1. Maybe you’ve heard someone talk about the “new” Group Health
Maybe you’ve heard someone talk about the “new” Group Health. Certainly appreciation for what we call the Group Health Difference has been growing locally, nationally, even internationally. Members or purchasers raving about our over-the-top personalized service. Articles on our innovations in the New York Times and Wall Street Journal. Visitors from health care systems around the world who travel to Group Health to learn about our care model. But what can this difference mean for you?

2. AGENDA HEALTH PLAN Customizable benefit design Funding options
Comprehensive network options
CLIENT SERVICES
Customer service
Core administrative services
Reporting
CARE DELIVERY
Patient-centered care
Care management
Wellness Solution
Occupational Health Services
That’s what we’re here to talk about today. In the next hour, our agenda will cover many of the topics you might expect to hear from a health carrier. But with one major difference.

3. Contain your total cost of care by integrating a customized health plan with our unique care delivery system and exceptional client services.
Group Health can help you contain your total cost of care. That’s right—by integrating a customized health plan, a unique care delivery system, and exceptional client services, we can help you gain control over spiraling health care costs for the long term. We are, after all, the only health plan among our competitors that operates its own care system—and we’ve been doing it for 65 years. Because our coverage and care are integrated into a single system that we own and operate, we can be more efficient and cost-effective, while delivering a higher quality of care. At Group Health, doctors and plan administrators are partners—not adversaries. Our medical group leaders and health plan executives are in the same building. They serve on management teams together. What doctors know about patient health care needs—about prevention and motivating healthy behaviors and caring for urgent and chronic conditions—helps us develop smarter, more relevant health plans and population health services. And what plan administrators know about coverage and the reality of costs leads to innovations in care, such as promoting the use of generic meds or improving care to eliminate unnecessary hospitalization. For us, it’s about finding the smartest way for people to help people so we can offer high quality health care that’s as affordable as possible. Let’s look at how this works for you, starting with health plan customization.

4. All of this—the reporting, the level of customer service and consultation, our care delivery system and health plans—in the end it’s all about helping you manage your total health care costs and providing real value for your business and for your employees.
Here’s how King County Executive Dow Constantine summarized it in October of 2012: “Since 2007, we have saved $46 million below our projected health care costs. $6.5 million of that is directly a result of savings from people choosing Group Health instead of traditional insurance. Another $14.6 million is because people are becoming healthier, and a lot fo them because they are getting the early preventive care that Group Health focuses on.”
So it isn’t surprising that King County offers employees a benefits package with a financial incentive if they’d choose Group Health over their preferred provider plan. And Dow Constantine hasn’t stopped bragging about the money he’s saving the County.

5. Achieve optimal coverage for your company with our flexible options.
One size does not fit all when it comes to building a health plan. To meet your organization’s needs and find the right balance of costs versus benefits, you need the flexibility to pick and choose features from a full menu of options.
Choice is a big part of the “new” Group Health. You can toss out any preconceived notions you have about Group Health or things you’ve heard about us being restrictive. There’s a reason we have more than 700,000 plans filed with the state.
Let’s look at how this flexibility is revealed in our full range of plan designs, funding options, and network options.

6. Customize your benefits to meet the needs of your employees.
Defined network
Point-of-service plans (POS)
Preferred provider organizations (PPO)
Consumer-directed health plans (CDHP)
Health savings account (HSA)
Health reimbursement arrangement (HRA)
Integrated HSA and HRA administration through HealthEquity®
High deductible health plans (HDHP)
Opt. 1 intro: When it comes to plan options, we offer the full range—from defined network to PPO to consumer-directed plans.
Opt. 2 intro: Out of the full range of plan options we offer, today we’re here to talk to you about [which of the following they’ve already expressed interest in].
Our defined network provides access to Group Health Physicians, as well as access to community providers and hospitals across the state. Group Health Physicians is one of the largest multispecialty medical groups in the country and the only medical group in the region to have earned the prestigious Acclaim award from the American Medical Group Association. They practice at 25 Group Health Medical Centers locations.
With point-of-service plans, employees have access to a wider range of physicians than a defined-network plan. Some POS members can choose any doctor with Virginia Mason and The Everett Clinic as in-network, in addition to Group Health Physicians and contracted providers across the state.
Our PPO with Group Health Options, Inc. features access to a broad network of providers—including regional First Choice Health and national First Health Network—with care from these doctors being discounted.
Value-based insurance designs encourage use of high-value services like preventive care by offering these services at lower costs. They discourage use of other, higher-cost services when it’s proven the benefits don’t justify the expense. High-deductible health plans are generally combined with a Health Reimbursement Agreement or Health Savings Account, which are consumer directed.
And what are consumer-directed health plans? With a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA), employees can pay for qualified medical expenses with pretax money. By giving patients more control, they become more aware of the cost of care and, hopefully, make better informed financial decisions as a result.

