Section 1: Cost Containment Considerations Checklist
o Is the plan designed to optimize saving?
o Is there utilization management in place to help control pharmacy spend?
o Have medical carveouts been identified and reviewed?
o Have eligible members (due to age or diseases) transitioned to Medicare?
o Are tools in place to ensure members find high quality providers with appropriate costs of care?
o Are chronic disease management tools in place to promote wellness for plan members?
o Have the previous plan year’s claims been analyzed to put an effective wellness plan in place?
o Are all plan members aware of wellness benefits available to them?
o Are wellness incentives in place or necessary?
5
Section 2: Claims Analytics
Powered by
Included with VERIS and all other Benecon Consortiums. ConnectCare3 can provide a clinical review of claims data by a registered nurse in conjunction with the ConnectCare3 Wellness Solutions team. At the end of the data review, a customized wellness plan is provided to the client. www.connectcare3.com
Springbuk is the health data analytics solution that equips employers and benefits advisors with the deep, immediate insights they need to sharpen strategies, improve health, and contain costs. www.springbuk.com
Deerwalk Plan Analytics is a software solution that provides integrated informatics and actionable insights and savings recommendations, presented in an easy to use application that requires no special training. www.deerwalk.com
Analytics enables insurers to identify high risk claims sooner. It can enhance the policyholder experience while achieving an improvement in claims indemnity and expenses. www.athenium.com
6
Utilizing our proprietary risk algorithm, the Abacus data team mines medical and pharmacy claims data to develop a risk stratification analysis that drives customized outreach.
www.abacushealth.com
Innovu empowers advisors and employers to continuously eliminate waste from their healthcare costs, delivering material savings and improving the health and financial security of employees and their families.
www.innovu.com
Cotiviti focuses on improving the financial and quality performance of our clients. In healthcare, this means taking clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality.
www.cotiviti.com
BHI analytic tools help payers, providers, and other healthcare stakeholders make accurate business decisions and isolate root causes of quality and cost issues.
https://bluehealthintelligence.com/
7
Remedy works with plan sponsors to transform convoluted claims data into easy to digest, actionable information. www.remedyanalytics.com
Vital Incite is known for using a plan’s healthcare data to sustainable changes to decrease costs. www.vitalincite.com
8
Section 3: Healthcare Cost and Quality Analysis
Healthcare Bluebook's purpose is to protect consumers and companies nationwide from overpriced, low quality healthcare. Healthcare Bluebook is a tool that compares both cost and quality of care. www.healthcarebluebook.com
Pratter is a medical cost savings and transparency company. Their tools include a low cost care locator, actionable savings solutions, and Medicare or network specific pricing. www.pratter.us
Assists patients with savings of up to 13% and flexible payment options reducing the financial stress of paying out of pocket medical expenses. Member savings are dependent on the payment term and payment method they choose. www.ablepayhealth.com
The KISx Card focuses on high cost/low incidence surgeries within Orthopedic, General Surgery, Colonoscopies, and Major Imaging. Our direct provider “non” network is built on a bundled price model with a quick payment turnaround time to the facility, surgeon, and anesthesiologist. www.getkisx.com
9
SimplePay Health gives you more than a simple health plan. You also have access to the SimplePay Health Platform and Benefits Hub. If you have any questions about coverage, where to go for medical treatment, or even just wellness advice, you can reach out to your SimplePay Health Pro available via phone, email, or online at simplepayhealth.com www.simplepayhealth.com
10
Section 4: Biometric Screening
CardioKinetics performs onsite biometric screenings, and further produces reports to combine reactive and preventive medicine to an individual. They also offer executive physicals and live health presentations.
https://www.cardiokinetics.com/
Health Designs provides onsite biometric screenings for groups over 40 employees. They also provide live health presentations, health coaching, and a wellness portal.
https://www.healthdesigns.net
CHC Wellbeing offers biometric screenings, health coaching, education tools, customizable challengegs, and activity and incentive programs.
https://www.chcw.com/
Onsite Health Diagnostics is a market leader in biometric screenings to provide advanced health assessment solutions.
https://onsitehealthdiagnostics.com/
11
HealthcCheck 360 offers wellness program management, incentive design, and compliance review. They also offer a wellness platform, biometric screening, health coaching, and other consultative services. www.healthcheck360.com
VirtualCheckup is a simple, at home testing solution combined with face to face video consultations with licensed healthcare providers. www.catapulthealth.com
12
Section 5: Diagnosis Group Tools and Programs
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
Included with VERIS and all other Benecon Consortiums. ConnectCare3 provides Chronic Disease Management to any client with a diagnosis of hypertension, diabetes, hypercholesterolemia, or obesity This program pairs the client with a team of health coaches, registered dieticians, and registered nurses to make lifestyle changes to combat the effects of these diseases.
