The new year has begun — and that means it’s time to perform utilization reviews. These reviews ensure that your medical claims remain optimal and don’t cut into your bottom line. Let’s discuss what this process entails and how you can make this process easier for your company.

What is a utilization review?

A utilization review collects and synthesizes data on the medical procedures of every participant in your company’s healthcare plan from the last 12 months. An executive summary of this data reveals on which services money was lost/spent and if that money could be spent more efficiently for the coming plan year. 

These reviews cover transactions like services performed by a medical professional, X-rays, lab tests, doctor visits, and prescriptions. Each of these transactions can be broken down into cost categories, locations, and regions to provide insight into what’s costing your company the most and where it costs the most.

With the financial information laid out in an easy to read employer executive summary, you’ll see areas in which you could reduce costs without reducing the quality of care.

For example, let’s say that one of your employees utilizes their medical benefits to visit the doctor. As a result of that visit, the doctor prescribes this employee a name-brand drug, and this transaction is charged to your medical plan. By performing a utilization review at the end of the year, you could determine that a generic version of that same drug exists and costs significantly less than the name-brand. This allows you to develop cost-saving measures for your company’s healthcare plan for the coming year.

Optimize your utilization review with an experienced employee benefits consultant

Of course, utilization reviews are rarely as straightforward as the example above. Researching which services have lower-cost alternatives of comparable quality requires a significant time investment. This is especially true when you’d need to synthesize this information for every participant in your healthcare plan.

J5 Consulting uses decades of industry experience to simplify the process for you. You can fully optimize your company’s costs on participants’ medical services by performing in-depth research on all major hospitals, providers, and drugs. We analyze every dollar spent and provide better solutions to reduce your costs as much as possible. We’ll help you determine what’s working, what isn’t, and offer actionable next steps to reduce the financial burden on your company for the coming year.

J5 Consulting makes this easy for you. What’s your broker doing for you? 

Contact us today to learn how we can make the utilization review process easier so you can save time and money.