Effective July 1, 1990, Department of Finance and Administration officials contracted with Healthmarc, Inc., for a state employee and retiree health insurance utilization review program similar to those of forty-seven other states. The contract costs $1.70 per month per participant, or approximately $918,000, annually. The department’s consultants estimate that utilization review will save $4 to $5 million in FY 1990. The process assumes that prior consultation with Healthmarc professional staff will encourage participants to avoid unnecessary surgery, treatments, or hospitalization and to seek second opinions under certain circumstances.
PEER did not analyze the performance of the utilization review process to verify the accuracy of the projected program savings since the review program in Mississippi has just begun. PEER’s unannounced tests found that Healthmarc employees complied with contract terms by responding to telephone calls as promptly as specified.
For a paper copy of this report, contact PEER by telephone at 601-359-1226 or by e-mail at reports@peer.ms.gov.