7. Manage your risk with our full-spectrum of funding options.
Funding options are all about how much risk your company wants to assume for health care costs. Do you want to pay more for health care up front and share the risk? Or do you want to own more risk in return for lower upfront costs? At one end of that spectrum you have the fully insured option. This means that for a premium, Group Health assumes financial and administrative responsibility for the plan.
At the other end of the spectrum, you have the self-funded option, where you can design and manage your health plan for maximum flexibility by assuming financial and legal responsibility.
Between these two are options such as: rate stabilization reserve (nonrefunding) in which you as a purchaser proactively offset the financial impact of unforeseen claim fluctuation. rate stabilization reserve (refunding): In this option, you receive the surplus dollars from paid premiums when actual claims are less than projected.” and retrospective adjustment, where health plan expenses are aligned more closely when actual claim expenses are known.

8. Your employees can get the care they need wherever they live.
Group Health Medical Centers is the heart of our award-winning care delivery system. It features the Group Health Physicians medical group with 1,300 clinicians, including nearly 1,100 physicians. It’s where primary care has been transformed with our innovative medical home model of care. It’s where virtual medicine has been most fully realized. And where we’re using Lean principles of continuous improvement. With our own care system, we can naturally innovate—and implement—faster. And it’s something no other health carrier can offer you. Obviously, we think care at Group Health Medical Centers is the very best we can offer your employees. That’s why it’s included in every network we offer. But we don’t have clinics in every neighborhood. And we don’t offer every conceivable specialty or operate hospitals.
That’s why we also offer contracted providers and hospitals across the state in every network. So your employees and their dependents have access to Seattle Children’s for complex pediatrics or UW Medicine for heart transplants. And you can get hospital care close to where you live—from Virginia Mason in Seattle and Mary Bridge Children’s in Tacoma to Providence hospitals in Spokane. We partner with community hospitals in every area that we serve. And we make sure that our members have access to board-certified specialists and primary care doctors regardless of where they live.
If your company needs more choice, we have health plans that add The Everett Clinic and Virginia Mason Medical Center, or add First Choice Health, a regional provider network, and First Health Network, a national provider network.
And, for the most in provider choice, our choice plans offer any licensed provider in the U.S. as an out-of-network option.

9. Care at Group Health Medical Centers
It offers our greatest competitive advantage.
It’s where care and coverage work together to create more value for patients and employers.
In addition to the advantages of care at Group Health Medical Centers, we know that you can realize optimal long-term cost savings when your employees receive care there. A report from Milliman in December 2011 stated that there are proven results that our care inside the I-5 corridor improves health outcomes of the total population and for specific conditions—which obviously would lead to reduced absenteeism, increased productivity, and reduced costs.

