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Firm forms cost management unit

Meritain Health, the Amherst-based national third-party health plan administrator, said it has formed a new cost management strategies department to help clients manage their costs and evaluate their medical spending.

The company, which says it's the largest independent provider of services to self-funded employer health plans, will evaluate clients' plan design and individual consumer behaviors to spot trends and stabilize expenses over the long-term.

It said it will review and manage high-dollar individual claims, to educate consumers and reduce medical costs by encouraging healthier lifestyles.

The division will then use the information to cut the percentage of claims paid at retail cost and find the best -- and cheapest -- ways for both groups and members to access doctor and hospital networks. The division will employ 31 in its Amherst, Baltimore and Minneapolis offices.

"Meritain is committed to containing and assessing health care costs for our clients," Tracie Canby, senior vice president of cost management strategies, said in an e-mailed press release. "Our clients can look to Meritain to aid in promoting the financial health of their benefit plans, and the well-being of their employees."

As health insurance premiums and medical expenses continue skyrocketing, health insurers and third-party administrators like Meritain are putting increasing focus on tighter cost control, plan management and employee wellness. Meritain noted that the U.S. health care system is complicated by "inflated prices, inappropriate care, waste and fraud."

Meritain was originally North American Health Plans before its acquisition more than a year ago by an investor group, now a Connecticut-based health services holding company called Prodigy Health Group. The parent serves 3.5 million members nationwide, and also owns a national medical management firm and a stop-loss insurer.


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