LARGE GROUP PRODUCTS AND SERVICES. Experience the Group Health Difference

Transcription

1 LARGE GROUP PRODUCTS AND SERVICES Experience the Difference

2 HEALTH PLAN We ll work closely to help you develop a health plan that has the right combination of benefit design and network options to ensure King County self-funds with No one else brings it all together in one package like we do. that your employees get the care they need, wherever they need it. Which is the best funding choice for you? Funding options are all about how much risk your company wants to assume for health care costs. Do you want to pay more for health care up front and share the risk? Or do you want to own more risk in return for lower upfront costs? You can consult with our experts to decide on the funding option that s best for your company. Since 2007 we have saved $46 million below our projected health care costs. $6.5 million of that is REQUEST A QUOTE Contact your producer Contact your sales representative directly Call our sales department toll-free at When requesting a quote, we need the following information: Gaining control of long-term health care costs requires experts you can trust and learn from. That s where we come in. We ve been offering coverage and care for 65 years, right here in Washington state. And because of that, we can help you contain your total cost of care and improve the health of your employees by integrating a customized health plan, unique care delivery system, and exceptional client services. Based on your specific needs, we can deliver on our promise to help you control your health care spending at a competitive price. They include: Fully Insured: For a premium, assumes financial and administrative responsibility for the program. Rate Stabilization Reserve (Nonrefunding): Purchasers proactively offset the financial impact of unforeseen claim fluctuation. Rate Stabilization Reserve (Refunding): Purchasers receive the surplus dollars from paid premiums when actual claims are less than projected. Retrospective Adjustment: Health plan expenses are aligned more closely when actual claim expenses are known. Self-funded: Purchasers can design and manage the program for maximum flexibility when they assume financial, legal, and administrative responsibility. directly a result of savings from people choosing instead of traditional insurance. Another $14.6 million is because people are becoming healthier, and a lot of them because they are getting the early preventive care that focuses on. Dow Constantine King County Executive, 2012 Producer of record Manage your risk with our full-spectrum of funding options Employee census (in Excel) Details on desired benefits ( Summary of Benefits if you have one) GROUP HEALTH RISK SHARED RISK EMPLOYER RISK Detailed claims and premium information FULLY INSURED RATE STABILIZATION RESERVE (NONREFUNDING) RATE STABILIZATION RESERVE (REFUNDING) RETROSPECTIVE ADJUSTMENT SELF-FUNDED 2 LARGE GROUP PRODUCTS AND SERVICES LARGE GROUP PRODUCTS AND SERVICES 3

3 HEALTH PLAN HEALTH PLAN Flexible benefit designs for a better fit We ll look at your organization s health care needs including budget and then match those needs to one of the many benefit design options available through : Defined network Consumer-directed health plan (CDHP) Point-of-service (POS) Health savings account (HSA) Health reimbursement arrangement (HRA) Preferred provider organization (PPO) Integrated HSA and HRA administration through HealthEquity High deductible health plan (HDHP) Coverage for your employees wherever they live We think care at is the very best we can offer employees. However, we don t have clinics in every neighborhood, so we ve with and hospitals in all areas that we serve. The regional First Choice Health network, national First Health Network, and even any other licensed provider are available with some plans for maximum regional and nationwide coverage. Our network options Our provider network options are competitive on both local and national levels. GROUP HEALTH COOPERATIVE GROUP HEALTH OPTIONS, INC. GROUP HEALTH DEFINED POS PPO ALLIANT SELECT OPTIONS ALLIANT PLUS OPTIONS PPO 25 GROUP HEALTH MEDICAL CENTERS Including nearly 1,100 physicians* REGIONAL COVERAGE Contracted, specialists, and hospitals in all areas we serve MAXIMUM REGIONAL + NATIONAL COVERAGE Regional First Choice Health network, national First Health Network, and any licensed provider available with some plans In-Network Out-of-Network First Choice Health: regional coverage in Wash., Ore., Idaho, Alaska, and Mont. First Health Network: national coverage in all other U.S. states The Everett Clinic The Everett Clinic The Everett Clinic The Everett Clinic First Choice Health* First Choice Health* First Choice Health First Health Network* First Health Network* First Health Network Any licensed provider in the U.S. Any licensed provider in the U.S. Any licensed provider in the U.S. Coverage provided by Cooperative or Options, Inc. * Members may have in-network access to First Choice Health and First Health Network outside s service area when pre-authorization is obtained. The advantages to Your potential for cost savings is maximized when employees receive care at. It s where care and coverage work together to create more value for patients and for employers.** Western Washington Bellevue Bothell Burien Capitol Hill Downtown Seattle Everett Factoria Federal Way Kent Lynnwood Northgate * Source: OIC Provider Form A ** Source: Milliman report, December 2011 Olympia Port Orchard Poulsbo Puyallup Rainier Redmond Renton Silverdale Tacoma Tacoma South Spokane area Lidgerwood Riverfront South Hill Veradale Our plans feature care with outstanding organizations like: The Everett Clinic Franciscan Health System Mary Bridge Hospital Overlake Hospital Providence Regional Seattle Children s And many more 4 LARGE GROUP PRODUCTS AND SERVICES LARGE GROUP PRODUCTS AND SERVICES 5