Like our Chronic Disease Management program, our Chronic Disease Prevention program is open to any client that is pre diabetic, pre hypertensive, has a family history of chronic diseases, or is overweight. No formal diagnosis is needed for the Chronic Disease Prevention program.
www.connectcare3.com
Cancer
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
13
Your genome impacts your health, but the odds are, your medical care is happening without any understanding of your unique genetic makeup. Genomic makes sure the care you are receiving is targeted to the genome of the disease.
www.genomiclife.com
Cardiac Disorders (including hypertension)
Included with VERIS and all other Benecon Consortiums. ConnectCare3 provides Chronic Disease Management to any client with a diagnosis of hypertension, diabetes, hypercholesterolemia, or obesity. This program pairs the client with a team of health coaches, registered dieticians, and registered nurses to make lifestyle changes to combat the effects of these diseases.
Like our Chronic Disease Management program, our Chronic Disease Prevention program is open to any client that is pre diabetic, pre hypertensive, has a family history of chronic diseases, or is overweight. No formal diagnosis is needed for the Chronic Disease Prevention program.
www.connectcare3.com
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
14
The program allows for streamlined blood pressure self management with individually tailored feedback. The eBlood Pressure Platform engages, supports, incentivizes and rewards users for health behaviors based on established clinical guidelines for managing blood pressure. www.abacushealth.com/hypertension management/
A virtual first chronic care provider helping members make lasting changes to improve health and reduce care costs for organizations. www.omadahealth.com
Dermatological Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers. www.connectcare3.com
15
Endocrine/Metabolic Disorders (including diabetes)
Included with VERIS and all other Benecon Consortiums. ConnectCare3 provides Chronic Disease Management to any client with a diagnosis of hypertension, diabetes, hypercholesterolemia, or obesity. This program pairs the client with a team of health coaches, registered dieticians, and registered nurses to make lifestyle changes to combat the effects of these diseases.
Like our Chronic Disease Management program, our Chronic Disease Prevention program is open to any client that is pre diabetic, pre hypertensive, has a family history of chronic diseases, or is overweight. No formal diagnosis is needed for the Chronic Disease Prevention program.
www.connectcare3.com
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
Improve adherence to care standards by fostering a deeper relationship between the member and their doctor. Increase medication adherence via proprietary process through timely, relevant incentives in the form of co payment waivers for diabetes medications and supplies.
Provide lifestyle and behavioral support via certified diabetes educators and clinical pharmacists. Engage members in precision health activities based on their unique situation at a time and place where the member is most likely to be receptive.
www.abacushealth.com/diabetes management/
16
Virta improves your existing diabetes portfolio by providing the choice of reversal for patients who want to eliminate medications while restoring metabolic health. We employ licensed physicians and deliver a high touch, personalized experience to patients in all 50 states. www.virtahealth.com
Get advanced technology and personal coaching to help you live healthier no cost to you. Get help managing diabetes, blood pressure, weight, stress, and more at no cost to you. Get the App. Tailored to You. Free Unlimited Strips. Personalized Lessons. Tips and Insights. www.livongo.com
Highmark Health is launching Well360 Diabetes Management, a virtual care program powered by Onduo, a Verily company, for adults with type 2 diabetes. As part of Highmark Health's Living Health model, the program is designed to give members simple, personalized, and proactive support to better manage the chronic condition, improve health outcomes, and reduce costs. www.onduo.com
We address chronic conditions and the mental health conditions that accompany them. Every Vida member receives a personalized treatment program that addresses their individual needs and risk factors in chronic, mental, and lifestyle health. www.vida.com
17
A virtual first chronic care provider helping members make lasting changes to improve health and reduce care costs for organizations.
www.omadahealth.com
Eye/ENT Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
Gastrointestinal Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
Hematological Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
18
Mental Health
Taking care of employee mental wellbeing poses a significant challenge to companies of all sizes, all around the world.
