Employee Healthcare and - TML Conference · 2019. 10. 29. · NCQA Accredited Competitive...

NCQA Accredited

Competitive

MemberCentric

Employee Healthcare and Technology

Texas Municipal League Annual Conference

October 10, 2013MemberCentric

Affordable

Innovative

Presented by: Andy Rainosek, CIO

Demos Presented by: Mona Gamble and Ramon Rivera

TML Intergovernmental Employee Benefits Pool

1 Dedicated to Service for Over 30 Years

Health plan members and employers are increasingly relying on electronic tools to access information about their benefits, healthcare resources, and services.

Healthcare Online Tools and Services

Technology and Healthcare Technology and Healthcare ‐‐Scope of PresentationScope of Presentation

Healthcare Online Tools and Services

Employee

Employer

Provider


Many factors impact the Healthcare Technology trend. The primary drivers to increased use of technology are largely technical but other factors such as age and technology awareness also have an impact. Internet/Website Payer, Vendor, and User Electronic Sophistication Open Software Architecture and System CompatibilityA il bili f A

Healthcare Technology DriversHealthcare Technology Drivers

Availability of Access PC's Mobile Devices Social Media

Advances in Affordable Technology End‐user Demands Generational Expectations Desire for Self Service Access Ease of Use


Plan members or subscribers have a variety of tools, resources, and applications available in today’s environment of Healthcare Technology. The main items are listed below ‐more detail on each is addressed in subsequent slides. Provider Lookup

Healthcare Technology Access Healthcare Technology Access ‐‐ EmployeesEmployees

Electronic Resources

Online Customer Service

Online Enrollment

Rx Vendor Access and Pricing Transparency

Telemedicine

Electronic Health Record

Healthy Initiatives4 Dedicated to Service for Over 30 Years

Provider lookup is more than just finding a provider by specialty. Educated consumers want to know comparative pricing and outcomes.

Search for Network Providers

Provider Pricing Transparency through Comparison of

Healthcare Technology Healthcare Technology ‐‐ Provider LookupProvider Lookup

Procedure Charges

Online Review of Outcomes

Provider Selection Based on Performance Based Outcomes


A healthcare consumer only needs a PC, tablet, or smartphone to have immediate access to information about their plan benefits and the availability of healthcare services.

e‐Friendly Employee Guides

Healthcare Technology Healthcare Technology ‐‐ Electronic ResourcesElectronic Resources

Online Forms

Summary of Benefits and Coverage

Plan Benefit Books

Healthcare Reform Legislation


The concept of self service has reached the world of healthcare information. Members want to access their healthcare data online and on their schedule. Self Service to Information Previously Requiring a Phone Call to Customer Service

Claim Status Lookup Electronic Explanation of Benefits (EOB’s)

Healthcare Technology Healthcare Technology ‐‐Online Customer ServiceOnline Customer Service

Electronic Explanation of Benefits (EOB s) Claim Benefit Information Health Authorization ID Card Request Monitoring of Debit Card Balances Rx Inquiry Single Sign‐on Access to Third Party Vendors Online Question Submission and Response FAQ’s


Online enrollment is more than just a nice feature ‐ it is now a mandate. PPACA Requirement of Groups with 250+ Employees Employee Online Access Consumer Centered Plans Defined Contribution Subsidies

Healthcare Technology Healthcare Technology ‐‐ Online EnrollmentOnline Enrollment

Online Calculator Plan and Rate Variations Based on Parameters Hours Worked Wellness Participation Tenure User Defined Variables

Additional Contributions to HRA/HSA Contributions to Section 125 (Flex) Interface to Internal Systems such as Payroll and HR


Filling a prescription is a consumer decision from the point of sharing Rx Plan benefits with the prescribing doctor to obtaining the medication from the most cost effective pharmacy. Reporting Portal and Online Inquiry

Healthcare Technology Healthcare Technology ‐‐Rx Vendor Access and Pricing TransparencyRx Vendor Access and Pricing Transparency

Rx Claim History

Pharmacy Locator

Drug Cost Comparisons

Drug Interaction Analysis Rx Customer Service

Medical Therapy Management Program

Prescription Data Warehouse


Telemedicine is convenient, effective, and less expensive.