4 CARE DELIVERY CARE DELIVERY Empowering your employees to improve their health through our patient-centered care model, cost-effective care management, Wellness Solution, and Occupational Health Services can result in a more productive workforce and lower overall costs. More time for patients has 25 locations around Washington state. Each features a variety of services, including doctor visits, X-rays, pharmacy services, and lab. Our model of care promotes collaboration between physicians, specialists, and other members of the health care team, which can optimize health outcomes for your employees. Doctors spend the time they need to build relationships with their patients so that they can truly understand their needs. These relationships are strengthened and deepened through ongoing doctor-patient communications using or telephone consults, which reduces absenteeism and overall cost. IMAGING AND X-RAY MORE TIME WITH DOCTOR PHARMACY PATIENT- CENTERED CARE SERVICES WELLNESS SOLUTION CARE MANAGEMENT ELECTRONIC MEDICAL RECORDS LAB OCCUPATIONAL HEALTH SERVICES MYGROUPHEALTH FOR MEMBERS + MOBILE APP Innovations for a better experience At we use the latest technology to save time and money and improve the quality of our outcomes for both you and your employees. Instant connection for easy collaboration s electronic medical records put a patient s medical history and treatment plan instantly at the fingertips of everyone involved in their care. Specialists in different locations can look at records virtually in real time, speeding consultation and coordination. Members also have ready access to their medical records online, as well as benefit and claims information. Tools you can use day and night Members enjoy easy and convenient online access to care with our secure website at ghc.org. Features include: Doctor-patient s* Appointment scheduling* Online medical records* Lab and test results* Immunization history* Prescription refill ordering After-visit summaries* Wellness tools and resources Convenience on the run The award-winning*** mobile app for iphone and Android smartphones lets members access their care on the go. Giving you our best Here are examples of approaches and techniques our leading physicians use to address a variety of health issues: Mohs micrographic surgery is used to treat skin cancer and has the highest cure rate. For corneal transplants, we use Descemet s Stripping Automated Endothelial Keratoplasty which leads to more rapid visual rehabilitation. Our bariatric surgery department, led by Top Doc Dr. Steven Bock**, was one of the first in the state. Robotic laparoscopic surgery is used for unparalleled surgical accuracy when treating prostate cancer. The state of Washington has only three doctors who specialize in interventional pulmonology. Priscilla Madsen, MD, with Physicians, is one of them. My Care* Secure doctor-patient , and more Consulting Nurse Service 24/7 advice Wait Times Lab and pharmacy wait times at Cooperative has been a willing and supportive partner in adapting their services to meet our needs through our self-funded program. Julie Sheehy Director, Employee Health & Wellness Benefits Microsoft Corporation Symptom Checker What ails you? Find out. Locations Maps and directions to our facilities Settings Personalized settings * Service available when care is received at. ** Source: ghc.org/topdocs *** Mobile App of the Year, 2011 TechFlash Newsmaker Awards 6 LARGE GROUP PRODUCTS AND SERVICES LARGE GROUP PRODUCTS AND SERVICES 7

