It may be difficult for those outside the healthcare field to understand what Stephanie Kilpatrick and Debra Potterfield, owners of Self-Insured Solutions, do. Their clients are companies with self-insured healthcare, third party administrators and workers’ compensation.
Simply put, Potterfield says, “I’m a medical professional and I want everyone to do the right thing. We communicate with the medical community to make sure the correct medical course is delivered within the law and at a fair cost.”
That includes such things as bill review and auditing, fraud investigations, pre-certification and claims reviews, case management, consultation for coding and billing issues, and medical cost projections.
“Our goal is to see that the appropriate treatment is provided at the right place,” Kilpatrick said.
Both business owners are registered nurses with many years of experience. Each had her own business before coming together in 2002 to begin Self-Insured Solutions. They saw a need to assist companies with reducing the costs of workers’ compensation, group health, liability and long-term care costs while maintaining the quality assurance of their healthcare delivery system.
“We look at what a company needs and customize services for what’s important to them,” Potterfield said. “It’s a relationship business, and we always want to be available to the claimant.”
She describes Self-Insured Solutions as a hands-on business that is small (eight employees) and will remain that way. Five different circles — carrier, patient, provider, employer and Self-Insured Solutions — all touch and interact, she and Kilpatrick believe.
“We never forget, first and foremost, that we are advocates for the patients,” Potterfield said. “Second, like any other business, healthcare providers must care about the bottom line and the management of group and workers’ compensation must take this bottom line into account to save money.”
Foster Wellburn is a satisfied customer. He is director of the Mississippi Manufacturers Association Workers’ Compensation Group, comprised of 300 employers with over 16,000 employees.
“We strive to see that each injured employee receives the highest degree of care at a reasonable price,” he said. “One of the ways we do this is by employing Self-Insured Solutions. That allows us to personalize the medical care received by the injured employee while reducing our overall medical costs.”
He added that in his 25 years in the business, he has used other vendors and looked at other products but feels that Potterfield and Kilpatrick are the gold standard against which other medical bill review, pre-certification and medical management companies are measured.
Self-Insured Solutions is one of a few such companies doing business in the state. Their operations extend to Alabama, Arkansas, New Jersey and Tennessee. They review appropriateness of all services against a national database of criteria.
For instance, if a patient with a back injury were told on his first visit to a doctor that surgery is required, that would throw up a red flag for the professionals at Self-Insured Solutions.
“There are certain things — physical therapy and anti-inflammatory medication — that could be tried before surgery,” Potterfield said. “To protect the patient and employer, we make sure the doctor does the normal things for medical practice.”
The owners of Self-Insured Solutions and their caseworkers have one-to-one meetings to assist patients with recovery and to develop a plan. They also work with providers and employers to negotiate care and cost solutions.
“It’s very important that we have a lot of trust throughout,” she added. “A strong relationship with vendors is necessary if we need to negotiate something like a discount for an artificial leg. They know we won’t ask for anything out of the norm.”
Stephanie Gilcrease, claims manager for Benefit Management Systems in Madison, is responsible for 10,000 employee lives and is pleased with the large case management and pre-certification for group health that Self-Insured Solutions provides.
“They’re wonderful and go above and beyond what they’re supposed to do,” she said. “They get on a personal level with patients and keep up with them on a daily basis. Their expertise is superb.”
Potterfield, who projects that her business will double in the next five years, says there is a healthcare crisis in this country. “Costs are rising at phenomenal levels to keep up with technology,” she said. “The more technology and specialists we have, employers are having a harder time providing insurance.”
She feels there must be some controls put on costs and profit margins, particularly with pharmaceutical companies and technology.
Potterfield is originally from upstate New York and worked with the Foreign Service in India taking care of 650 Americans. She has worked in hospitals, is a certified case manager and one of 10,000 nurses nationally certified in patient rehabilitation.
A native Mississippian, Kilpatrick began her career as an Army operating room trauma nurse serving in the Vietnam War. She has been a hospital director of nursing, worked 13 years in care management and is one of very few nurse certified medical coders in the state.
Contact MBJ contributing Lynn Lofton at firstname.lastname@example.org.