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Brokers/Consultants

As regional and national health plan choices become increasingly limited and more expensive, your clients look to you for accurate and timely advice and recommendations about the healthcare industry.


Three factors inflating medical cost

RECENTLY, PricewaterhouseCoopers’ (PWC) HEALTH RESEARCH INSTITUTE (HRI) reported on three factors that are inflating medical cost trend:

Care anywhere and everywhere. Responding to increased consumer pressure, employers and health plans are improving convenience by giving consumers more ways to get care. The long-term goal is to decrease unnecessary spending, but in the short term, more access points can raise inappropriate utilization.

Provider megamergers. The provider landscape will become more concentrated after several recently announced mega-deals are completed. Prices tend to rise when health systems merge and purchase local providers as the consolidated entity gains marketshare and negotiating power.

Physician consolidation and employment. More doctors are practicing as employees of hospitals, health systems and medical groups. These organizations tend to charge higher prices than independent doctors.


A new health plan solution

That same PwC HRI study identified several solutions that are slowing healthcare spending increases.

High-performance networks. These limited-provider networks emphasize high-quality care and customer satisfaction alongside cost savings. Some employers are using their buying power to negotiate directly with providers to create this type of network.

Care advocacy. Employers and health plans are offering consumers new services that engage and guide the consumer to better quality and lower-cost care

Demonstrating value. Companies that are armed with knowledge about their workforce populations can target investments strategically (e.g., offering employees a value plan option with a limited network.) This “value option” emphasizes cost savings and value by focusing on quality and customer satisfaction


Affordable, accessible, quality health plans

Insurance carriers who have dominated the market and enjoyed a pricing advantage have little incentive to provide exceptional service, measurably improved health outcomes, and plan flexibility. Our market presence corrects this through competitive pricing and a flexible, best-in-class service partner model with accessible, locally-focused options and national access.

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Health plan solutions for small, large, and hourly workforces

You’ll be able to offer your clients a variety of integrated, flexible health plan and network solutions that solve for concerns of large companies, small businesses, and hourly/part-time workforces with the data access and transparency needed to gain cost-savings insights and dedicated customer service and effcient reimbursement models.

High-performance networks for large business

Our health plan networks deliver savings by providing both broad and high-value network options. The broad network plans have more participating providers and generally cost more for participants. Our high-value network plans place limits on the doctors and hospitals available to their members, often excluding high-cost providers. As a result, the premiums for such plans are lower, and attractive to your price-sensitive clients.

Provider discounts are a one-time saving that only works if you start with a common price. And not all providers price the same: in fact, hospital rates can vary 300 percent or more on medical billing codes. We negotiate directly with providers who agree to meaningful discounts and commit to increased engagement with patients.

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HCH Plus | Our Broad Network

Our broad network, HCH Plus, offers a wide selection of quality hospital systems, physician groups, and ancillary providers who offer highly competitive discounts. This network option, may be tiered with Healthcare Highways Sync to provide even more choice in affordability and coverage.

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HCH Sync | High-Performance Network

The flagship network, HCH Sync delivers performance excellence through financial alignment with providers incentivized to increase effciency in practice and optimum health outcomes, which may mean fewer procedures and a lower total care cost.

Clients utilizing this option will also enjoy our embedded care-coordination solution that ensures processes are in place to maximize in-network use. Members (covered employees and dependents) have an advocate for advanced or chronic care who can help them navigate the healthcare systemand avoid gaps in care, while in-network providers deliver the most affordableand highest-quality health care.

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HCH SyncEPO Network

Our lowest-cost solution, an exclusive preferred provider option (EPO), comes from HCH Sync EPO and requires members to utilize only the providers that are part of its predetermined network. Except for emergency medical needs, only in-network providers are covered.

HCH SYNC HCH SYNC EPO HCH PLUS
(OK Only)

Hospital systems and physician group coverage

Directed Directed Broad Access

Out-of-network coverage with a benefit differential in the primary area - INCLUDED

X X

Out-of-service area coverage - CLIENT SPECIFIC

X X X

Network designed to meet cost and quality metrics goals - INCLUDED

X X

Provider incentives for meeting effciency and quality metrics - INCLUDED

X X

Network wrap solutions

All of Healthcare Highways’ proprietary networks operate with national networks to create a nationwide solution for employers and members. Offering a state-wide high-value solution that includes national network partners gives employers health plans that provide effcient, affordable access to quality health care, care coordination, and claims administration at home and throughout the U.S.

