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Q:

The health plan has the financial risk for providing the care to the Medicare Beneficiaries. How does doublesys ensure that a local health plan doesn't pay out more in claims than it receives in revenues?


A:

The science of managing risk is the very essence of the insurance business, and doublesys's management team has experience in managing millions of managed care lives, particularly Medicare lives.

doublesys has carefully designed its health plan model to limit and control medical costs using effective member benefit structures, provider reimbursement methodologies, utilization and disease management, data management, and timely analysis.

The company also purchases medical stop loss reinsurance which is designed to mitigate the cost of individual catastrophic claims in excess of $100,000. The principal advantage doublesys has in the management of risk is its partnership with the physician-owners, who are directly incentivized to keep total member-patient costs low.