By: Cheryl Demars

 

Last week we sent a letter to the Wisconsin Congressional Representatives in the United States House and Senate to reiterate our priorities as they continue with plans for health care reform.  While the Massachusetts Senate election has added more uncertainty to the prospects for health care reform, we felt it was timely and important to remind our representatives of our priorities:

 

First and foremost, expanding coverage must be coupled with real strategies to control costs and maintain or improve quality (value). Beyond that,

You may also read the complete letter here.

 

As health care reform efforts continue in the next few months, we will continue to keep members as up-to-date as possible.

 
Back to top

Dig deeper into the benefits of self-funding at our next Alliance Learning Circle - Self-Funding: Embrace the Power and Maximize Your Plan. The event on February 17 will focus on how to maximize the power of a self-funded plan.

The event will be held at the Monona Terrace Community and Convention Center, not The Alliance as previously announced. Learn more and register today.

Back to top

The executive summary from Getting Hitched on Wellness: What Does it Take to Get to Employee Engagement?, our January Alliance Learning Circle event, is now posted In the Circle.

 

You can also find the resource guide provided at the event and other worksite wellness resources in our Employer Resource Center. You will need to log in first to access the resource guide. If you are unsure of your username and password, contact Cathy Lanser, 800.223.4139 x 6639.

Back to top

For more ways to implement or improve employee wellness programs, two new books from the nonprofit International Foundation of Employee Benefit Plans (IFEBP) may serve as great resources:

Also, a new report from the Wellness Council of America, Implementing Wellness Programs in Small Business Settings, targets employee wellness in small-business settings. The two-part report examines commonalities between successful wellness programs at businesses that employ less than 50. Included is a list of 10 key activities to get a small-business wellness plan off the ground. This free PDF report is available online (e-mail registration required).

Back to top

Claims Repricing
Our contracts require that we reprice claims we receive from providers and send them on to the claims administrator within three business days. In 2009, we averaged 0.01 days for electronic claims and 1.76 days for paper claims, for a total average turnaround of 0.43 days for all claims.

 

The majority of our claims are filed electronically through our electronic data interchange (EDI):

Call Volumes
Our customer service team experienced an increase in the number of telephone inquiries in 2009 from 2008. Calls from providers represent 67 percent of all the calls received by our customer service staff in 2009, with enrollees 27.92 percent, TPAs, others and employers making up the rest.

 

Three of the top five inquiries from all sources continue to be items that are best addressed by TPAs, not The Alliance, representing over 50% of the calls directed to our Customer Service department.  These include initial claims status (35.06%), question about benefits (11.4%), and eligibility verification (9.8%), which are then forwarded on to the TPA.

 

Our increased EDI connectivity with TPAs appears to be positively impacting claims forwarding efficiency as fewer provider calls are related to claims not received by TPA. It is no longer one of the top five reasons for provider inquiries.

Last month we told you about our new partnership with Quantum Health to offer their Coordinated Health/Care™ program to employers with more than 200 employees across all networks.

 

Quantum Health's mission is to help people maintain their health and provide support and guidance through the complicated health care process. By coordinating services with patients and their physicians, plus the many other areas of the health care system, Coordinated Health/Care program has kept participating employers' costs to a 4.3 percent trend over the past 10 years. They've done this without cutting benefits or shifting costs to employees. Read more about this partnership and Quantum on our Web site.

 

We are looking forward to working with agents and consultants to offer Coordinated Health/Care to our mutual clients. Members with more than 200 employees across all networks and their agents will be receiving more information in their mail in the next few weeks. If you have questions in the meantime, please contact Bobbi Jones, product management specialist, at 800.233.4139 x 6638.

Back to top

During February, employees may be thinking about their hearts, which makes it the perfect time to talk about heart health in the workplace. Members can use this linked article from Health Solutions, Ltd.^®  It's a great way to tag on to promotions in the news, magazines, and online when interest is high.

 

Our partnership with Health Solutions, Ltd. allows you to offer this solution to mutual clients at a 15-25% discount. For more information about Health Solutions, Ltd.'s complete suite of wellness solutions, and for more information about our partnership with them, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.

 

 

Aerial Company Inc. has also recently joined The Alliance. A family business with roots dating back nearly 100 years, Aerial Company Inc. is a wholesale distributor of professional salon products. The business is headquartered in Marinette, Wis., and boasts 80 sales locations across 11 states. Aerial Company Inc. also prides itself on a commitment to continued training in hairstyling, coloring and manicure techniques, scheduling nearly 2,000 onsite programs for its customer salons each year.

 

Carol Mandernach has joined The Alliance as contract analyst in our provider relations department. Carol brings nearly nineteen years of health care experience in reimbursement and analysis, specializing in Medicare facility reimbursement and data modeling of hospital and physician contracts. As a contract analyst, Carol will support The Alliance's contracting efforts and work with Wisconsin Health Information Organization (WHIO) data.

 

Daniel Lehnherr has joined The Alliance as communications and Web specialist in our marketing and member services department. He brings six years experience in writing, design and Web work from positions in the public relations, newspaper, and advertising industries. In his role here at The Alliance, Daniel will be responsible for the design and content of the Web site as well as analyzing usage statistics and developing strategies to increase page views and site visitors. He will also manage the format, design and distribution of electronic and print materials for The Alliance, including the design of this newsletter.

 

Please join us in welcoming Carol, 800.223.4139, x 6653 and Daniel, 800.223.4139 x 6634.

Back to top

The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.

 

Just a reminder: Always check the online provider directory for the most current provider information!

 

 

The Alliance released our QualityCounts™ Inpatient Hospital Report a few months ago. The report was released in an e-book format, which like a PDF makes the report digital.

 

This QualityCounts for Employees piece helps individuals with access to The Alliance network understand how to navigate through the report. Members can print it out and share with employees so they will access the QualityCounts report next time they are making a decision about inpatient or outpatient care.

 

The Alliance highlights health care and benefit management news for employers in News You Can Use with a link to take you to the original story or report.

 

Survey: Per-employee Health Benefit Costs to Top $10,000
Want a Healthier Staff? Cash Incentives Work Best
A new survey predicts medical benefit expenditures will top $10,000 on a per-employee basis next year, and other research shows that financial incentives are the best way to get employees involved in valuable wellness programs. Read News You Can Use now.

 

 

Questions Related to Current Alliance Members:
Jesse Oberloh
800.223.4139 x 6645
joberloh@the-alliance.org 

 

Questions Related to Prospective Alliance Members:
Diane Loram
800.223.4139 x 6643
dloram@the-alliance.org

 

 

You can read past issues of this online newsletter here.

 

Reader comments, suggestions, and topics are always welcome.

 

Cathy Lanser, Editor
Daniel Lehnherr, Design
Diane Loram, Business Development Manager