Online Access to a Medical Doctor

Certain Medications Prescribed

Available 24/7

Healthcare Technology Healthcare Technology ‐‐ TelemedicineTelemedicine

Quick Response

Opportunity for Educated Consumer to Manage Out of Pocket Expense

Employee/Dependent Registration with Telemedicine Provider

Eligibility Data Uploaded to Telemedicine Provider


Complete healthcare now involves data downloads of patient health information from multiple service providers to databases of consolidated information to assist providers in the delivery of quality care.

Consolidated Patient Health History Summary

Healthcare Technology Healthcare Technology ‐‐Electronic Health RecordElectronic Health Record

Consolidated Patient Health History Summary

Personal Health Profile on Completion of Biometric Screenings and Health Power Assessment

Health Record Sharing/Access between Providers

Consent by Patient Required


It pays to stay healthy and Healthcare Technology has the tools to help you. With the availability of the many tools and resources it is easier for the covered individual to be more engaged in their health.

Healthcare Technology Healthcare Technology ‐‐ Healthy InitiativesHealthy Initiatives

Information Resources

Health Fact Sheets

Biometric Tracking

Lifestyle Guides


Employers have many tools available to electronically access healthcare information, services, and reporting. Online Enrollment Benefits of online enrollment as discussed under the Employees slide Benefit to HR from reporting and enrollment tracking perspective

e‐Friendly Employer Guides Online Report Access via Secured Website

Healthcare Technology Healthcare Technology ‐‐ EmployersEmployers

Online Report Access via Secured Website Online Ad Hoc Reporting Online Census/Eligibility Verification Online Billing Online Customer Service Electronic Payment to Providers (EFT/ERA) Provider Network Comparisons Identification of Premium Providers and Performance Based Outcomes


Providers have a number of technology tools and services available that help streamline their operations. Online Claim Status and Benefit Verification Fax Back Website HIPPA Standard 270/271 Eligibility and Benefit Verification

Healthcare Technology Healthcare Technology ‐‐ ProvidersProviders

/ g y

Electronic Claims Submission Electronic Payment ACH Virtual Card Employee Remittance Advice (ERA)

Online Specialty Reviews Online Authorizations for Length of Stay


Interactive Voice Response (IVR) for Claim Status and Benefit Verification

Phone System Sophistication

Smartphones/Tablets Increasing Usage for Healthcare Related Inquiries/Tracking

Availability of Numerous Apps

Healthcare Technology Healthcare Technology ‐‐ OtherOther

Availability of Numerous Apps

Compatible Website Design (Responsive)

Social Media

Business Continuity Planning Security

Physical

Data


TML IEBP Services

Online Customer Service

Online Enrollment

Restat Rx Reporting/Inquiry

Healthcare Technology Healthcare Technology ‐‐Demo of Selected ItemsDemo of Selected Items

Debit Card Activity/Balance InquiryNew Website on 11/1/13


NCQA Accredited

Competitive

MemberCentric

Online Enrollment System

Demo Presented by: Mona Gamble MemberCentric

Affordable

Innovative


Online Help

Employee Guide

Enrollment ResourcesEnrollment Resources

Employer Guide




NCQA Accredited

Competitive

MemberCentric

myTML IEBP

Demo Presented by: Ramon RiveraMemberCentric

Affordable

Innovative


NCQA Accredited

Competitive

MemberCentric

Thank Youfor your Time and Attention!

Questions and Answers SessionMemberCentric

Affordable

Innovative


Employee Healthcare and - TML Conference · 2019. 10. 29. · NCQA Accredited Competitive...

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