are with the ease and comprehensiveness of their coverage, setting ProVision apart in the healthcare industry."
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Corbin Williams

Pacific Shore Holdings

"Our experience with ProVision has been nothing short of extraordinary. The substantial cost savings allow us to invest more back into our employees. Moreover, the extensive PPO network and innovative plan design solutions have significantly improved our employee satisfaction and morale. ProVision has proven to be a partner in our success, not just a provider."

Jerry Gregory

Vets Securing America Inc.

The ProVision Healthcare Product