10. Empower your employees to improve their health and the result can be a more productive workforce and lower overall health care costs.
And that’s a good segue for us to talk about what we offer that no other health carrier can offer you—our award-winning care delivery system. Issues that can occur with health care today include unnecessary tests and procedures repeated by different providers, care that isn’t coordinated, information that isn’t shared, and lack of follow-up care to avoid complications. This can result in fragmented care with additional costs.
Our care delivery system is built on overcoming the waste, poor outcomes, and high costs associated with such a fragmented health care system.
Let’s look at this closer, starting with our award-winning Group Health Medical Centers and Group Health Physicians, followed by an overview of our care management, wellness, and occupational health services. Bringing all of these features together allows you the opportunity to get everything your company needs from one health care partner.
Optional background on awards
As just one example, Group Health Medical Centers has been rated "above regional average" in 12 out of 25 quality measures in the 2012 Puget Sound Health Alliance Community Checkup. NCQA's Physician Practice Connections — In 2010, Patient-Centered Medical Home 2010 program awarded all of our Group Health Medical Centers clinics for the vital role our clinicians and clinical practices play in delivering high-quality, patient-centered care that's built on nationally recognized clinical standards.

11. No one else brings it all together in one package like we do.

12. Experience something different with patient-centered care at Group Health Medical Centers.
Patients can spend more time with their doctors*
Doctors with Group Health Physicians partner with patients in health care decisions
Primary and specialty care physicians can focus more attention on patient care
Each clinic features a variety of services, including doctor visits, X-rays, lab, and pharmacy services
* Group Health Research Institute study published in Health Advisor, Vol. 29, May * Group Health Research Institute is the research division of Group Health Cooperative.

13. Employees can save time and money with online services at ghc.org.*
Appointment scheduling
Prescription refill ordering
Electronic medical records, including lab and test results
Secure exchanges with their doctor
An award-winning** app for iPhone® and AndroidTM smartphones to access care on the go
All registered health plan members can use MyGroupHealth for Members' online services to refill prescriptions, choose a doctor, get a health risk assessment, and check their coverage and benefit usage. But members who get their primary care at a Group Health Medical Centers clinic get much more.
For one thing, they can their doctors at Group Health Medical Centers—with no copay or added cost. Patients can also view lab results online—sometimes the same day—and track their results over time. They can schedule appointments, and look up medical records. One member became ill while in Italy and was able to log on to give doctors important details of her medical history which aided in her being treated [Can add your own story here].
Most of these features are also accessible from Group Health's award-winning mobile app, available for the iPhone® and Android™ smartphones. All members can use the app to contact the Consulting Nurse Service, use the interactive Symptom Checker, get directions and maps to our clinics, and check wait times at our pharmacies and labs.
Another huge advantage of Group Health Medical Centers is our electronic medical records. Every health professional caring for a patient has instant access to their record—both for viewing and for adding new information. That’s why a prescription can be ready by the time a patient walks from the doctor’s office across the clinic to the pharmacy. It’s why a primary care doc can review a patient’s EKG they just had with a Group Health cardiologist who works in another clinic. These virtual consults bring the specialist to the family doctor—sometimes while the patient is still in the exam room. No need for a specialist referral, another visit, another copay. Just an expedited process that speeds diagnosis and treatment.
** Some services only available with care at Group Health Medical Centers
** Source: Best Mobile App of 2011, TechFlash Newsmakers Award

14. Here is what Tom Hunt, director of Compensation and Benefits for Puget Sound Energy, had to say about his company’s experience with Group Health.

15. Manage your medication costs with our safe, competitive pharmacy solution.
Extensive pharmacy network includes 25 Group Health pharmacies, contracted network pharmacies, and the MedImpact pharmacy network.*
2013 Medicare 5-star quality rating for prescription drug coverage for Group Health Cooperative Clear Care® (HMO) plans.
Market leader in prescribing generic drugs.
Competitive formulary based on rigorous review of new drugs for safety and effectiveness.
Online and mail-order refills.
Remember when I said earlier that we like to eliminate waste and make sure costs are focused on what’s most effective? This slide shows the result of research done by the Group Health Research Institute to evaluate whether “medical home,” with its smaller patient loads and added access to doctors, would lower costs and keep people healthier. This is what they found after a two-year study. It’s comparing performance from before and after medical home implementation.
After two years, there were more secure messages and telephone visits to docs (no cost to patients or employers associated with those) and fewer face-to-face visits. Most importantly, there were fewer ER and urgent care visits and hospital stays. These settings are where we know the costs for care can really skyrocket. With the right health care, people stay healthier and are less likely to use those services.
I’m not promising that these are the results you’ll experience with your population. But this was a scientific study and indicates the trends that result from this kind of patient-focused care.
Medicare 5-star: We were one of only 9 in the country to earn this rating in 2013.
Competitive formulary: Our physician-led Pharmacy and Therapeutics Committee examines the research behind new drugs before allowing them in our formulary. Because of this diligence, Group Health members were never prescribed drugs like Vioxx, Fen-Phen, Meidia, and 17 others—all eventually pulled off the market by the U.S. Food and Drug Administration due to serious side effects.
* Available for some plans

