600 MSAs in 90 Days

This case study highlights how American Airlines partnered with Tower to draft 600 MSAs in 90 days for a settlement project
resulting in a significant reduction in open claims.

SCHEDULE A CONSULTATION

CHALLENGE:

The largest airline in the world, initiated a claims closure project driving to reduce not only the number and cost of claims but litigation and pharmacy spend as it pertains to the total medical costs and value of MSAs.

American Airlines chose Tower to partner with the employer, the carrier, the physician peer review and other settlement partners to manage MSA and post-MSA intervention strategies for claims involving Class I and Class II Medicare beneficiaries.

SOLUTION:

Tower prepared more than 600 MSAs over a 90-day period, following its Pre-MSA Trigger Identification Decision Tree Process. Specifically, identifying medical and drug triggers that create a barrier to settlement as well as making recommendations regarding treatment not aligned with evidence based medical guidelines. If settlement was feasible, the MSA and case were transferred to the settlement partners. If settlement was not feasible, the claims team partnered with Tower and PRIUM to determine the appropriate medical and pharmacy intervention technique. Through an integrated software platform with PRIUM, Tower served as gatekeeper throughout the process – communicating accountability, measuring progress and confirming acceptable CMS outcomes. Based upon the success, new paradigms for early identification were embedded into the claims management process and culture.

RESULTS:

While simultaneously working with all stakeholders, the settlement project and subsequent changes in claims management best practices, the partners achieved the following results over a 3-year period:

  • 40% reduction in aged pending
  • 24% reduction in total incurred

0%

MSA Cost Savings from Clinical Intervention

$0

Average Conditional Payments Savings

0

Pre-Validation Checks

0%

Conditional Payments Reduced to $0