Exemplary Health

“Exemplary Health is a physician owned and physician-led health plan for employers delivering a robust population health management program that uses state of the art data analytics and clinical engagement with members to proactively manage member health to reduce costs, improve measurable quality metrics and improve the overall health of the members”

Exemplary Health is a fully bundled health and prescription plan combining all administration member service and health management expertise competing with traditional insurance carriers but differing in meaningful ways.

Top reasons why employers select Exemplary Health as the program for their employees.

1. You and your employees are the focus – not on earnings per share or stockholders.
2. Employees have access to a large medical provider network accepted by providers nationwide.
3. No need to change current doctors if not in the national provider network.
4. Tight and transparent management of pharmacy costs. Multiple sources provide the most competitive pricing.
5. The clinical team is focused on approving appropriate care rather than denying services.
6. Cost management efforts recognized by stop-loss carriers result in better financial terms.
7. Member service is of concierge quality. No delays in approvals, many opportunities for care at reduced or zero ($0) member out of pocket expense.

Exemplary Health embeds effective physician-led Population Health Management processes with tight cost controls and full transparency to produce better health, lower costs and a better member experience.

• Care Management services provided by a team of clinical nurses perform a comprehensive review of the members’ clinical notes, lab reports, pharmacy reports etc. to stratify members into various risk categories.
• Uses state-of-the-art data analytics system to create a comprehensive, 360-degree view of a member across the healthcare continuum and provides a complete picture of a member’s clinical and financial health. All clinical recommendations are built using the Best Practice and Evidence
• Based Guidelines as established by the various Medical Societies. Clinical team engages with Members directly and for choric conditions, continuously.

Examples of Success.

1. The member’s 7-year-old son was scheduled for a simple outpatient procedure at a local hospital when Exemplary health engaged. The hospital offered services for the 20-minute procedure at $14,000. The clinical team proposed an alternative physician and scheduled the appointment resulting in a total cost for the services of $3,000. Employer costs were reduced from $11,200 (80% of $14,000) to $3,000 and the member costs were reduced from $2,800 (20% of $14,000) to $0.
2. The member was taking Enbrel – a medication used to treat Rheumatoid Arthritis. Plan had been paying $7,400 per month and receiving no rebates prior to Exemplary Health. After engaging the members’ prescribing physician the clinical team agreed alternatives to Enbrel were not appropriate. Enbrel now being sourced by Exemplary Health via a different provider at a monthly cost of $3,400.