WHAT WE DO

Even with this significant cost to plans, diagnostic testing is primarily done in high-cost settings such as inpatient facilities and sleep centers. CareCentrix has unparalleled experience managing sleep benefits on behalf of plans – with over 50,000 new patients a year on sleep therapies.
 
Our program success relies on several critical factors:

Right Site of Care.  Sleep testing can (and in many cases, should) be redirected to the home. By using evidence-based clinical protocols and prior authorizations, CareCentrix is typically able to redirect a majority of testing to a home-based setting, resulting in near-immediate savings of 30 – 40%. 
 
Supply Costs and Overutilization.  We prevent unnecessary overutilization of sleep supplies and ensure product pricing is highly competitive through significant discounts negotiated with our specialized sleep network partners, often resulting in lower unit costs for expensive medical equipment and supplies.
 
Member Engagement for Adherence.  Approximately 50% of patients with sleep disorders are non-adherent with therapy,1 potentially resulting in adverse outcomes for the patient and significant wastage for the plan.  Plans that work with CareCentrix typically have 30% higher adherence rates than their unmanaged peers.  We achieve these rates through technology, ongoing member engagement, including written communications, phone outreach, and patient education initiatives.
 
Identification of At-Risk Patients.  Given our significant specialization in sleep disorders, we can also identify members that may be at-risk for certain conditions, such as sleep apnea, and work with physicians and other care providers to remove barriers to awareness, diagnosis, and treatment.
 

MARKET CHALLENGE

Approximately 70 million Americans suffer from sleep disorders2, of which Obstructive Sleep Apnea (OSA) is the most common. More than 80% of patients with OSA go undiagnosed.3 It is estimated that undiagnosed patients incur $4,000-$6,000 incremental annual healthcare costs4 due to:
 
  • Increased risk of high blood pressure
  • Increased risk of heart disease
  • Increased risk of diabetes & obesity
  • Double the risk of stroke
  • Medical trend for diagnostic testing and therapy is growing 10-15% annually, with average plan costs ranging from $1.75-$3.50 per member per month
 

BENEFITS

CareCentrix’s Sleep Management Solutions program can:
  • Ensure that patients are treated in the most cost-effective setting while receiving quality clinical care
  • Reduce risks associated with sleep disorders
  • Increase productivity and quality of life that comes with regular, uninterrupted sleep

 
[1] Berry, et al. SLEEP, Vol. 31, No. 10, 2008 
[2] http://www.cdc.gov/sleep/about_us.html
[3] American Sleep Apnea Association
[4] https://sleep.med.harvard.edu/le_download/100
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