16. Care management beyond the exam room helps patients get the care they need, and reduces unnecessary services.
24/7 Consulting Nurse Service
Complex case management
Transition management between care settings
Utilization review
Disease management coaching
We’re also very focused on managing medication use so it maximizes the benefit for both your employees and your bottom line.
First off, your employees can access their pharmacy benefits through an extensive network that includes Group Health Medical Centers pharmacies, contracted pharmacies, and for some plans MedImpact pharmacy network. They can also use our mail-order system and can refill their prescriptions by phone or online.
Our Pharmacy and Therapeutics Committee examines the research behind new drugs before making a decision on which should be included in our formulary. Because of this work, Group Health members were never prescribed drugs such as Vioxx, Fen-Phen, Meridea, and 17 other drugs that were pulled from the market due to serious side effects.
We’re also a market leader in generic prescribing. Eighty-eight percent of the time we’re able to substitute an equally effective generic drug for a brand name. (Pharmacy Dashboard, Jan.-June 2011)
We have a program in place to help new members review their prescriptions and get prescriptions transferred to our mail-order system. And we work with patients on medication reconciliation to identify inappropriate drug combinations or dosage levels. This attention to detail is essential to achieving the highest possible quality of care.

17. Keep employees healthier with our Wellness Solution.
Group Health’s care management program is another integral part of our coordinated, patient-centered care. It positively impacts medical expense trends and directly supports the needs of our patients across all our physician networks. 
The first aspect of care management outside of the exam room is our Consulting Nurse Service for care advice and triage. RNs staff the phones 24 hours a day, 7 days a week, and a physician is on site for consultation (unlike other advice lines). Nurses triage symptoms and advise patients whether they should make an urgent or routine appointment, get to an emergency or urgent care facility, or try self-care treatments. This is one of our most popular services, especially for parents of young children.
And, as noted earlier, patients at Group Health Medical Centers can also seek advice by calling their doctor or care team or sending a secure .
Complex Case Management offers short-term, phone-based nursing interventions for patients who have chronic or acute conditions and are capable of improving their health with focused support. These care managers are located in Group Health Medical Centers and throughout our contracted network.
One area where a health care system often fails is in transitioning patients from one care setting to the next. Transition management engages the patient’s care provider in supporting the person as they transition from one setting to another.
And our utilization review—staffed by health professionals—monitors patient care to help make sure your employees are receiving appropriate services.
Additional services can be purchased as a buy-up.
Disease management coaching uses predictive modeling and risk stratification to put patients into four population categories: High Financial Risk, High Risk for Elective Surgeries, High Risk for Chronic Conditions, and High Lifestyle Risks. Registered nurses then proactively support these patients to help them manage their conditions, make needed lifestyle changes, and thoughtfully evaluate elective surgeries.

18. Make wellness an integral part of the workplace.
We provide wellness consulting to help you build multi-year programs and for an additional fee, we offer:
Wellness challenges
Worksite biometric screening events
Worksite flu shot events
It’s probably no surprise that with Group Health’s long history of promoting prevention, we offer members many programs supporting wellness. We want to keep our members as healthy as possible—free of disease and out of the hospital. That’s why care starts with a health risk assessment, and, when needed, phone-based lifestyle coaching to get members on the path to better health.
We proactively remind members to get their screenings and immunizations. We offer discounts for gyms, weight management programs, and alternative care like acupuncture and naturopathy. A highly successful tobacco cessation program. Support groups. And lots of resources for information. Our Group Health Fitness Network offers member discounts on fitness events around the state, and an online community where people can learn about events and participate.

