AWAC / Managing Disease
AWAC scrubs every claim we receive against a relational database that spots potentially catastrophic health conditions before they progress into high cost claims. This revolutionary tool combines state-of-the-art software with highly trained physicians and specialists who identify potential high dollar claims, sometimes from claims as small as $30.
Why is AWAC different than other predictive modeling systems?
AWAC calls on peer specialists acting as consultants to review cases that have the potential to become "catastrophic" claims. These practicing specialists understand the complexity of treatment, can identify unnecessary procedure codes, and offer cost effective solutions without diminishing the quality of clinical treatment for the patient.
We operate on two basic principles. First, what is in the best interest of the patient is usually in the best interest of the plan. Second, the earlier a health plan can identify and intervene in high dollar claims, the more effectively the plan can manage and control costs.
Since inception, the system has reviewed millions of claims, pre-certifications and prescription saving those health plans an additional 37% (average) above conventional network discounts.
With AWAC, Stirling Benefit plans can exceed the savings generated by conventional ASO carrier discounts.
Once we identify individuals that are likely to have future health issues, physicians work with the treating physician to draft a treatment plan that is sound and cost effective. This is a long term approach, which incorporates:
- Linking wellness compliance to financial incentives
- Claims reviewed by physician led disease specialists
- Wellness programs tailored to fit each group’s benefits philosophy
Compared to traditional ASO offerings, our combination of AWAC with integrated pre-certification, effective large case management and custom tailored wellness program produces:
- Improved health of members,
- Greater workplace productivity and
- Short and long term cost reductions over other ASO plans.
Contact us to find out more about our unique approach to partially self funding your plan.