Medical Costs Management Achieves Reductions in Admissions & Claims Costs



 ~ Estimated cost savings of up to €100 million by 2016 already yielding better care outcomes for patients ~


Laya healthcare, Ireland’s second largest healthcare insurance provider, has today announced the results of a major medical costs management programme, which has already resulted in significant claims cost savings. The health insurance provider is predicting total savings of almost €100 million as a result of the review over the five year period from 2012 to 2016. The company believes that the savings over time from its medical cost management programme can be passed on to its members and will lead to better value for consumers.

The medical costs management programme has also led to a significant reduction in hospital admissions through the promotion of better practices and efficiencies.

Included in the broadened medical costs management review is a clinically led utilisation review programme - which strives to deliver better patient care and outcomes through medical reviews undertaken against international best practice guidelines. The review also encompasses hospital rate negotiations, changes to orthopaedic policy and the on-going identification of potential overcharging for a wide range of hospital procedures by laya healthcare’s medical costs management team.

The utilisation review programme, and its associated cost savings, has enabled laya healthcare to reinvest in initiatives such as in-home healthcare options allowing members to be treated in their own home which has a positive effect on a patient’s care pathway. Through this programme, laya healthcare has already seen a reduction in hospital admissions, where patients are not admitted to hospital unless medically necessary. Laya healthcare also encourages the use of pre-assessment clinics by hospitals, which is international best practice, to facilitate same-day surgery where possible.

Laya healthcare is the first private healthcare insurance provider to implement a medical costs management programme which is largely clinically led. The framework for the review programme was designed in conjunction with US utilisation review expert Dr. Ben Safirstein who is Clinical Associate Professor of Medicine at the Mount Sinai Medical School in New York. Dr. Safirstein collaborated with laya healthcare in developing an improvement process tailor made for the Irish healthcare sector. These internationally recognised best-practice medical reviews will enhance patient care and outcomes. This process is designed to ensure that laya healthcare’s almost half a million members receive best quality healthcare in the most appropriate setting for their medical needs.

Dr. Ann O’Doherty, Medical Advisor at laya healthcare explains the benefits of medical costs management: “The Irish health system has been under the microscope in recent times with particular focus being placed on cost efficiencies and best care pathways for patients. While better practices, high-spec technology and improved treatments are all translating into best patient outcomes, they are driving medical costs higher, which in turn has a negative impact on premiums.

By successfully containing our medical costs we can help ensure that consumers continue to have access to quality, affordable healthcare solutions.”

Dr. O’Doherty continues: “While cost savings are important for the business, it is never at the expense of ensuring the best outcome for the patient. Laya healthcare believes strongly in investing in the nation’s health and our unique HeartBeat benefit is a good example of this. HeartBeat is a free cardiac screening initiative that is available to all laya healthcare members to detect for underlying heart conditions that can lead to Sudden Adults Death Syndrome (SADS).”

Looking forward, laya healthcare is confident that it can continue to successfully implement cost efficiency measures that keep its average cost of claims lower than the market average across all age groups as is currently the case. In doing so, laya healthcare can continue to keep private health insurance affordable for its members, and invest in healthcare initiatives that benefit and support not only laya healthcare members, but all patients.