1. Annual Payor Conference
Welcome!
Lakeland Care Network
Annual Payor Conference
October 17, 2018

2. Lakeland Care Network - Update
Spectrum Integration
Affirmant
Blue Cross Blue Shield – Medicare Advantage PPO
Blue Care Network – Medicare Advantage HMO
ACO
Managed Care Distributions
$900,000
Better
Monthly Payor Meetings – 4th Tuesday

3. Quality & Care Management Team
What we do:
We are SMEs in the following programs:
CPC+
PGIP
Payer programs
CMS programs
Patient satisfaction
Practice transformation
Dual eligible groups – Aetna & Meridian
Care management onboarding
Etc.
Provide quarterly outreach
Update EBGs and protocols for Quality Committee approval
Contact sheet is available on the Lakeland Care table

4. Occupational Medicine
Occupational medicine is the medical specialty devoted to prevention, treatment and management of workplace injury and illness and the promotion of health and productivity of workers, their families, and communities.
Dr. Cathy Boomus, MD, MPH
Ursula Adent – Supervisor
Amanda Stevens - Manager
2500 Niles Ave, St. Joseph
Open late November, 2018

5. Spectrum Health Lakeland – Benefits 1/1/19
Medical Plan: Priority Health will be our new third-party administrator replacing ASR.
Prescription Drug Plan: Express Scripts will replace EnvisionRx as pharmacy benefit manager.
Flexible Spending Accounts: Infinisource will become our new administration replacing ASR.
ID Cards
Will be re-issued by mid to end of December
Medical ID Card – Issued by Priority Health
Prescription Drug Card – Issued by Express Scripts
Flexible Spending Account Debit Card – 2 new debit cards will be sent from Infinisource

6. Spectrum Health Lakeland – Benefits 1/1/19
Medical Plan
Group Number:
Employee premiums will increase slightly in 2019
Spectrum will become as tier 1 provider, no extended network referral required
Emergency Room Co-Pay
The ER co-pay will increase from $150 to $200 for 2019

7. Spectrum Health Lakeland – Benefits 1/1/19
Deductible and Out of Pocket Changes
The changes to the Traditional Plan deductible and out of pocket maximus are outlined below. There are no plan changes to the High Deductible plan.

8. Spectrum Health Lakeland – Benefits 1/1/19
Prescription Drug Plan
Express Scripts will become our new pharmacy benefit manager effective January 1, You will be receiving a new pharmacy benefit ID card by mid-December. the burden of covering these medications has become increasingly difficult. Lakeland has put several programs in place such as step therapy, pre-authorizations to help contain costs.

9. Spectrum Health Lakeland – Benefits 1/1/19
2019 PRESCRIPTION DRUG PLAN OVERVIEW
Lakeland Pharmacy
Non-Lakeland Pharmacy
Prescription Type
30 Day Supply
90 Day Supply
30 Day Supply Only
Generic
15% Cost of Rx Min: $2 / Max: $100
15% Cost of Rx Min: $5 / Max: $200
30% Cost of Rx Min: $10 / Max: $400
Preferred Brand
25% Cost of Rx Min: $10 / Max $200
25% Cost of Rx Min: $20 / Max: $600
35% Cost of Rx Min: $25 / Max: $400
Non-Preferred Brand
35% Cost of Rx Min: $20 / Max: $300
35% Cost of Rx Min: $40 / Max: $600
35% Cost of Rx Min: $35 / Max: $400
Specialty
35% Cost of Rx Min: $100 / Max: $400
Not Available
Rx Out of Pocket Maximum-Traditional Plan: $2,900-single $5,800-2 person/family

10. Lakeland Care Operations
List of contracted payors
Credentialing News:
Midlevels
Mental Health
CAQH
Reminders in the mail
Notification of Changes / Workday
CHAMPS deadline 1/1/19
GMS reminder
Update requests
News
Search for providers
Print a directory
Contracted payor list
Provider portal links
Team contacts