The Adjudica Approach

Adjudica's Group Self-Management platform is a comprehensive tool for providing transparency into group health care spending and configuring and controlling the decision making process of a group plan. The platform gives plan members the ability to see whether group spending is within budget and how that impacts each person's premium. Group members can be asked for input on plan changes or can even suggest their own ideas, such as covering health club membership fees or raising deductibles.  By becoming part of the process, members become more engaged in their healthcare and responsible for the associated costs.  Plus it's a way for plan sponsors to avoid being "the bad guy" when costs go up and coverage changes at the end of every year ...  to everyone's surprise.  

The GSM is designed to be implemented by employers with existing group health plans, companies with self funded plans and government health program administrators, for both existing and new health plan offerings. Over time, the GSM can drive toward spending within a set budget amount for the group as a whole instead of an open ended financial commitment.

A Gradual Transition

Initially the GSM is used to provide transparency into what the group is spending on care allowing group members to see where their budget is going. Plan administrators can decide the level of implemention of the democratic aspects of the GSM, from using it as a one-way communication tool to using it to gain membership feedback to using it to encourage the membership to actually help shape the plan directly.

A New Option for Self Funded Plans

Companies that self fund their health insurance plans face constant cost pressures and are directly impacted by the health care choices of their employees. With Adjudica, companies can give a tool to their employees that provides transparency and reporting, driving an awareness of the cost elements behind their monthly premiums. Once aware of the causes of health care cost increases, the employees become empowered to make wise decisions and can take advantage of the Adjudica system to control costs while still receiving the care they desire. With company self-funded plans, the costs savings that result from implementation of Adjudica will be directly measurable and apparent.

A New Option for Insurance Companies

Insurance companies and health plan administrators are under constant pressure to reduce costs for the companies that offer employer-funded health care while also providing strong customer service to the plan participants. With the Adjudica GSM, insurance companies will have a means of reducing their own costs, putting a cap on their expenditures for the group as a whole and improving their group members' control of the health care they are receiving. Adjudica provides insurance companies a revolutionary new approach that can address many of the concerns of our current free market health care system..

A New Option for Government Plans

Adjudica's GSM is also uniquely suited for use with government-funded health care plans. Federal and state governments are under constant pressure to reign in the growth in health care spending. Adjudica's GSM allows the people actually receiving the government health care to decide how best to allocate the money being spent on their care.  That will be critically important as tough decisions will need to be made in the future regardring the cost of care.  With the membership choosing between options, those decisions can be made in a politically palatable way.