Alithias: Navigating Healthcare at Affordable Cost

Ross Bjella, Founder & CEO, AlithiasRoss Bjella, Founder & CEO
John Torinus in his book ‘The Company That Solved Healthcare’ delineated the effective strategies that helped Serigraph’s transition from a company that consistently received large premium increases to one whose annual premium increases were 50 percent below the national average over a 10 year period. John’s work opened a serious discourse on the need for self-insured businesses to enact similar programs to control healthcare expenses. Inspired by Serigraph’s incredible story, Ross Bjella—an astute entrepreneur— sought a data-driven solution to healthcare cost management, which led to the creation of Alithias, a highly skilled data analytics firm that applies big data analytics to operationalize healthcare cost management at the employee level.

Alithias’ first-of-its-kind business intelligence platform provides employers’ with healthcare data analytics and employee advocacy services through easy-to-understand dashboards and live Care Navigators. Employers use these dashboards to access insights of their employees’ healthcare claims, enabling HR managers to understand cost drivers, identify savings opportunities and measure the value of wellness programs. Instead of waiting for brokers or TPA to provide a months’ old report, the dashboard provides automatic notifications when opportunities for savings appear in the data. All of the employer’s data is aggregated into one platform, enabling fully integrated population health analytics. “All aspects of care navigation are integrated into a single format, enabling employers to quickly visualize trends and measure specific program outputs to make informed decisions,” says Bjella, founder and CEO, Alithias.

As Alithias enters into a partnership with a business employer, it first works with the company’s third-party administrator for data feeds of medical and prescription claims, then fully integrates with the employer’s onsite clinic for EMR, and any wellness. Once Alithias has all the information, it runs first pass analytics to screen the profiles of the groups of employees, looking at their historical claims to identify the largest savings opportunities. These data are used to create cost comparison summary report that identifies a virtual network of the highest value providers within the preferred provider organization (PPO).

The dashboard and our Navigators’ knowledge of benefit plan designs, specific employer programs, treatment options, CPT codes, DRGs, and typical billing errors allows us to guide employees to the most efficient and cost effective healthcare solution possible

This information is also used to identify Centers of Value, make benefit plan design adjustments and assist the employer in setting up direct or fixed bundled price contracts with providers. The final product is a healthcare data dashboard that proactively identifies actionable overspending and suggests immediate actions HR Managers can take to reduce costs.

Many employers also purchase Alithias Concierge Services to support the initiatives launched because of the ability to measure results through detailed analytics. The Concierge Services are provided by a dynamic group of committed healthcare benefits specialists called “Navigators,” whose knowledge of benefit plan designs, specific employer programs, treatment options, CPT codes, DRGs, and typical billing errors allows guiding employees to the most efficient and cost effective healthcare solution possible.

The effectiveness of Alithias’ platform can be substantiated by its delivery of proven savings to a manufacturing firm in Rice Lake, Wisconsin. When this 450 employee company approached Alithias, it was considering self-insurance but had experienced a number of catastrophic medical claims the previous year. Alithias’ analytics of the historical claims showed a potential 50 percent reduction in the number of catastrophic claims in the following year and identified a strategy to keep similar cases below the stop loss spec. This eventually led the firm to adopt Alithias’ platform, and within a year, the company had a reduction in their medical costs by >20 percent and a reduction in catastrophic claims by 70 percent.

With this ingenious application of big data analytics, Alithias has emerged as a revelation to healthcare management tools for employers. The increasing adoption of the platform has not only helped employers reduce their healthcare expense but can improve the overall health of the employees and increased the value of their benefit plan.