Introduction
BeneBridge360™ — Reducing OOP, Creating Steerage
We combine Gap Insurance + Advocacy to lower member OOP and steer cases to Novant.
What We Do
- Integrated Gap + Advocacy: single member experience that resolves large claims.
- Direct Provider Payment: we adjudicate discounts and pay Novant directly.
- Consumer Clarity: members see clear OOP, earlier — and choose the lowest OOP setting.
Value to Novant
- Soft Steerage: lower OOP at Novant sites guides member choice — no network restriction.
- More Volume: captures cases otherwise going to Atrium/OrthoCarolina.
- Reliable Cash: fewer write-offs; patient responsibility is funded and paid quickly.
Target: employer groups (not Novant employees)
Value to Members
Strategy
Steering Orthopedics & Neurosciences Volume
Focus on facility-based procedures where Novant can win share — joints, sports injury, and spine.
Market Context
- Novant Health Orthopedics & Sports Medicine seeks revenue and share growth.
- Novant Health Neurosciences Institute is a parallel service line (overlap on spine).
- Atrium leads in facility-based orthopedics; OrthoCarolina remains dominant in practice volume.
Soft Steerage with BeneBridge360™
- Members see lower OOP when care is delivered at Novant facilities.
- Guides choice without narrowing the network — financial nudge, not restriction.
- Produces predictable cost-sharing revenue and fewer write-offs for Novant.
Case Example
Incremental Revenue from Total Knee Arthroplasty
How BeneBridge360 turns a lost case into reliable Novant revenue.
Illustrative Case: TKA (CPT 27447)
- Total Allowable: $30,000
- Payer Portion (70%): $21,000
- Member Liability (30%): $9,000
Status Quo (Case to Atrium)
- Novant Revenue: $0
With BeneBridge360 Steerage
- Payer pays: $21,000
- BeneBridge360 collects member liability with 30% discount → $6,300
- Total to Novant: $27,300
Even 100 incremental TKA cases = $2.7M new revenue. 500 cases = $13.6M annually.
Process
How BeneBridge360 Steerage Works
Member sees lower OOP at Novant early — selects Novant — Novant gets paid cleanly.
Step 1
Procedure Trigger
During prior authorization or when a specialist office‑visit claim is received (e.g., TKA 27447).
Member view: scheduling initiated; benefits ready.
Step 2
Engagement (Pre-Service)
Navigator + app present OOP comparison with Novant lowest.
Member sees: plan ID card & clear OOP — nudged to select Novant.
Step 3
Discount + Gap
Member liability reduced; BeneBridge360 funds and pays Novant directly.
Member sees: applied discount + payment/resolution options.
Step 4
Outcome
Case lands at Novant → incremental revenue, faster cash.
Member result: final responsibility minimized; no surprises.