About Reliacare

Quality, Collaboration and Innovation

ReliaCare understands the unique needs of the member populations that our clients serve. We also understand the strain that serving these populations places on provider relationships - as well as the associated costs, both obvious and hidden, that these services place on the insurance carrier's bottom line. Utilization rates that are higher than the norm means that the re-authorization and reordering processes are cumbersome and time consuming for a health plan and frustrating and redundant for providers and members. Add to that the administrative burden of credentialing, network management, and fee schedule management and it is easy to see how these costs can spin out of control quickly.

About ReliacareFacts:
  • The cost of care continues to escalate while premiums remain flat or are reduced
  • The acuity of patients in the home has continued to increase
  • Due to a sicker, aging population, chronic long-term diseases have increased
  • All of the above has led to long-term dependencies on equipment in the home in order to sustain healthy conditions and activities of daily living.
While simply reducing the overall provider reimbursement rates can provide marginal offset in a health plan's financial exposure, these are short sighted opportunities which generally result in an increase in volume of services or a network which is unwilling to accept the most deeply discounted cases.

ReliaCare has developed a delivery model to assist health plans in saving dollars through appropriateness of services, provided by a regional network of quality providers. Our model differs from our competitors in that we guarantee a savings to the health plan in the first year as well as in out-years of the agreement through appropriate utilization of services, using the most competent providers at the most competitive rate.

On average, we find that while DME and O&P only represents one percent of a plan's revenue for actual product, the true cost of the benefit can only be found by applying some industry standard administrative costs that are often hidden from view. Typically a plan can spend an additional 30% on the administration of the DME benefit in costs that are obscured as "normal" administrative and medical costs. With ReliaCare a health plan can share as much or as little risk as they are comfortable with. This flexibility allows us to maintain both a right sized network and right sized fee scheduling which is ultimately where your savings lie.

  • Credentialing & Contracting
  • Price Setting
  • Benchmarking & Reporting
  • Access Guarantees
  • Follow payer and regulatory guidelines
  • Follow benefit design
  • Physician Outreach
  • Patient/Family Coordination
  • Delivery Confirmation
  • Regulatory guidelines followed
  • Electronic submission increased
  • Reporting to support benchmarking
  • All languages supported
  • Multi-tiered Operational Reporting
  • Extensive Data Aggregation