VALUE PROPOSTION FOR EMPLOYERS
A New Approach to Employer Provided Healthcare Benefits
There are five major differentiators that allow PEACEPlan to create more value than other Insurers, TPAs and competitors.
PEACEPlan and its best-of-breed service firms are connected electronically so that the use, cost and payment of health benefits occurs quickly and seamlessly. These linkages allow PEACEPlan to track and assess how Members are using their benefits and what adjustments to the PEACEPlan model could improve performance for employers. This type of assessment doesn’t happen with the insured benefit plans offered by competitors to small employers.
The Healthcare Bluebook technology managed by American Health Group, (“AHG”), drives cost-effective utilization of the PEACEPlan provider network. PEACEPlan also has its own smartphone and tablet application that gives Members immediate access to plan benefits and PEACEPlan service firms. These technology investments are not in place with most competitors.
PEACEPlan offers its Members 24/7 access to AHG Advocacy Coaches. These Advocacy Coaches support Members in understanding prevention, treatment options, provider choices, and how to navigate the healthcare system. Most competitors do not invest in advocacy services. In addition, the AHG Advocacy Coaches use Healthcare Bluebook online price/quality tools to help Members compare price and quality rankings between local providers for any healthcare procedures, tests, or services they may need. Prices can vary by more than six hundred percent (600%) for the same in-network procedure or service of similar quality, depending upon which provider is selected. When Members understand how to choose high-value providers, significant cost savings occur for both Members and their employers.
Healthcare Bluebook is also integrated into AHG’s precertification platform for approval of certain inpatient and outpatient services that are required by PEACEPlan. With almost all competitors, precertification requests come from network providers after such providers have been contacted by employees and dependents. In PEACEPlan’s model, precertification requests must be made by the Members directly to the AHG precertification team. AHG then utilizes Healthcare Bluebook tools with Members to identify high quality and lower cost providers before approving the precertification requests. Similar to Advocacy Coaches, less costly provider alternatives yield material cost savings.
Primary care physician visits with PEACEPlan are covered at no cost to Members. Health benefit plans from competitors almost always charge copays or deductibles for PCP care. In addition, most competitors don’t make efforts to encourage Members to select a primary care doctor. PEACEPlans’ advocacy partner, American Health Group, Inc., reaches out telephonically to Members to help them choose a PCP and build a relationship with their primary care physician for prevention, wellness and referrals to other providers.
PEACEPlan health benefit plans cover all 66 preventative services for men, women and children that are required by the Affordable Care Act. There is no cost to Members for these services. Nearly all preventative services can be provided by primary care physicians in the PEACEPlan provider network. But with competitors that don’t incent and encourage primary care, the preventative services can end up being delivered by specialists who may “capture” the Members and provide unnecessary or costly additional services that aren’t discussed with the primary care physicians.
The PEACEPlan self-insured benefit plans are less expensive when compared to insured benefits provided by competitors. When compared to self-insured plans of the competition, PEACEPlan has its own captive insurance firm that generates superior cost savings for employers; the financial risk assumed by the captive lowers’ reinsurance fees and the reduced costs are passed on to employers. As noted above, PEACEPlan’s’ differentiation in prevention, primary care, advocacy and technology cuts the use and cost of health benefits for Members and employers. These savings are also passed on to employers through lower benefit plan pricing. PEACEPlan believes its pricing advantage will be between 15-30% in the CO market.
PEACEPlan benefits and funding comply with all regulatory requirements in both the fiscal management and technology services area.
Employers, now more than ever, have the ability to gain visibility and control of health benefits through an innovative product like PEACEPlan. We have made it easy by curating market competitive benefits, embedding key features like Primary Care, Vision, and Discount Drug Card, securing on the stop-loss coverages, and providing an Advocate for your employees.