Employee Healthcare and Technology
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- Pearl Bates
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1 NCQA Accredited Competitive MemberCentric Affordable Innovative Employee Healthcare and Technology Texas Municipal League Annual Conference October 10, 2013 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 Technology and Healthcare Scope of Presentation 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 Employee Employer Provider 2 Dedicated to Service for Over 30 Years Healthcare Technology Drivers 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 Compatibility 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 3 Dedicated to Service for Over 30 Years
2 Healthcare Technology Access Employees 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 Electronic Resources Online Customer Service Online Enrollment Rx Vendor Access and Pricing Transparency Telemedicine Electronic Health Record Healthy Initiatives 4 Dedicated to Service for Over 30 Years Healthcare Technology Provider Lookup 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 Procedure Charges Online Review of Outcomes Provider Selection Based on Performance Based Outcomes 5 Dedicated to Service for Over 30 Years Healthcare Technology Electronic Resources 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 Online Forms Summary of Benefits and Coverage Plan Benefit Books Healthcare Reform Legislation 6 Dedicated to Service for Over 30 Years
3 Healthcare Technology Online Customer Service 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) 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 7 Dedicated to Service for Over 30 Years Healthcare Technology Online Enrollment 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 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 8 Dedicated to Service for Over 30 Years Healthcare Technology Rx Vendor Access and Pricing Transparency 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 Rx Claim History Pharmacy Locator Drug Cost Comparisons Drug Interaction Analysis Rx Customer Service Medical Therapy Management Program Prescription Data Warehouse 9 Dedicated to Service for Over 30 Years
4 Healthcare Technology Telemedicine Telemedicine is convenient, effective, and less expensive. Online Access to a Medical Doctor Certain Medications Prescribed Available 24/7 Quick Response Opportunity for Educated Consumer to Manage Out of Pocket Expense Employee/Dependent Registration with Telemedicine Provider Eligibility Data Uploaded to Telemedicine Provider 10 Dedicated to Service for Over 30 Years Healthcare Technology Electronic Health Record 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 Personal Health Profile on Completion of Biometric Screenings and Health Power Assessment Health Record Sharing/Access between Providers Consent by Patient Required 11 Dedicated to Service for Over 30 Years Healthcare Technology Healthy Initiatives 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. Information Resources Health Fact Sheets Biometric Tracking Lifestyle Guides 12 Dedicated to Service for Over 30 Years
5 Healthcare Technology Employers 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 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 13 Dedicated to Service for Over 30 Years Healthcare Technology Providers 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 Electronic Claims Submission Electronic Payment ACH Virtual Card Employee Remittance Advice (ERA) Online Specialty Reviews Online Authorizations for Length of Stay 14 Dedicated to Service for Over 30 Years Healthcare Technology Other 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 Compatible Website Design (Responsive) Social Media Business Continuity Planning Security Physical Data 15 Dedicated to Service for Over 30 Years
6 Healthcare Technology Demo of Selected Items TML IEBP Services Online Customer Service Online Enrollment Restat Rx Reporting/Inquiry Debit Card Activity/Balance Inquiry New Website on 11/1/13 16 Dedicated to Service for Over 30 Years NCQA Accredited Competitive MemberCentric Online Enrollment System Demo Presented by: Mona Gamble Affordable Innovative 17 Dedicated to Service for Over 30 Years Enrollment Resources Online Help Employee Guide Employer Guide 18 Dedicated to Service for Over 30 Years
7 19 Dedicated to Service for Over 30 Years 20 Dedicated to Service for Over 30 Years 21 Dedicated to Service for Over 30 Years
8 22 Dedicated to Service for Over 30 Years 23 Dedicated to Service for Over 30 Years 24 Dedicated to Service for Over 30 Years
9 25 Dedicated to Service for Over 30 Years 26 Dedicated to Service for Over 30 Years 27 Dedicated to Service for Over 30 Years
10 28 Dedicated to Service for Over 30 Years 29 Dedicated to Service for Over 30 Years 30 Dedicated to Service for Over 30 Years
11 31 Dedicated to Service for Over 30 Years 32 Dedicated to Service for Over 30 Years NCQA Accredited Competitive MemberCentric mytml IEBP Demo Presented by: Ramon Rivera Affordable Innovative 33 Dedicated to Service for Over 30 Years
12 34 Dedicated to Service for Over 30 Years 35 Dedicated to Service for Over 30 Years 36 Dedicated to Service for Over 30 Years
13 37 Dedicated to Service for Over 30 Years 38 Dedicated to Service for Over 30 Years 39 Dedicated to Service for Over 30 Years
14 40 Dedicated to Service for Over 30 Years 41 Dedicated to Service for Over 30 Years 42 Dedicated to Service for Over 30 Years
15 43 Dedicated to Service for Over 30 Years 44 Dedicated to Service for Over 30 Years 45 Dedicated to Service for Over 30 Years
16 46 Dedicated to Service for Over 30 Years 47 Dedicated to Service for Over 30 Years 48 Dedicated to Service for Over 30 Years
17 49 Dedicated to Service for Over 30 Years 50 Dedicated to Service for Over 30 Years 51 Dedicated to Service for Over 30 Years
18 52 Dedicated to Service for Over 30 Years 53 Dedicated to Service for Over 30 Years 54 Dedicated to Service for Over 30 Years
19 NCQA Accredited Competitive MemberCentric Thank You for your Time and Attention! Questions and Answers Session Affordable Innovative 55 Dedicated to Service for Over 30 Years
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