19. For help with workplace injury care and safety, there’s our Occupational Health Services.
Injured worker care at Group Health Medical Centers
For an additional fee, we offer the following:
Industry-specific physicals and employment exams
Screening
Drug and alcohol testing
Prevention services
In addition to providing programs and services that employees access directly, we can help you launch a successful worksite wellness program. The ultimate goal of any on-site program is not only to reduce health plan costs, but to create a self-sustaining culture of wellness. Think of our wellness experts as your partners. A dedicated wellness expert can help you design and manage population health management programs customized to your group’s financial and health risk needs.
We also have various buy-up wellness services that you can take advantage of, such as onsite flu shot events or incentive tracking for your wellness program.

20. Published research demonstrates that our model of care boosts quality and curbs costs.
Group Health offers an all-in-one workplace health and safety program that is staffed by board-certified occupational medicine physicians and certified clinicians. Group Health At Work is dedicated to treating work-related injuries and illnesses with quality medical care, and to providing prevention and safety services.  
For an additional fee, these services include:
Industry-specific physicals, exams and evaluations (such as evaluations or exams necessary for Commercial Driver's Licenses, law enforcement officers, asbestos exposure, etc.) Prevention, screening (such as audiometry and vision screening), and immunization services
Drug and alcohol testing.
These services can help lower time-loss days and costs associated with work-related injuries. 
Occupational Health care is available to both health plan members and nonmembers at 12 Group Health Medical Centers locations.
Optional:
Our program received a certification score of 97.8 out of 100 from the National Association of Occupational Health Professionals.

21. You don’t just get a plan. You get advice every step of the way.
So we’ve covered the extensive health plan options we offer and the breadth of our unique care delivery system. The third area we’ll look at is equally important—and in some respects the most important. It’s about the ongoing client services we offer. It’s what we do to make your job easier and ensure your plan operates smoothly.

22. Exceptional customer service you can rely on.
Local designated account management and customer service teams
Win-win relationships where everyone benefits— employees, employers, and providers
One advantage we hope we’ve demonstrated here is that we bring together many of the services and programs you need in one package with just one account team and organization to partner with. Our physicians and nurses are also partners in these efforts to serve you well.
And there’s another advantage many of our customers mention about us. They say we offer a truly exceptional level of service. As one employer put it, “Group Health should be selling ‘partnership,’ because they do it much more authentically than anyone else.”
Maybe it’s because we’re local. We’re based in Seattle. We live and work in communities where your employees live and work. And we get our care and coverage from Group Health—so of course we work hard to make it the best option for health care for all our members.
Maybe it’s because we’re a nonprofit organization, so our focus isn’t on growing profits for shareholders. Our organizational mission is totally about serving others and helping them have healthier lives. People helping people—that’s what it’s about for us.
Optional: If someone asks about the quote, it was given as part of a survey by a third party and brokers and employers who participated were promised anonymity.

23. Core administrative services
Claims administration
Subrogation
Coordination of benefits
Eligibility maintenance
Appeals
Summary of benefits and coverage
We have the usual core administrative services you expect: Claims administration Eligibility maintenance Appeals Summary plan description

24. Ongoing data-driven consultation helps you understand both health plan and care delivery cost and utilization.
But we also offer reports for both health plan AND health care utilization. Like you, we want to know where your costs are coming from, how your employees are using services, and then work together to find the right combination of plan adjustments or care programs that will improve health and reduce costs further.
Which services and providers are your employees using most frequently? What are the top drugs they’re ordering? What do claims trends reveal?
Have your employees done their health risk assessment, so we know how to help them improve their health? Is there a high incidence of heart disease or hypertension? A high usage of ER or other expensive services? Does everyone have a primary care doc? Are they engaged in using our online services? Based on what we learn, we can customize support to address the needs of your group.
For example, if these reports reveal that you have a large population of smokers or employees with diabetes, we can put together a program or event designed to address those particular health issues.

25. Let’s talk about how your company can benefit from the Group Health difference.
We’d like to help you achieve similar results.