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Roadmap to a Partnership Kalispell School District December 8, 2010.

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Presentation on theme: "Roadmap to a Partnership Kalispell School District December 8, 2010."— Presentation transcript:

1 Roadmap to a Partnership Kalispell School District December 8, 2010

2 About New West

3 Established in 1998 Provider Sponsored – Montana Based Quality Focused Approximately 41,000 covered lives Current Accounts Federal Employees University System of Montana State of Montana Employees CMS Approved (Medicare Advantage) Over 500 Employers Financially Sound

4 Vision Statement We Believe in Simplifying Healthcare

5 Change In How We Measure Value From health as the absence of disease to health as vitality and energy. From focusing on the cost of health care to the total value of health; most current health care reform proposals mistakenly focus on the costs of coverage (and who pays this cost). From individual participation to population engagement. From behavior change to creating a culture of health. Even if a few individuals change behaviors, the gains will not be sustained if they return to the same culture.

6 Integrated Strategy New West Member EmployerProvidersEmployeeAgent/BrokerNew West

7 What does the customer get? Lower premium Better access to quality health care Better health leading to more predictable future premiums Less frustration and anxiety about coverage Right information at the right time Problems solved quickly and effectively

8 Employee Satisfaction Claim Payment Accuracy – over 98% YTD Claims paid within 13 days on average Commercial Business (Goals) Week Ending 11/05/10 Nov 2010 Month to Date Previous Month 2010 Year to Date ACD CallsN/A1,513 5,75260,938 Average Speed to Answer :30 0:33 0:320:45 Abandoned Calls 3% 1.5% (23 Calls) 1.5% (23 Calls) 2.4% (136 Calls) 3.2% (1,926 Calls) Average Abandon Time N/A 1:21 1:201:41

9 New West Health Services The Plan

10 Long Term Strategy H.S.A. concepts Access to an online portal –View and pay claims online –Estimate the cost of medical services –Manage healthcare spending A state-of-the-art wellness program with a proven track record –Participation incentives and rewards –Benchmarks

11 Prevention New West believes in quality and affordable health care and we focus on prevention and wellness for our valued members –Well child covered at 100% –Immunizations covered at 100% –Breast cancer screening covered at 100% –Cervical cancer screening covered at 100% –Colorectal cancer screening covered up to $1,300 –Prostate cancer screening covered at 100% –Cholesterol and Lipid disorder screening covered at 100% –One yearly vision screening exam for a $10 copay

12 Medical Services Utilization Review – smart use of appropriate services within benefit plans = cost containment Case Management – Registered Nurses to help problem solve and identify options Transition of Care – temporary out of network use Happy to serve as your advocates

13 Network Access Montana Network – Provider Search - Results | New West Health Services Provider Search - Results | New West Health Services National Physician and Facility Participation –Beech Street – Beech Street CorporationBeech Street Corporation –For use while traveling out of state –For use when the services are not available in MT

14 H.S.A. Concept Dual Option provides choice for employees Employer contribution can drive behavior Employees and employers save money on premiums Employees can invest what they save Reduces utilization Employees become empowered to make informed purchasing decisions No use-it-or-lose-it and portability

15 Wellness MyNewWest Fully integrated online portal Comprehensive content and tools Online Health Assessment Interactive health coaching Personal health record Incentives and rewards Nutrition, fitness, weight loss, stress, diabetes, heart health and smoking cessation modules

16 Introducing

17 Plan Designs Guardian $500 $500/$1,000 Deductible $2,000/$4,000 Maximum Out of Pocket 80/20 Coinsurance $20/40/60 Co-payment for pharmacy $500 First dollar coverage for in-network urgent care visits and office visits

18 Plan Designs High Deductible Health Plan $3,000/$6,000 Embedded Deductible $3,000/$6,000 Maximum Out of Pocket 100/0 Coinsurance $500 Preventive Endorsement Well Child Care paid at 100% through age 7 Health Savings Account eligible Integrated Pharmacy Benefit

19 Plan Summary New West Health Services: Provides Kalispell School District with a wellness solution that is measurable Provides top of the line preventive and wellness benefits Provides employees with a member portal to manage their medical spending Provides employees with a secure, robust wellness portal to help employees manage their health Provides stable pricing, reporting management software and true cost management

20 Rapid Implementation New West Health Services: Establish a timeline Determine employee enrollment meetings Provide enrollment packets and training Meet individually with folks undergoing current care Electronic enrollment is possible pending data available: Current membership report Payroll records (SSN, contact info, etc.) Current billing statement and 12 months prior The New West Rapid Implementation Team!

21 Believe in the right choice for Montana!

22 Roadmap to a Partnership Kalispell School District December 8, 2010

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