The C.A.R.E. Plan
Cash-Pay/Contract-Creating/Care-Centric/Concierge-Led
Affordable
Reimagined
Elevated
Why are we here with this new plan?
Everyone agrees not only that health plans are becoming unbearably too costly, but also that they traditionally lack featuring the member at the center, which leads to plan use frustrations, unknown quality of care, nebulous financial responsibility for the patient, and higher costs each year.
We wager you are here because:
You are an employer, broker, or industry expert that recognizes the need for a completely re-tooled health plan to fix population health and actually reign in costs.
You believe the existing status quo is unsustainable and even irresponsible when it comes to managing costs and promoting a fundamentally sound model for care.
You are ready to embrace change that can fix healthcare, one employer group at a time!
The C.A.R.E. Plan comes in different varieties depending upon a group’s size, stance on network preference (if any), and geography. We are able to help groups with 25 or more enrolled employees with a number of unique vendor sets that all have the same tenets at heart when it comes to member-centric, innovative, and health promoting ideals.
We keep the Quadruple Aim in mind with our plans:
Improve population health
Reduce the cost of care
Enhance patient experience
Improve provider satisfaction
Cash-Pay
Eliminating the confusion that comes with a network agreement that neither the employer or employee had a say in creating frees up the innovation of cash payment. Our health plan model includes same-day payments to providers using a novel and unique technology that also allows for member responsibility to be reduced or eliminated. Providers are freed from collections efforts and payment delays, which leads to a more elegant and effective model for all.
Contract-Creating
Providers and patients have been tied to insurance networks as that has shaped the group medical industry for decades, however, is value created by using a national network, or is it more of a ‘everyone is in our network and your prices are reduced by 50%’ kind of proposition? The fastest way between 2 points is a straight line, and the most efficient payment method happens to mirror that axiom. Our health plan features the technology and advocacy to have contracts created between the employer and providers, simplifying the process and eliminating middlemen in the process of your care and payment model. This is the future!
Care-Centric
We all realize that when insurance is placed in between the patient and the provider that issues arise, but why should we accept that flawed model? The CARE plan is built with the member at the center of the care ecosystem. In fact, members may find that they have very little need to use the insurance plan much at all. Imagine that, healthCARE without the headache?!
Concierge-Led
Your staff need an Advocate, a Concierge, a Guardian….basically, a right-hand friend to help them best navigate their medical benefit program, so we’ve included that with every plan! Unburden HR and empower your members with next-level health plan advocacy.
Components
Your Medical Home
Depending upon your geography, you may elect a brick-and-mortar Direct Primary Care provider or utilize a virtual platform to serve as your member’s patient-first medical home.
We’ve eliminated pressure and incentives to refer patients to higher cost settings of specialty care when simply not needed. Providers in this model have smaller patient panels, which allows for an elevated patient experience that’s fundamentally built upon maximizing care for the member, driving down out-of-pocket costs, and offloading preventative care costs from the health plan (a positive, winning trifecta)!
Our underwriting partners provide discounts to offset the cost of the proactive investment in sound, back-to-basics holistic primary care.
Pharmacy Innovations
Our plan boasts a custom-built formulary that is designed with value, performance, and flexibility in mind. Not only are our PBM partners eager to help provide a seamless experience for members, they are also dedicated to transparency and innovation. We’ve designed the benefits to
Stop Loss Insurance
Stone Mountain Risk
Innovators in community health plan development, our partners at SMR have extensive experience in creating direct contracts with local health systems and then pricing risk accordingly to yield aggressive rates.
This unique program structure allows for us to write cases as small as just 5 enrolling employees and, if desired, their dependents. We do not have participation requirements to meet, either!
East Coast Underwriters
Groups with over 50 members may find it challenging to collect health applications, so ECU has a solution for such groups. With the ability to underwrite based on a full census, rate information, and benefit summaries, we eliminate hurdles to transitioning into our plan.
Underwriting Techniques
We help you more easily bring groups into new health plan structures.
