Trifecta Health Solutions
Addressing Healthcare Overspend with Modern Technology

The recent pandemic has driven millions of companies into disarray. Enterprises are not only experiencing low business growth due to economic troubles, but also struggling to contain the increasing medical and insurance costs associated with COVID-19 and other factors. The uncontrollable and unpredictable rise in staffs’ healthcare expenses has large and small enterprises attempting to curb the medical charges and stay abreast of the increasing rate of inflation. “The key to controlling such expenses lies in identifying and removing unnecessary overspend by targeting specific variables in an employer’s healthcare margins,” explains Derek Rine, CEO, Trifecta Health Solutions.

Based in Ohio, Trifecta Health Solutions combines healthcare supply chain management strategies with Artificial Intelligence (AI) and Machine Learning (ML) to help organizations realize significant savings on their medical spend, while driving substantial ROI. “We are encouraging employers to look at healthcare spend through a supply chain management lens rather than a traditional insurance solution and technology makes this much easier” says Rine.

The company’s moniker is derived from the three benefits it offers to employers through its single platform, which includes Trifecta Rx, Trifecta Claim Forensics and Trifecta Claims Intelligence. The first layer of Trifecta Health Solutions’ platform is Trifecta Rx, which employs analytics to help employers and employees source medications through alternative platforms at much lower costs outside of their traditional pharmacy contract. This approach helps self-funded employers realize over 50 percent savings on their pharmacy spend.

Trifecta’s Claim Forensics program helps clients identify unnecessary overspend as a result of medical billing and coding errors. Through AI and ML technology, the company discovers unintended faults in medical billing and coding processes, helping employers recover capital as a result of overspend. Additionally, the Claim Forensics program ensures provider payment integrity, which supports insurance payment accuracy as well. “The combined effect of the Trifecta Rx and Claim Forensics program is typically a net savings of over 20 percent on healthcare for self-funded employers,” says Rine.

The platform’s third feature is the AI Predictions component, also known as Claims Intelligence, which forecasts healthcare costs based on AI analysis of individual health encounters by extracting employees’ data from the insurance company’s database. This allows for early intervention if there are any healthcare risks or inadequate treatments occurring. It’s also a valuable financial forecasting tool for employers from a budgetary standpoint. All these impressive features of the platform empower clients to obtain meaningful savings while enhancing the employee experience. Additionally, Trifecta places an ROI guarantee on their services, which eliminates financial risk to employers engaging with Trifecta. Prior to deploying these features, Trifecta Health Solutions performs a complimentary analysis by extracting healthcare data from the clients’ TPA / Insurance partners to understand what modifications could lead to cost-saving. “We use modern technology, including AI and ML analytics to show clients how their healthcare plans would benefit from our solution, while generating meaningful savings. Our team is passionate about educating employers and employees on how to become smarter consumers of healthcare and maximize efficiencies while making minimal modifications to existing processes,” remarks Rine.

Although a new player in the market, Trifecta Health Solutions, has already helped businesses generate substantial savings on their healthcare spend. For an enterprise with nearly 3,000 employees, Trifecta Health Solutions initiated the Trifecta Rx program and reduced the pharmacy spend by 56 percent. Additionally, the company has used their claim forensics program to identify millions of dollars in savings for large employers as a result of medical billing and coding errors. They’re also helping organizations forecast future costs and develop early intervention strategies with their Claim Intelligence program, while consulting in many other areas.

“We aspire to continue bringing value to the healthcare marketplace using modern technology. We’re continually expanding our capabilities to meet the needs of employers and strategic partners,” says Rine. Trifecta Health Solutions’ ideal partners include self-funded employers, TPAs, health systems, brokers and other healthcare technology vendors.