Creating a legacy of health for Tribal communities

Transcription

1 Creating a legacy of health for Tribal communities

2 Providing personalized solutions through real understanding With an emphasis on customizing programs and services to meet the individual needs of each Tribal community, we collaborate with you to remove barriers to care through an empathetic and strategic planning process designed to close health disparity gaps and ensure quality and consistency across the continuum of care. Since 1997, the experienced, culturally responsive team at Comprehensive Care Services (CCStpa) has been offering Tribes a full range of integrated third-party administrative (TPA) services that include: Administration of 506 legislation of Medicare-like rate (MLR) pricing and other reliable cost management tools Simplified claims integration with MLR and re-pricing capabilities at the point of claim Flexible in-house or Tribal-site administrative processing service models Customized group self-insured medical plans that maximize use of Indian Health Services (IHS), Tribal clinics, and other Tribal resources Implementation and plan design support for health savings accounts (HSAs), health reimbursement arrangements (HRAs) and flexible spending accounts (FSAs) Pharmacy benefits administration Medication therapy management services COBRA and HIPAA administration Comprehensive and customized reporting packages Local, regional and national network offerings Tribal-specific health and wellness programs Stop-loss reinsurance Extensive 24/7 online services for clients and members Your claims will be processed efficiently and effectively by our processors, who have an average length of service of 12 years.

3 Our commitment Honesty We will protect every Tribe s financial resources as if they were our own. Integrity We will adhere to the highest ethical standards every day, in every way. Community We will understand and respect the uniqueness of each Tribal culture and Tribal member. Respect We will practice compassion toward those we serve through careful listening and thoughtful problem solving. Wisdom We will serve all Tribes equally through our dedicated and culturally responsive Tribal-focused and experienced service team. Equality We will continuously improve access to high-quality, cost-effective care and services as we aspire to improve the health of Tribal communities. Subscribing to important values has enabled CCStpa to build a breakthrough health advocacy model to meet the needs of individual Tribal communities through an empathetic understanding of the barriers to care and a strategic product design process to close health disparity gaps and improve care quality and consistency. Guiding Tribal members to care and services right for them From pre-enrollment, to enrollment, to ongoing assistance, we guide members to the health and wellbeing resources they need to get the most from their health care benefits. Three steps to ensure member understanding: 1 Pre-enrollment 2 3 To ensure high satisfaction, we will collaborate with you to conduct an integrated marketing campaign (for example, , texts, posters, events) designed to provide information about health plan options, value-added services, and decision-support tools. Open enrollment During open enrollment, members will receive the guidance and resources needed to choose their options with confidence: Printed materials. These include information on plan benefits, administration, networks, care management programs, frequently asked questions, and more. Telephone support. Our dedicated Tribal team members are available to answer questions about specific benefits, networks, and transition-of-care issues. Internet resources. These resources enable 24/7 access to valuable tools, such as the Find-a-Doctor feature, even before coverage is effective. Ongoing assistance Our work has just begun when enrollment is complete. We use things like and text marketing, office posters and signs, and special events, to remind members of resources available to help improve and maintain health. 1

4 Eight ways CCStpa helps create a legacy of health for Tribal communities The unique needs of each Tribal community are well understood and respected. Tribal and CCStpa leaders meet regularly to ensure we are following through on our commitments. A dedicated and culturally responsive Tribal-focused and experienced service team will serve as client and member advocates every step of the way. A suite of services enables you to experience a fully integrated health care solution. Through our family of companies, your health care and other benefit needs will be met. You can choose from a number of plan options, whether streamlined or fully customized benefit packages, to meet the needs of diverse groups. Medical management programs are included in the administration of your health plan. These programs focus on monitoring and improving clinical effectiveness and efficiency of health care delivery. are things like pre-admission notification, concurrent review/discharge planning, medical case management, mental health/ chemical dependency case management, utilization review, and program integrity (i.e., fraud and abuse). Medicare-like rates (MLR) claim re-pricing improves cost management. MLR regulations reduce expenses for hospital services and enable Indian health programs to use the significant resulting savings to increase services to their beneficiaries. We perform MLR claim re-pricing and deliver the savings back to Tribes. Our Tribal clients have achieved average savings of $25 $35* per member, per month, by taking advantage of MLR pricing. *Source: Based on CCStpa tribal claims experience in Minnesota, Highly customized reporting options inform decision-making. With over 20 comprehensive reports and hundreds of reporting options available, you can expect to see a thorough view of claims, services provided, and overall health status of your Tribe to help balance benefit design with benefit costs. Your reports will not only show where you are succeeding, they also monitor existing concerns and help identify small health and financial issues before they become large ones. Broad networks assure value and choice. There is a CCStpa network solution to serve every need. You never have to worry your members or Tribal employees will be without convenient access to health care providers wherever they live, work, study or travel. Member education promotes shared responsibility. CCStpa benefit plans balance flexibility and choice with cost considerations. Encouraging members to become more aware of costs and the shared responsibility of choosing care wisely leads to better overall health for Tribal communities. Health and wellness programs and services are robust and Tribal specific. To promote health equality for all, CCStpa offers a wide array of health and wellbeing tools that focus on seven habits most commonly found to affect good health. 2