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Health plan features

Care Coordination

We provide more timely interventions on identified health problems of our members, tackling these health risks earlier to avoid or reduce the occurrence of major health events. Through an engaged team relationship of member, PCP, and care coordinators, everyone understands the agreed upon treatments and medications, shares a common goal towards a health outcome, and works together to manage care. Moreover, we think data matters and that better outcomes arise from better access to data by all stakeholders, especially patients and their providers. Data helps personalize treatment planning, improves PCP practice effciencies, raises overall quality of health outcomes, and reduces the total cost of care.

We provide our in-network Primary Care Providers (PCPs) with the tools and additional support they need to ensure their patients follow the best care pathway to optimal health outcomes. Our predictive analytics, access to patient health claims information, and technology platforms make it easier for PCPs to leverage patient and peer insights in treatment planning.

Diabetes Management

Healthcare Highways Health Plan provides diabetic members with an FDA-cleared* meter that allows the care team to track glucose readings. Employees receive immediate feedback after each blood sugar reading without manually logging results.

Certified diabetes educators provide highly personalized support and set goals for each patient based on their unique medical needs, eating habits, food preferences, and exercise routines.

* FDA clearance does not imply approval.


Renal Solution

Our end-to-end, customized chronic kidney disease care and cost management programs that include monthly data analysis, cost containment services, and re-insurance reporting. Our dialysis solution, consistently produces significant savings in billed charges, which can be applied in conjunction with self-funded plans. Re-insurers may reduce or waive laser treatment options when this program is applied.

Telemedicine

We engage with multiple telemedicine partners that offer a superior clinical experience through a range of basic, telehealth services, including 24/7 access to a health professional, remote monitoring, medication adherence apps, and online wellness apps in HD video on mobile, desktop, and tablet devices.

Our telehealth systems connect seamlessly through a single sign-on process, so members with telemedicine benefits see this in-network option whenever they sign on to search for a provider. Members’ use of telemedicine benefits is tracked along with all other claims information for trend and cost-savings analysis, provided to your clients through our reporting services.

Plan Administration

Employers that self-insure its medical plan for their employees often seek outsourced partners who can bear much of the administrative burden, and it is here that expertise and well-equipped resources and facilities can contribute to lowering healthcare costs. Healthcare Highways Health Plan offers the people, platforms, and expertise that are necessary to handle claims through the entire adjustment, auditing, and appeals process and to administer services like underwriting, stop loss, and premium billing.

Our dedicated account executives become the single point of contact for direct implementation, member enrollment, and renewal, backed by our customer service call center and online self-service portal for members.

Employers, too, have a secure portal to support convenient uploads of information as plans are implemented and changes in the workforce occur. Employers also have access to information about benefits and claims and how their healthcare plan is performing, among other features.

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Stop Loss Services

Medical stop loss provides protection against catastrophic or unpredictable large claims. Stop loss services are appropriate for employers who have decided to self-fund their employee benefit health plans but do not want to assume 100% of the liability for losses that arise from their health plans. The service includes:

  • Collection and posting of health plan premiums
  • Statistical recording and reporting of claims and health plan premiums
  • Claim audits
  • Daily printing of reimbursement checks
  • Collaborative calls to set strategies for each case

Healthcare Highways Health Plan is rated by an A.M. Best A+ Superior stop loss company, and we participate in the risk through arrangements with partners, so our partners are as important to us as they are to our clients.

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Precertification

By identifying high-risk cases through precertification, we can begin to manage our high-risk members early on, which increases the opportunity for cost savings. Our evidence-based clinical guidelines provide the criteria for authorization, and drive high-quality care through tools like care-pathway tables, flagged quality measures, andintegrated medical evidence. Automated triggers in our system identify members who may benefit from case management intervention, which supports the quality of care and cost containment.

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Utlization Management

Our utilization-management services include precertification, concurrent review, and discharge planning. Parameters can be customized based on your requirements and your plan so you can track the effectiveness of your benefits program.


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