Koa helps your team prioritize mental health with practical, engaging and easy to use digital tools, grounded in science and designed by experts.
www.koahealth.com
Calm improves employee well being by promoting better sleep, reducing stress and anxiety, and developing more mindfulness.
www.calm.com
Not enough employees are getting the care they need. Average wait for a mental health visit is 21 days for a child it’s 7.5 weeks. With Lyra, members can sign up and begin their journey to feeling better in just a few clicks.
www.lyrahealth.com
Innovative, digitally enabled solutions for employee assistance, chronic condition management, managed behavioral health, and more.
www.uprisehealth.com
19
Those with Cigna now have access to Ginger. Mental health support made just for you. Behavioral health coaching, therapy, psychiatry, and self care resources, all from the privacy of a smartphone. www.ginger.com
Insight Timer is a meditation app that helps make meditation convenient, easy, and engaging www.ingishttimer.com
Through science backed meditation and mindfulness tools, Headspace helps you create life changing habits to support your mental health and find a healthier, happier you. www.headspace.com Musculoskeletal Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers. www.connectcare3.com
20
A virtual first chronic care provider helping members make lasting changes to improve health and reduce care costs for organizations.
www.omadahealth.com
Neurological Disorders
Included with VERIS and all other Benecon Consortiums. ConnectCare3 will provide a Nurse Navigator to clients with a medical diagnosis requiring a specialist that requests one. Nurse Navigators can assist clients in understanding their diagnosis, finding a second opinion, and finding qualified, well credentialed providers.
www.connectcare3.com
Obesity
Included with VERIS and all other Benecon Consortiums. ConnectCare3 provides Chronic Disease Management to any client with a diagnosis of hypertension, diabetes, hypercholesterolemia, or obesity. This program pairs the client with a team of health coaches, registered dieticians, and registered nurses to make lifestyle changes to combat the effects of these diseases.
Like our Chronic Disease Management program, our Chronic Disease Prevention program is open to any client that is pre diabetic, pre hypertensive, has a family history of chronic diseases, or is overweight. No formal diagnosis is needed for the Chronic Disease Prevention program.
www.connectcare3.com
21
Section 7: Plan Carveouts
Competition in the benefits marketplace post PPACA has never been greater. Kidney dialysis for the treatment of End Stage Renal Disease is one of the most expensive, chronic conditions faced by plan sponsors. Brokers that offer our patented program can save their clients an average of $900,000 per dialysis member annually. Win more business by saving clients on expensive dialysis.
www.dialysisppo.com
Star Health Insurance offers plans to cover autism spectrum disorders, diabetes, women’s care, as well as many other plans.
www.starhealth.in
25
Ultimate Health and its sister product, Plena Health, help employers meet the specific benefit expectations of top performers. Plus, they do so while maintaining control over health plan costs. That’s because these products can be offered to just a select group of employees on a tax efficient* basis. Clients regularly tell us how much they value the positive impact these solutions have on their retention and recruiting efforts.
*This is not local, state or federal tax advice as each person and each company is unique. It is recommended that you seek the independent counsel of a professional tax adviser.
www.armadacare.com
The Phia Group, LLC is an experienced provider of healthcare cost containment techniques offering comprehensive consulting services, legal expertise, plan document drafting, subrogation, and overpayment recovery, claim negotiation, and plan defense designed to control costs and protect plan assets.
www.phiagroup.com
26 Section 8: Miscellaneous
Section 9: Wellness Platforms
Included with VERIS and all other Benecon Consortiums, ConnectCare3’s wellness platform offers incentive tracking, education, health literacy resources, and direct contact to the ConnectCare3 Clinical Services. The ConnectCare3 platform and app are a turnkey solution for companies looking to make wellness easy.
www.connectcare3.com
The Wellworks For You Wellness Portal is the one stop solution for employees participating in their corporate wellness program. Users have quick access to their program requirements, participation, incentives, and various resources. Wellworks also provides chronic care management and health coaching, financial well being solutions, mental well being solutions, and data analytics.
www.wellworksforyou.com
Health portal providing content and resources to help you on your journey to health. www.wellnesscoachesusa.com
Advanta Health Solutions’ reward program helps your workforce build healthy habits to improve their physical and mental wellbeing. www.advantahealth.com
27
Wellness platform that brings all aspects of health together with a single point of entry to a benefits ecosystem. www.navigatewell.com
WellRight provides wellness solutions and a platform for your employees. www.wellright.com
Wellable integrates with leading consumer wellness technologies that employees know and love, features a clean, easy to navigate user interface, and is full of multi media, holistic wellness content. www.wellable.com
HealthCheck 360 offers wellness program management, incentive design, and compliance review. They also offer a wellness platform, biometric screening, health coaching, and other consultative services. www.healthcheck360.com
28
CHC Wellbeing offers biometric screenings, health coaching, education tools, customizable challenges, and activity and incentive programs.
https://www.chcw.com/
29