5 Each year $132 billion is spent in direct annual medical costs and $151 billion is lost in productivity nationally due to tobacco use. Supporting your members efforts to reduce tobacco use is one of the most effective cost-saving measures you can take.* *Source: U.S. Department of Health and Human Services, The Health Consequences of Smoking, 2014, Morbidity and Mortality Weekly Report, 2014; 57(45); Expect 99 percent of claims to be processed within 14 days and 100 percent within 30 days at an accuracy rate of 99.6 percent. Source: CCStpa operational results,

6 Tools and resources to promote better health We offer a range of tools and resources to help your members take charge of their overall health, engage in specific health and wellbeing goals, and become more confident health care consumers. You may choose only the options that best fit the needs of your Tribal community. INFORM: Educate about general benefits, wellness and prevention topics Service Description / Member services Tribal specialists Answers to benefit questions and referrals to nurses, when necessary. Online wellness and prevention resources Onsite educational seminars Employee/member communications A library of articles, videos, quizzes and calculators about preventive care, health conditions, diseases, procedures and prescriptions. One-hour seminars on various health-related topics help increase member knowledge and prompt changes in health behaviors. A member engagement strategy with support materials to increase understanding and use of health and wellbeing programs. ACTIVATE: Encourage individuals to learn about their health status and set personal health goals Service Description / Online health assessment A snapshot of individual health status, along with tools to develop a personal health improvement plan. Health screenings Individuals learn their numbers (weight, blood pressure, cholesterol, glucose, etc.) so they can develop a plan for making healthier choices. Fitness member discounts Up to $20 monthly discount for meeting workout goals. Calls to Member Services are answered within 30 seconds, with an inquiry accuracy rate of 99.6 percent. TREAT: Provide individuals access to integrated, appropriate and high-quality care, when and where they need it Service Description / Nurse advice line Members may contact a nurse 24 hours a day, seven days a week for answers to health-related questions. Online care A convenient face-to-face option for members to get care from a board-certified doctor from home, work or even on vacation. Provider cost/quality Case and condition management support Members easily get recommendations on doctors, hospitals, prescriptions and other information based on cost and quality. Members with complex health care needs or very high cost conditions receive support from a variety of health care professionals to stay on track with their health goals. Full suite of clinical and behavioral programs are now integrated. 4

7 COACH: Support individuals as they take meaningful steps toward Improving health habits Service Description / Employee Assistance Program Member access to confidential, short-term counseling with licensed professionals by phone, as well as referrals for in-person counseling. Prenatal support Education, support and rewards guide expectant mothers to essential care throughout their pregnancies. Online health coaching Online health coaching helps members address health goals and concerns. Stop-smoking support Smokers develop and maintain a quit plan with information and support from a Quit Coach. Access to free, over-the-counter nicotine replacement therapy is an available option. Telephone-based lifestyle coaching One-on-one, over-the-phone coaching to support personal health goals. MANAGE: Help individuals with chronic or serious conditions achieve improved outcomes Service Description / Utilization management Medication management Support to assure effective, appropriate, efficient use of medical and behavioral health care resources. Helps minimize errors and adverse drug events while directing patients to the most cost-effective therapies. Home-care solutions Services and products that enable patients to remain in a safe home environment. For every dollar you invest in our nurse advice line, you can expect a return of $1.86. Source: Average savings provided by AxisPoint Health (includes CCStpa and parent company results). 5

