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:

Employer’s Choice

Employer’s Choice is a new specialty referral program for employers and their employees through SSM Health, St. Louis MO. SSM Health offers multidisciplinary, comprehensive and proven medical care for your specialty health care needs.

 What is covered? The Employer’s Choice coverage tier covers all inpatient and outpatient Hospital services performed within the SSM Health System in the St. Louis Mo area.

Why Employer’s Choice – There is no co-pay or deductible for inpatient or outpatient services provided by SSM. All billed services are covered 100% by your employer health plan.

Who is the Employer’s Choice SSM Health Providers It includes the SSM Health System’s seven-top rated hospitals and the SSM Medical Group Physicians located in St. Louis, MO. SSM Health has seven hospitals, more than 9,500 physicians and other medical staff and 8,700 nurses. The hospital locations are:

 SSM Health Cardinal Glennon Children’s Hospital, 1465 S. Grand Blvd., St. Louis, MO 63104

 SSM Health DePaul Hospital, 12303 DePaul Drive, St. Louis, MO 63044-2588                               

 SSM Health St. Clare Hospital, 1015 Bowles Ave, Fenton, MO 63026                                            

 SSM Health St. Joseph Hospital, 100 Medical Plaza, Lake Saint Louis, MO 63367              

 SSM Health St. Joseph Hospital, 300 First Capital Drive, St. Charles, MO 63301                             

 SSM Health St. Mary’s Hospital, 6420 Clayton Road, St. Louis, MO 63117                                    

 Saint Louis University Hospital, 3635 Vista Avenue, St. Louis, MO 63110 

For more information, please contact us at 217.221.3460

 

PBM Arrangement

Employer purchasing power is important in today’s pharmacy benefit marketplace. That’s why we’ve chosen to align with Employers Health Purchasing Corp. to deliver our employer members a market-leading PBM arrangement.

 Working with best-in-class vendors, CVS Caremark and OptumRx, the PBM group purchasing solution brings hundreds of plan sponsors together to better purchase and manage the increasingly complicated pharmacy benefit. Plan sponsors get the most from the PBM relationship, while implementing their own plan design strategies, managing vendors or working through established consultants.

 Here’s the program overview: 

  • Approximately 215 individual plan sponsors headquartered in 34 states.
  • Collectively spends more than $1 billion on pharmaceuticals.
  • Covers nearly 900,000 lives.
  • Contract oversight by legal experts and claims audit at no cost to the plan sponsor.
  • Dedicated account management team from the coalition to ensure the PBM relationship is meeting/exceeding expectations.
  • Clinical oversight by coalition pharmacists to monitor new drug launches, analyze trends and provide information on plan design strategies.
  • Participating employers receive objective ad hoc reports from a dedicated analytics team to help interpret plan performance metrics.

 Contact Bev Helkey, Executive Director, Employers Healthcare Coalition, at 217-221-3460, or bev.helkey@ehcqcy.com.

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 Purchasing Coalition  – Employers Health –  HMS Relationship

The Tri-State Health Care Purchasing 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.

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   

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.