CareCost Estimate vs. Agilum

CareCost Estimate delivers a comprehensive solution tailored for infusion centers and specialized medical practices, addressing a frequent question from patients: what is the expected cost of treatment? By inputting details such as medication, dosage, and insurance information, staff members can quickly calculate the patient's out-of-pocket expenses, often in under 90 seconds. This estimate takes into account various elements, including Medicare Part B coinsurance, any secondary insurance, Medigap coverage, weight-based dosing, and potential vial waste considerations (JW/JZ). Additionally, it factors in any available manufacturer copay assistance programs and foundation grants that the patient might qualify for, ensuring that the provided estimate accurately reflects the patient's financial responsibility. Beyond just cost calculations, the platform also offers valuable insights into payer requirements, outlining necessary prior authorizations, step therapy guidelines, and site-of-care conditions, all derived directly from the payer's policy documents with relevant links for easy access. The pricing data is based on the CMS Average Sales Price files, which are updated quarterly, and importantly, since the estimates are generated within the browser, patient information remains confidential and is not sent to outside servers. Furthermore, CareCost enhances its offering by providing free resources on billing and coding practices, including infusion CPT codes, J-codes, and modifiers, as well as a quarterly Infusion Reimbursement Index that aids healthcare providers in optimizing reimbursement processes. This comprehensive approach not only streamlines cost estimation but also supports healthcare professionals in navigating the complexities of patient billing.

We support the shift towards value-based healthcare by assessing a range of treatments, medications, processes, and costs, which assists hospitals, life sciences companies, and insurance providers in identifying treatment approaches that result in the best patient outcomes. Our CRCA™ P&T platform empowers P&T committees to make data-informed improvements in quality measures, including average length of stay (ALOS) and 30-day readmission rates. Moreover, our cutting-edge POP-BUILDER Rx™ solution presents comparative insights between selected groups and CRCA's vast database of real-world data, which includes over 140 million longitudinal patient records. In addition, our drug remittance dashboard thoroughly examines and reports on drug remittance details across various payer categories, with a focus on high-cost medications down to the National Drug Code (NDC) level. We also enable hospital finance teams to effectively monitor and improve service line costs, profitability, productivity, and revenue cycle performance through our detailed analytics and reporting, along with the support of our Agilum Healthcare Intelligence team. This ensures healthcare providers can make well-informed decisions that enhance their operations and patient care. By integrating these diverse resources, we create a comprehensive understanding of the complex financial and clinical environment in which healthcare providers function, ultimately aiming to improve overall healthcare delivery.