Trials and Tribulations of Simplifying the Health Care Experience

Transcription

1 Trials and Tribulations of Simplifying the Health Care Experience Kim Berdinsky, Director, Benefits Calvin Hilton, Vice President, Corporate Human Resources March 2017

2 Have your employees ever been frustrated with their health care experience? 2

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4 Three Businesses. One Focus. ALLIANCE DATA is made up of three business families: LoyaltyOne, Epsilon, and Card Services. Although we look different from the outside, we have a lot in common. We use data to drive higher levels of customer engagement, sales for our clients and consumer brand loyalty. LoyaltyOne does it through its AIR MILES Reward program. Epsilon does it through their proprietary database, creative agency and technology solutions. Card Services does it through credit card marketing programs. 4

5 Our health care programs 4 Medical Plans Cigna Enrollment and Benefits Service Center Willis Towers Watson EAP Cigna Prescription Plan (1 card) ESI Concierge and Advocacy Cigna One Guide FSA/HRA/HSA WageWorks 2 Dental Plans MetLife PPO Onsite Clinic Broad Street Health Center (OH) Telephonic Medical Care MDLive Diabetes Support Livongo Vision Plan VSP Health Improvement Healthy Alliance, Weight Watchers, Jiff Expert Opinion and Provider Guidance Grand Rounds Cost Transparency and Account Hub Castlight 5

6 Our associate experience 4 Medical Plans Cigna 2 Dental Plans MetLife PPO Vision Plan VSP Prescription Plan (1 card) ESI Onsite Clinic Broad Street Health Center (OH) Expert Opinion and Provider Guidance Grand Rounds Telephonic Medical Care MDLive FSA/HRA/HSA WageWorks Enrollment and Benefits Service Center Willis Towers Watson Diabetes Support Livongo EAP Cigna Concierge and Advocacy Cigna One Guide Health Improvement Healthy Alliance, Weight Watchers, Jiff Cost Transparency and Account Hub Castlight 6

7 Pre-op Pre-op appointment with surgeon Post-op A true story Patient: Researches benefit coverage and costs Patient: Receives confusing information from surgeon s staff about billing and payment for services Carrier: Adjudicates claim (within 10 days) Carrier: Verifies benefit coverage Patient: Calls Carrier; Carrier verifies patient s benefit coverage Carrier: Pays surgeon Patient: Secures HSA funds to pay patient s responsibility charges Surgeon: Despite coverage verification, Provider still requires payment in full from the patient, prior to surgery Surgeon: Reimburses patient ($2,000) 37 days after surgery Patient: Pays $2,000 out-of-pocket using HSA fund Patient: Reimburses HSA fund HSA Partner: Denies charge over $1,000; patient told mutual funds must be sold to replenish HSA fund (2 to 3 days) Patient: Initiates sale of mutual funds Patient: Pays surgeon using HSA funds (1 day prior to surgery) 7

8 Our biggest game changer yet: Onsite health center Direct local partner, with shared goals Easy access Staffed 5 days/week Affordable Free to non-hsa members Reasonable market cost for HSA members High-quality, collaborative care and services Acute and chronic condition care Preventive care visits, screenings Educational sessions I have visited twice. The care I received has been better than some visits to my personal doctor. The health center is a great addition to Alliance! It was easy to set up appointment and everyone was very kind. Rx was sent directly to my pharmacy. It was very convenient to have a Health Center at work so I didn t have to miss work to go see a doctor. 8

9 Building simplicity and ease into the employee experience We re doing more. Cigna One Guide Dedicated customer service advocates Mobile access Direct connection to other partners Customized claims administration Non-standard claims processing Benefits WE want to offer Best phone call by far with Cigna. My One Guide representative scores 11 out of 10! Stephanie went over everything she needed to know to help her understand her plan. Stephanie gets a BIG A+! Source: Cigna One Guide Customer Experience Overview 9

10 End the frustration! What can you do? Localize health care Raise your voice Push partners Insist on solutions that make sense for you 10