High-touch, high-quality care at lower costs for elective procedures. Zero out-of-pocket for members.

HealthSmart MyDecision Clinical TeamElective procedures account for a substantial percentage of the
dollars spent on healthcare today. Costs for these procedures
vary immensely, which means higher medical claim spend for
self-funded plans and high out-of-pocket costs for members.

MyDecision™ by HealthSmart provides the answer. Leveraging our HealthSmart
Preferred PPO Network, we have developed a high-quality, lower cost network of
providers for bundled, all-inclusive procedures.

How much savings? HealthSmart’s comprehensive bundled payment solution provides 30 to 40 percent incremental savings for elective procedures over what traditional PPO networks offer. Our clients have seen reductions of 4 to 7
percent on their overall medical claim spend. No surprise billing, lower claims costs and zero out-of-pocket for members.

How it works:

  • We contract directly with high quality providers at aggressively priced bundled rates
  • Our clinical team provides integrated utilization management to determine medical necessity
  • Our real-time concierge outreach redirects members to the right providers that they can select
  • We pay the providers and distribute savings to the members and the plan

The plan’s success is a combination of clinical oversight and member outreach. In 2017, Member Advocates delivered a 92 percent redirection success rate.

Types of covered services include orthopedic, general surgery, spinal and neurological, women's health, advanced imaging, endoscopic procedures and more.

HealthSmart MyDecision Infographics

Good for employers, good for members

  • Freedom of TPA or UM Choice - MyDecision isn’t tied to solely to HealthSmart solutions. We can integrate with any TPA or Utilization Management partner.
  • Accredited Care Management - A key part of MyDecision’s success is the integration with our Care Management solution, which is URAC accredited and staffed by more than 140 Registered Nurses.
  • High-touch, Compassionate Service - Navigating healthcare can be difficult. Our Concierge Team provides one-on-one interactions to help members navigate through the entire episode of care.
  • Member Engagement - HealthSmart provides effective web, text and print communication capabilities to drive member engagement and utilization.
  • Member Incentives - We incentivize members through waiver of coinsurance and deductible amounts, and can even issue rewards through checks or deposits into HRAs.
  • Pricing Flexibility - We offer several options, including PEPM, PMPM or a per usage “shared savings” methodology.
  • HealthSmart Experience - MyDecision was developed and is managed by HealthSmart, one of the largest independent TPA and Care Management partners in the country.

Our Member Advocacy team

MyDecision Members

  • Schedules members into high quality, bundled provider settings
  • Explains how members can benefit from the approved surgery or service
  • Supplies pre-service information to prepare the members for their procedures
  • Delivers a concierge service to ensure positive member experiences
  • Pay ZERO out of pocket for services included in the bundled price
  • Have complete transparency into the price and quality of providers
  • Receive targeted, real-time, personalized guidance from beginning to end

Take control of the high cost of elective procedures with MyDecision!

MyDecision – Part of HealthSmart’s SmartDecision Solution
MyDecision has been a core offering for HealthSmart since 2012. But our hard work didn’t stop there. We have continued to explore other creative ways to lower healthcare costs. MyDecision is now a key component of HealthSmart’s SmartDecision solution, which offers Reference Based Pricing, MyDecision bundled pricing and Healthcare Blue Book. Plus, members can navigate all of these solutions with HealthSmart’s signature Concierge Team.