Tri-State Health Care Purchasing Coalition

 

Tri-State Health Care Purcahsing Logo

The Tri-State Health Care Purchasing Coalition provides its consumer-only perspective to many of the health care issues facing the tri-state area.  The Purchasing Coalition sponsors educational programs designed to evaluate new ideas to lower health care costs.  Examples include the quarterly wellness roundtable where employers meet to discuss the successes and failures of local wellness programs and a speaker series focusing on new techniques to control health care costs.  The Purchasing Coalition also analyzes statistical data to determine trends in the medical care provided in the tri-state area.  This analysis will identify high cost areas and abnormally high rates of negative outcomes in an effort to reduce health care costs.

The Purchasing Coalition has worked with health care vendors to develop competitively priced products and services that fit the needs of the tri-state area.  These products and services include:

 

 WeCare TLC

 Basic CMYK

 

WeCare TLC establishes and manages PCMH (Primary Care Medical Home) clinics that are available to employees and dependents. Your PCMH serves as a medical risk management platform that exploits your unique problematic areas health care spending. Not only are robust primary care services offered, but also occupational health, chronic care management and convenient care. All services performed within the clinic would be at no cost to the patients.

 

This strategy consistently results in 15-20% cost reduction in health care costs (net the costs of the clinic) across our book of business. Please click here to find out more in our new 90 second video.

Overview

 Most employers nationwide experience similar healthcare problems. Healthcare costs are rising at rates twice of inflation (or more) and are perceived as having limited opportunities to change. In addition, the local healthcare community does not appear to appreciate the financial challenges they have imposed on employers, nor does the national data indicate that their quality measures support the elevated prices presently charged.

Historically employer solutions have been limited to:

  • Competitive Bidding for networks and services
  • Benefit reductions transferring costs from the plan to patients
  • Increased Employee contributions

The successes of all of the above solutions have been short term and limited. None begin to address the real problem with the healthcare system in the US. The short list of problems accounting for the healthcare problems would include:

  • Lack of transparency in service fees by providers
  • Perception that price and quality are the same – higher price equates to higher value
  • Failure by the healthcare service vendors to address their client’s problems

Objectives

 WeCare TLC views the critical objectives of the Member Health Clinic to be:

  • Immediate costs reductions
  • Reduced future cost increases
  • Improved access to affordable primary care
  • Improved quality locally
  • Improve healthcare community cost to increase outside industry investments

Contact Bev Helkey, Executive Director, Employers Healthcare Coalition, at 217-221-3460. Click here to contact us for more information.  

 

 

Dental Plan

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The coalition has an arrangement with Delta Dental of Illinois and Missouri to offer self-insured and fully-insured dental plans to our members.

Delta Dental PPO combines freedom of choice with cost-savings incentives.  Network dentists agree to reduce fees, lowering out-of-pocket costs for enrollees and claim costs for employers.  Nearly 107,000 dentists nationwide participate in Delta Dental PPO.

Delta Dental Premier is a managed fee-for-service plan with a difference.  Unique agreements with network dentists generate the industry’s most effective cost controls.  Three out of four dentists nationwide (184,248 dentist locations) and 70% of dentists in Illinois and 95% of dentists in Missouri participate in the Delta Dental Premier network.  Click here to contact us for more information.  

 

 

Dependent Eligibility Audits

Our members now have access to preferred pricing for “Dependent Eligibility Audits” through HMS. With the cost of health care rising each year and new health care regulations, employers are searching for new and innovative ways to reduce costs while still maintaining benefits coverage. More Employers Health members are turning to a proven cost-cutting strategy called Dependent Eligibility Audit.

A Dependent Eligibility Audit is a process that verifies those dependents enrolled in your organization’s health and welfare plans are eligible to receive coverage from your plan(s). Many employers believe that ineligible dependents are not a problem for their organization. Typically, Plans that have not conducted any type of audit or review are finding as many as between 4% and 8% of currently enrolled dependents are typically not eligible for the coverage employers are providing.  An ineligible dependent can be an ex-spouse or a grandchild of your employee.  These ineligible dependents are increasing the healthcare costs to your organization and the cost to your employees.

The Dependent Verification process or Dependent Eligibility Audit is a proven method to contain costs across your entire benefits structure.  On average, you can expect a return on investment within one year of 400% to 1000% depending on the size of your organization.  Small and medium sized fully-funded groups are executing these audits as well as their larger self-funded counterparts. Every employer has the opportunity to save dollars year after year no matter their size.

 

Tri-State Health Care Coalition  – Employers Health –  HMS Relationship

The Employers Healthcare Coalition, through a partnership with the Employers Health of Ohio has reviewed the providers of these services and chosen to partner with HMS. This partnership provides members with preferred pricing on dependent eligibility services, while decreasing the procurement cost of to each member company that would be needed to vet multiple service providers.

Please contact us should you have any questions.

 

  Employee Assistance Program (EAP)

CP Logo 541-1Our preferred EAP vendor is ComPsych, Chicago, IL.  ComPsych is one of the largest EAP service providers, which can accommodate your needs locally, regionally, as well as nationally.  The program is easy to implement and requires very little ongoing maintenance from the employer perspective.  You will find our rates to be very competitive.  Click here to view the brochure.  Click here to contact us for more information. 

 

Pharmacy Card

If your prescription is not covered by health insurance, or you currently do not have prescription coverage, FreeRx Card may be just what the doctor ordered for lower costs and better health.  It’s easy to use.  Just click here to receive your personalized card.

Pharmacy Card2Take the card to the pharmacy with your next prescription.  Discounts are at the register.  Because this is not insurance, there are no forms to fill and there is no wondering or waiting for reimbursements.

  • No fees, no paperwork, no restrictions
  • Over 60,000 participating pharmacies
  • Average savings of 20% on prescription drugs not covered by insurance
  • Use the card for every member of your family
  • Card must be presented at the time of service

Contact us for more information or for a larger quantity of cards.

 

Prescription Management Plan     

The Prescription Management Plan provides an extensive network of pharmacies, providing prescriptions to participating members at deeply discounted prices.  Employers may use virtually any plan design and still obtain the discounts.

In addition, a full array of services is available to assist employers in managing their prescription benefit, including benefit design consulting, on-line support services, fast and accurate claims processing, reporting, drug utilization evaluation and formulary management.  Click here for more about MedTrak Services.  Click here to contact us for more information.  

 

Vision Plan      

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Through an arrangement with Vision Service Plans (VSP), the nation’s largest provider of vision plans, companies may choose to offer vision care as an employee benefit.  The VSP arrangement offers various plan options, at extremely competitive prices. Click here to contact us for more information.  

 

Tri-State Coalition Open Access III and PPO Network   

HealthLink-Wellpoint_logo

Our members have access to HealthLink’s Open Access III and PPO Networks that provides an extensive network of providers.  Currently, the Open Access or PPO networks are the choice for thirty-three coalition employers, representing over 18,000 covered lives in the Quincy Area.

Employers have found HealthLink’s Networks to be a cost saver.   A claims data collection and reporting system provides extensive reporting about utilization, cost and quality.   Click here for more information about HealthLink, Inc. (HealthLink’s home page).  To contact us for more information, click here.