| BACKGROUND
In the next decade, annual private-sector employee
health and dental benefit costs in Canada will approach $25
billion. Approximately 40% of this is related to drug costs
with the balance attributable to dental and a wide array of
extended health care claims. These costs have risen dramatically
over the past number of years and are predicted to continue
to rise at an alarming rate. Drug cost escalation alone is
trending at 16 to 20% per annum and, at that rate, costs would
double in less than 5 years. A new paradigm for providing
benefits is needed.
The current health benefits market faces
increasing challenges:
- The existing insurance-centric model adds
an expensive administrative layer to costs.
- Most benefit management systems are 12 to
15 years old and require major overhauls to enable flexibility
in plan design.
- The pharmacist's role as a healthcare professional
able to help contain costs is neither recognized nor utilized.
- Improved health outcomes are not being realized.
- Chronic diseases that were fatal 10 years
ago consume over 60% of today’s health care costs
and will only increase with time.
- Cost escalation continues unchecked with
no real protection against catastrophic claims experience.
NexgenRx addresses these limitations
by:
- Dealing directly with plan sponsors or their
intermediaries.
- Lowering costs by charging for claim processing
on a transaction basis rather than the value of the claim.
- Accommodating sophisticated plan designs
with flexible, leading edge, rules-based technology.
- Providing the NexgenRx Intervention Suite™
for drug claims and outcomes management.
- Facilitating ancillary insurance protection
against excessive losses.
- Encouraging active pharmacist participation
in prescription therapy plans.
- Providing retrospective claims analysis
by health professionals as well as prospective trending
to give plan sponsors an idea of future claim patterns and
costs.
- Fielding a proven management team with over
100 years of experience in the electronic claims management
sector.
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