Under 50 Lives
Our online health application process is simple, or you may use paper, or bring your own system. We have a closely held relationship with the underwriters and risk-takers, so may get aggressive to help you win or retain your groups.
Over 50 Lives
With the use of a new technology, we are able to fully underwrite a case with a member-level census and a signed disclosure along with a copy of the groups renewal. Easy.
Care/Claims Management
Valenz Health
Connecting cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz engages members often and early in their care journey and leverages healthcare data to the advantage of your population. What’s more, they seek to ensure only justified and correct charges are being paid from your claims fund, aggressively protecting your medical plan dollars while improving the population health of your group.
Vālenz Care
Connecting the clinical dots
Empowering members to move from reactive care to proactive population health management – a smarter way to manage cost and quality.
Vālenz Access
The right care at the right time
Driving high-quality care, satisfaction and cost savings with high-value, client-centric provider networks, custom built for you.
Vālenz Claim
Enabling a clean claim workflow
Weaving analytics into claim workflow to reduce plan expenses, improve claim outcomes and enhance member experiences.
Vālenz Assurance
Payment integrity and assured compliance
Delivering smart, actionable solutions that reduce exposure, improve claim accuracy and enhance coding efficiency.
Pharmacy Innovations
ProAct Pharmacy Benefit Management
As the largest employee-owned pharmacy benefit manager, ProAct delivers a mission-aligned approach with clients by offering lowest-net-cost prescription initiatives and solutions to client partners. See the difference independence can make!
Therapeutic Alternative Program
As part of our business model we leverage generic utilization to reduce drug spend where possible. We provide five targeted drug classes, pharmacist communications and outreach. As part of our program, we also offer direct mail of medications to members.
Mail Order Program
Our mail order pharmacy is owned and operated by ProAct, providing our clients with a dedicated, integrated call center. Our services include voucher incentives, generic availability notices, outbound call programs, integrated substitution program and expedited dispensing and fulfillment. We pride ourselves on our commitment to excellence.
International Mail Order
Our international program provides an 85% cost savings on select brand medications covering over 250 brand name medications. Our international mail order program includes all tier one international countries. ProAct supplies client support and system integration regarding the international mail order program with 0% copay.
Specialty Pharmacy
Our specialty pharmacy, Noble Health Services is ProAct owned and operated. Our state-of-the-art custom-built facilities broke ground in 2013. Through our specialty pharmacy we are able to provide Coordination of Benefits and copay assistance. Noble Health Services supplies ancillary supplies at no additional cost to our members as well as individualized provider protocols. Our specialty pharmacy provides on-call support 24/7 for each account and is URAC accredited.
Specialty Cost Control
Our formulary management provides clinical guidelines and FDA indication guidance. Support also includes drug utilization management and adherence support. Account benefit design provides member cost share and copay assistance. When processing claim requests, prior authorization assistance and full claim analysis for the benefit of cost effectiveness is provided.
Formulary Management Options
We offer formulary management options whereby the decision to exclude a subset of drugs is your decision, not ours.
Customize, or choose one of our curated programs designed to maximize your savings. You dictate how the program is built based upon your unique needs and pay only for what you need. Welome
Embedded Legal
The Phia Group
Your health plan has an embedded legal resource to ensure your plan is set up properly and furthermore functions the way you intend as the plan sponsor. Our health plans are customizable to a degree and while we have built specific provisions into the programs to ensure compliance, you may or may not want to cover specific things within your program, like injuries resulting from illegal acts, professional motor racing accident treatment, minor covered dependent childbirth, etc. We put you in control, first, and then structure the plan with support to last the lifetime of your program.
Mobile App: Included
Delivering Convenience and Access
Each health plan partner is synced up with a mobile app, meaning all your groups receive the convenience of a mobile app that houses telemedicine, deductible integration, a healthcare concierge, pharmacy support, benefit information, and much more.
Healthcare Concierge: Included
Is healthcare potentially expensive, confusing, and yet extremely important? Of course it is all 3, so we build in a Healthcare Concierge to help you manage your conditions and healthcare journey. They can direct you to the best facilities and providers not only to save you money, but to ensure the highest level of care.