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Health Plan Cost for Patients with Complex Medical Conditions

Complex medical condition means a diagnosis, treatment, or procedure that has a high degree of outcome variation and requires specialized skills possessed by a physician or a patient care team to provide care for the patient in order to prevent a serious adverse outcome. Many times, patients with complex conditions may wander through the health care system searching for a diagnosis or effective treatment plan. Others may be unable to access specialized care for complex conditions based on where they live. These scenarios can increase health plan costs and become obstacles for positive patient outcomes.

Every time these patients wander or seek treatment from multiple disassociated providers, health plan costs increase, and these patients are often the drivers of 85% of the plan cost. Without intercession and collaborative treatment, these patients will drive up health costs year after year.

When complex care is required, the ideal situation is to have collaboration between multiple medical specialties. Experts trained in virtually every medical specialty and subspecialty, made up of teams of the world’s leading experts, are working together to ensure the best possible outcome for each patient. Coupled with innovative technology and research programs, the experience and expertise to effectively care for patients who have serious, complex, and rare conditions is paramount.

Mayo Clinic Complex Care Program: Realize the Value of High-Quality Care

If the employees and members of your medical plan are experiencing fragmented care, ineffective treatments, potential misdiagnoses, or difficulty accessing specialized care for complex conditions, Mayo Clinic can help. The program offers managed access to Mayo Clinic’s high-quality, cost-effective care for individuals with complex, rare, or undiagnosed medical conditions. In other words, Mayo Clinic helps minimize costs while getting patients exactly the care they need.

Learn more:

Exclusive Access to PBA Clients

Mayo Clinic’s Complex Care Program is an essential component of PBA’s FOCUS Care program which Fosters better Outcomes for patients while Creating Unparalleled plan Savings.

FOCUS Care Brochure
Mayo Complex Care Case Studies

About PBA

Professional Benefit Administrators, Inc. (PBA) is an independently owned and operated Third Party Administrator (TPA) with a national presence. Since 1985, PBA has been entirely focused on self-funded employer sponsored health plans. Our goal is to build relationships with advisors who believe in the value of self-funding health plans with a flexible, client centric TPA. Committed to leveraging the PBA Advantage, we offer a competitive edge and always search for innovation to break through the status quo.