It's no secret that the Patient Protection and Affordable Care Act has affected the insurance industry from top to bottom. In order to survive and thrive, operators have had to adhere to part of the mantra of the U.S. Marines: adapt and overcome.

One such company, U.S. Advisors Inc. of Brentwood, Tennessee, in August started offering an assurance program to hospitals and surgeons who use a prescription drug called Cellerate, which is used to treat surgical incisions and major lacerations. Cellerate works to speed the healing process so patients who have undergone major surgery recuperate from their incisions faster. It also has been used to prevent amputations performed on diabetics, and as a barrier to prevent further infections.

U.S. Advisors offers the assurance program in case a patient treated with Cellerate needs to be re-admitted to a hospital should an infection occur. For program purchasers, the company will reimburse up to $5,000 of unreimbursed costs. The program also can be used if an insurance company or Medicare says the infection was preventable and refuses to pay for a re-admit.

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"It's part of the drug purchase itself," says Terry Chesser, president of U.S. Advisors. "So when the hospital purchases Cellerate, it's bolted on and it comes with it. Hospitals are all about reducing re-admits. This is a way to reimburse and protect the hospitals financially."

The main customers so far for the program are hospitals or their corporate arms. Doctors and hospital administrators learn about the program through pharmaceutical representatives. So far, three hospitals have purchased the program, along with Cellerate.

"Hospitals and health plans have expressed strong interest in the program," says Randy Wright, president of Advance Benefits USA and the program's third-party administrator. "There is a general feeling among hospital administrators and payers that manufacturers can do more to help share in the risks associated with surgeries and other medical procedures. This program helps create a partnership between the two parties and will help control costs because of goal alignment that the program creates. Some hospital administrators have said that this program could be a requirement for future medical devices to be used in their hospitals."

Chesser and his colleagues got the idea for the program when they were approached by the manufacturer about helping the drug grow its use and also helping to assuage concerns about re-admissions.

"We were presented the need by a drug manufacturer," Chesser says. "And then we kicked around different ideas to help with the drug's acceptance — then also the prevention and re-admission to the hospitals. I thought we may be able to marry the two. So it acts as an additional level of protection that they get vis-à-vis the assurance and buying the program."

Chesser says the program frees doctors and hospitals to prescribe Cellerate by offering financial protection, but he says patients also benefit because Cellerate promotes faster healing and less time in the hospital should an infection occur.

Chesser adds that as doctors and hospitals move away from fee-for-service models of payment and reimbursement to a bundled payments model, assurance products like theirs have a bright future. By helping to guard against re-admission costs, doctors and hospitals will be able to make the bundled payments model more profitable.

"Now that we have the first prototype, there are going to be other widespread uses of our assurance program to protect and work with other health care products industry-wide," Chesser says. "We're working on many different applications right now."

Obamacare will continue to change the insurance industry. And companies such as U.S. Advisors are adapting by creating new revenue streams and products. The assurance program is one key example. 

"The Affordable Care Act was one of the key drivers behind the program," Wright says. "We believe that capitation and risk-sharing programs will be key elements of health care strategies for hospitals and providers in the future. Our program creates a risk-sharing partnership between the hospital and the manufacturer. We believe this program has the opportunity to create more affordable and effective ways to introduce new and promising technologies into the hospital and other care settings."

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