8 NOTICE OF NONDISCRIMINATION PRACTICES Effective July 18, 2016 CCStpa complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or gender. CCStpa does not exclude people or treat them differently because of race, color, national origin, age, disability, or gender. CCStpa provides resources to access information in alternative formats and languages: Auxiliary aids and services, such as qualified interpreters and written information available in other formats, are available free of charge to people with disabilities to assist in communicating with us. Language services, such as qualified interpreters and information written in other languages, are available free of charge to people whose primary language is not English. If you need these services, contact us at or by using the telephone number on the back of your member identification card. TTY users call 711. If you believe that CCStpa has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or gender, you can file a grievance with the Nondiscrimination Civil Rights Coordinator by at: Civil.Rights.Coord@CCStpa.com by mail at: Nondiscrimination Civil Rights Coordinator CCStpa S150 PO Box Eagan, MN or by phone at: Grievance forms are available by contacting us at the contacts listed above, by calling or by using the telephone number on the back of your member identification card. TTY users call 711. If you need help filing a grievance, assistance is available by contacting us at the numbers listed above. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: by phone at: or (TDD) or by mail at: U.S. Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington, DC Complaint forms are available at image_0008_ccs_ndl_portrait (09/16) 6 Comprehensive Care Services, Inc.

9 This information is available in other languages. Free language assistance services are available by calling the toll free number below. For TTY, call 711. Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al Para TTY, llame al 711. Yog tias koj hais lus Hmoob, muaj kev pab txhais lus pub dawb rau koj. Hu rau Rau TTY, hu rau 711. Haddii aad ku hadasho Soomaali, adigu waxaad heli kartaa caawimo luqad lacag la'aan ah. Wac Markay tahay dad maqalku ku adag yahay (TTY), wac 711. erh>uwdrundusdm'd;< Aw>u[h.eRusdmw>rRpXRuvDwz.M.vDRIAud; vx ATTY t*d><aud; 711 wuh>i إذا كنت تتحدث العربية تتوفر لك خدمات المساعدة اللغوية المجانية. اتصل بالرقم للھاتف النصي اتصل بالرقم 711. Nếu quý vị nói Tiếng Việt, có sẵn các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quý vị. Gọi số Người dùng TTY xin gọi 711. Afaan Oromoo dubbattu yoo ta e, tajaajila gargaarsa afaan hiikuu kaffaltii malee. Argachuuf bilbilaa. TTY dhaaf, 711 bilbilaa. 如果您說中文, 我們可以為您提供免費的語言協助服務 請撥打 聽語障專 (TTY), 請撥打 711 Если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Звоните Для использования телефонного аппарата с текстовым выходом звоните 711. Si vous parlez français, des services d assistance linguistique sont disponibles gratuitement. Appelez le Pour les personnes malentendantes, appelez le 711. አማርኛ የሚናገሩ ከሆነ ነጻ የቋንቋ አገልግሎት እርዳ አለሎት በ ይደውሉ ለ TTY በ 711 한국어를사용하시는경우, 무료언어지원서비스가제공됩니다 으로전화하십시오. TTY 사용자는 711 로전화하십시오. ຖ າເຈ າເວ າພາສາລາວໄດ, ມການບ ລການຊ ວຍເຫ ສາລ ບ. TTY, ໃຫ ໂທຫາ 711. ອພາສາໃຫ ເຈ າຟຣ. ໃຫ ໂທຫາ Kung nagsasalita kayo ng Tagalog, mayroon kayong magagamit na libreng tulong na mga serbisyo sa wika. Tumawag sa Para sa TTY, tumawag sa 711. Wenn Sie Deutsch sprechen, steht Ihnen fremdsprachliche Unterstützung zur Verfügung. Wählen Sie Für TTY wählen Sie 711. របស ន ប អនកន យ យភ ស ខមរមន អនកអ ចរកប ន សវ ជ ន យភ ស ឥតគ ត ថល ទ រស ពទមក លខ សរម ប TTY ស មទ រស ពទមក លខ 711 Din4 k'ehj7 y1n7[t'i'go saad bee y1t'i' 47 t'11j77k'e bee n7k1'a'doowo[go 47 n1'ahoot'i'. Koj8 47 b44sh bee hod77lnih TTY biniiy4go j8 b44sh bee hod77lnih. image_0002r01_general_portrait (09/16) 7

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12 Visit ccstpa.com Visit ccstpa.com/employer/tribalsolutions for information about all of our products, programs and services. You will also find connections to our online services such as myccstpa Member Center, CCStpa Client Center enrollment and maintenance, our provider search tool, and more. Comprehensive Care Services, Inc. P.O. Box St. Paul, MN Toll free: , ext Each health care provider in the network is an independent contractor and not our agent. Comprehensive Care Services, Inc. X20477R01 (11/16)