5 CARE DELIVERY CARE DELIVERY Benefit from our care model Published research done by the Research Institute to evaluate our model of care delivery demonstrated that our approach with smaller patient loads and more time with doctors lowered patient care costs and kept people healthier. After two years, there were more secure messages and telephone visits with doctors (at no cost to employees or employers) and fewer face-to-face visits. Most importantly, there were fewer emergency room and urgent care visits, and fewer hospital stays. Typically, these are the settings where costs for care can skyrocket. With proactive health care, people stay healthier and are less likely to use those services. While results from this kind of patient-focused care can t be guaranteed, the research indicates this approach should trend toward lower costs. A pharmacy solution that s safe and controls costs Managing medication use to maximize positive medical outcomes and minimize costs is another example of how care and coverage come together at. Clinical pharmacists at are embedded in care teams, working collaboratively with doctors and nurses to deliver safe, cost-effective care. Our comprehensive pharmacy solution includes: An extensive pharmacy network with 25 pharmacies, network pharmacies, and the MedImpact pharmacy network.* Convenient online and mail-order refills Competitive formulary We earned the 2013 Medicare 5-star quality rating for prescription drug coverage for Cooperative Clear Care (HMO) plans one of only nine in the country.** We also have one of the highest generic medication use rates in the country at 89 percent.*** Generic drugs cost a fraction of their brand equivalents, and are equally effective. To cut costs even further, an alliance with Kaiser Permanente enables us to leverage our contracts and purchasing power to receive extremely competitive pharmaceutical pricing price breaks we pass on to our members. Our physician-led Pharmacy and Therapeutics Committee examines the research behind new drugs before allowing them in our formulary. Because of this diligence, members were never prescribed drugs like Vioxx, Fen- Phen, Meidia, and 17 others all eventually pulled off the market by the U.S. Food and Drug Administration due to serious side effects. s model of care has been proven to boost quality and curb patient care costs Support beyond the exam room s care management programs are an integral part of our coordinated care. They address many states of health, from troubling symptoms to catastrophic illness to chronic and complex conditions. We offer: 24/7 Consulting Nurse helpline Complex case management Transition management between care settings Utilization review Disease management coaching Employees can make healthier choices with the help of our Wellness Solution programs and services Stay healthy with Wellness Solution services It s probably no surprise that with s long history of promoting prevention, we offer many programs supporting wellness, like those shown in the chart below. We want to keep your employees as healthy as possible free of disease, out of the hospital, productive, and on the job. Our wellness consultants can help you build a multi-year program that creates a self-sustaining culture of wellness in your workplace. For a fee, we also offer: Wellness challenges Worksite biometric screening events Worksite flu shot events CLASSES AND SUPPORT HEALTH PROFILE Expert help with workplace injury care and safety Occupational Health Services helps get your injured workers back on the job. Staffed by specially trained and board-certified physicians, our focus on quality care and thorough communication helps your new employees get started quickly and helps your existing, valued employees get back to work safely, quickly, and cost effectively. Our program features: Injured worker care Case management Staff who are in the Medical Provider Network 12 locations Employment exams, drug and alcohol testing, and prevention services (for an additional fee) LIFESTYLE COACHING 80% SECURE MESSAGING UP 5% TELEPHONE VISITS UP 1.5X QUALITY OF CARE UP POSITIVE UP ALTERNATIVE MEDICINE DISCOUNTS Wellness Solution for Employees TOBACCO CESSATION POSITIVE DOWN FACE-TO-FACE VISITS DOWN 6% SPECIALTY VISITS DOWN 3% ER/URGENT CARE VISITS DOWN AVOIDABLE HOSPITAL STAYS DOWN 29% 11% ALL HOSPITAL STAYS DOWN 6% GROUP HEALTH FITNESS FITNESS CENTER AND WEIGHT LOSS DISCOUNTS * Available for some plans ** Source: Center for Medicare and Medicaid Service 2013 Plan Ratings Fact Sheet *** Source: internal report, Oct Source: Two-year study of Medical Home Pilot, conducted at Factoria and published in Health Affairs, May 2010 HEALTH AND WELLNESS INFORMATION 8 LARGE GROUP PRODUCTS AND SERVICES LARGE GROUP PRODUCTS AND SERVICES 9

6 CLIENT SERVICES PROGRAM SERVICES Having you as a client is just the first step in what we hope will be a long relationship. You don t just get a plan, you get advice every step of the way with outstanding customer service, core administrative services, and reporting. is popular with our employees because it offers a CORE SERVICES Claims administration Subrogation Coordination of benefits Customer Service Eligibility maintenance Benefit from our exceptional customer service As a nonprofit organization that s part of your community, we believe in building win-win relationships. Work with our knowledgeable administration experts as well as having your own local designated account management team. Our specially trained customer service department is local, too. As experts these teams ensure that both you and your employees receive outstanding customer service in all areas. Our core administrative services include: Claims administration Subrogation Coordination of benefits Customer service Eligibility maintenance Appeals Summary of benefits Stay informed with our reporting package You ll gain a better understanding of costs through ongoing data-driven consultation for both health plan and care delivery utilization. Reporting is available to groups with 100 or more employees on the plan. Health plan expense and utilization reports Claims and total loss ratios Top Pharmacy usage and top drugs by therapeutic class Care delivery utilization reports Appropriateness of care Major diagnostic categories Member engagement Usage of online services Health Profile aggregate results comprehensive program at a reasonable cost. We also like the emphasis on wellness at, and the innovations such as the use of to provide easy access to health professionals. Tom Hunt Director, Compensation and Benefits Puget Sound Energy CARE MANAGEMENT WELLNESS SOLUTION Appeals Summary of benefits Designated account management Network access and network (available with some plans) The Everett Clinic (available with some plans) First Choice Health (available with some plans) First Health Network (available with some plans) Reporting 24/7 Consulting Nurse helpline Complex case management Transition management Utilization review Phone-based visits* Disease management coaching Wellness consulting Health Profile (online health assessment) Lifestyle Coaching Tobacco cessation Fitness center and weight loss discounts Health and wellness information Classes and support Fitness Network Alternative medicine discounts MyGroupHealth for Members (ghc.org) Secure s with doctor/care team* Mobile app Wellness challenges (for an additional fee) Worksite biometric screening events (for an additional fee) Worksite flu shot events (for an additional fee) OCCUPATIONAL HEALTH SERVICES Treatment of work-related injuries Industry-specific physicals and employment exams (for an additional fee) Screening (for an additional fee) Drug and alcohol testing (for an additional fee) Prevention services (for an additional fee) Services are provided by Cooperative or Options, Inc. * Service available when care is received at 10 LARGE GROUP PRODUCTS AND SERVICES LARGE GROUP PRODUCTS AND SERVICES 11

7 REQUEST A QUOTE Contact your producer Contact your sales representative directly Call our Sales Department toll-free at Cooperative or Options, Inc. 783GG