How It Works

Adjudica's Group Self-Management platform (GSM) is a tool used in conjunction with a group health plan to first give group members visibility into how their money is being spent and then allow group members to use this information to take control of their plan's spending.

Many decisions impact the care people in a group plan receive. The Adjudica system leverages the ability of the Internet to disseminate information and build community to enable the actual participants to understand the impact of decisions being made and be directly involved in making these decisions. Adjudica's GSM gives plan members the tools to:

• Understand how the group's health care budget is currently being spent by categories of care, and to further understand the financial impact to each member of these decisions. 

• Discuss possible changes to the plan to improve care, control spending or increase or decrease premiums and copayments.

• Project the impact of proposed annual changes to the plan in terms of cost and care. For example, if member participants were to propose changing the list of covered procedures, or whether to change co-pays for specific procedures.

• Democratically decide to change aspects of their own plan - add or remove covered procedures, set budgets for elective care, increase or decrease premiums or co-payment.

• Monitor ongoing group plan operations such as expenditures by category, numbers of key procedures, comparison to budget, etc.

• Participate in an online community of group members, a forum for discussion of care options and pricing or anything that might help improve the quality of care.