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UK Health Benefits Task ForceUK Health Benefits Task Force
October 24, 2001October 24, 2001
Agenda
CHA Health Profile
Current Relationship
Future Relationship
Questions & Answers
CHA Health Profile
Profile Roots began back in 1991 when a group of rural
healthcare providers in Eastern Kentucky approached UK Hospital about working together to develop an integrated healthcare delivery system
Network was known as CHA Provider Network
1995, CHA Health was created and licensed as an HMO by the Commonwealth of KY to offer fully insured health benefits to employers
CHA Health also maintains a Third Party Administrator (TPA) License for self funded administrative services
Profile
CHA Ownership– University of Kentucky Hospital 84.7%– Appalachian Regional Hospitals 9.6%– St. Luke Hospitals 3.4%– Our Lady of Bellefonte Hospital 0.9%– Pattie A. Clay Hospital 0.7%– Gateway Regional Health 0.4%– Rockcastle Hospital 0.3%
Profile Executive team and structure
Chief ExecutiveOfficer
Mark D. Birdwhistell
Chief FinancialOfficer
Dale Fisher
DirectorInternal AuditKen Taylor
Director Govt. Relationsand Legal AffairsShawn Crouch
Director of Corp. &Plan Development
Matt Sanger
Executive AssistantSharon Scales
Accounting
Chief OperatingOfficer
Brent Barber
Chief HealthServices OfficerTim Costich MD
Chief MarketingOfficer
Mark Lamberth
Claims
Member Services
Compliance/Appeals
Information Services
Medical Management
Quality Improvement
Pharmacy
Sales
Provider Relations
Marketing & Communications
Director of Human Resources
Kim Nesbitt
Premium BillingLegal Affairs
Financial Analysis
Account Services
Network Development
CredentialingUnderwriting
Profile
Mission Statement– Improve health and healthcare by providing value
and exceptional services
Vision Statement– CHA Health is the trusted leader serving the
community by making healthy living easier
Profile
CHA Network
Profile
347
2,410
1,214
472205
1,191
7,111
581686
6,025
343145
592
1,404
550
2,690
123178
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Total - AllRegions
CHA
Target
Kentucky Regions
Network Strength
Profile Total Membership
– 147,600
120,000
130,000
140,000
150,000
Mem
ber
s
Sep-00
Oct-00
Nov-00
Dec-00
Jan-01
Feb-01
Mar-01
Apr-01
May-01
Jun-01
Jul-01 Aug-01
Sep-01
Profile Member Satisfaction
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Ove
rall
Rat
ing
2001 CHA Health
Quality Compass Average (NCQA)
Health Plan Overall
Claims Processing
Customer Service
Profile
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ove
rall
Rat
ing
2001 CHA Health
Quality Compass Average (NCQA)
Getting Care
Quickly
Courteous and Helpful Office
Staff
Overall HealthCare
Provided
Specialist Care Overall
Personal Doctor Overall
Profile HEDIS Results
Cardiac Quality of Care Improvements
MeasureCHA2000
Threshhold2000
CHA2001
Threshhold2001
Beta Blocker Treatment After Heart Attack 80.65% 25-50% 98.67% > 90%
Cholesterol Mgmt. After Cardiovascular Event (LDL-CScreening)
64.16% 25-50% 80.42% 75-90%
Cholesterol Mgmt. After Cardiovascular Event (LDL-CControl)
33.53% 10-25% 61.54% 75-90%
Controlling High Blood Pressure 35.52% 10-25% 64.48% > 90%
Interventions: Cardiac Disease Management (DM) Program DM Program Education to all PCPs One-on-one communication with PCP (RE: specific DM program member outcomes)
Targeted Preventive Quality of Care Improvements
MeasureCHA2000
Threshhold2000
CHA2001
Threshhold2001
Breast Cancer Screening 72.67% 25-50% 75.66% 50-75%Cervical Cancer Screening (CM) 66.91% 10-25% 78.27% 75-90%Eye Exam 36.25% 25-50% 41.85% 25-50%
Profile
$0
$5
$10
$15
$20
$25
$30
Net
wor
th in
Mill
ions
1998 1999 2000 Aug-01
Regulatory Requirements Net Worth
Statutory Net Worth
Profile Received B++ Financial Rating from A.M. Best
– B++ is considered “very good”– Plans with B+ or higher are considered “secure”
Plans have a strong or good ability to meet their long-term obligations to members
Maintain a level of financial strength that can withstand unfavorable changes in the business, economic or regulatory environment
– Heavy emphasis is placed on financial rating by Consultants and Brokers
– “…rating formally ratifies the significant improvements that have taken place…”
Current Relationship
Current RelationshipUniversity of Kentucky
(Self Funded Employer)*Maintains Risk
UK Health Care Plans
PPO Plan UKHMO
Humana CHA Health Subcontracted Services
Subcontractors
Current Relationship
UKHMO has had a contract with CHA Health to provide certain Administrative Services for UKHMO Lexington Service Area (LSA) and Regional Service Area (RSA) members since July 1997
Obligations are different between LSA and RSA
Current Relationship
LSA RSA
Current Relationship LSA
Services Performed
UK HMO CHA Health
1. Payment settlement of all claims, 1. ID card production and COC
excluding OOA emergency and DME distribution
2. Member Services 2. Access to PBM
3. Utilization Management 3. Network Access and Provider
4. Financial Accounting Directory development/distribution
5. Benefit Administration 4. Utilization Management for OOA
6. Formulary Management and emergencies and DME claims
PBM Interface 5. Membership eligibility and
7. Service Area determination reconciliation
8. Member Appeals
Current Relationship RSA
Services Performed
UK HMO CHA Health
1. Financial Accounting 1. Payment settlement of all claims
2. Benefit Administration/Determination 2. Preparation of financial statements
3. Formulary Management and 3. All Utilization Management
PBM Interface 4. Coordination of appeals process
4. Service Area Selection 5. Member Services
6. ID card production and COC distribution
7. Access to PBM
8. Network Access and Provider Directory development/distribution
9. Reporting
10. eHealthConnectsm
access
11. Membership eligibility/ reconciliation
Profile UKHMO’s relationship allows for access to technology and
reporting capabilities that require economies of scale1. eHealthConnectsm
– CHA Health’s online service for members and providers that allows them to access key information
Members
– Order replacement ID card– View claims status– Verify member eligibility– Change PCP– View member benefit
information
– Available 24 hours a day, seven days a week
Providers– View claim status and
authorizations
– Verify member eligibility
– PCP access to patient list
– View patient benefit information
2. CHA Health’s Reporting Module– Allows for real-time ad hoc reporting
Profile
UK HMO has access to all these services at competitive marketplace pricing
Future Relationship
Future Relationship Today, UK Health Care Plans has 13,729
employees participating with its Plan– 98% reside in the Commonwealth of Kentucky
CHA Health is well positioned as a locally owned Managed Care Organization to meet the needs of UK Health Care Plans– In addition to the UKHMO RSA, CHA Health
Provider Network could accommodate a PPO product that would cover 96% of the UK employees
Future Relationship Distribution of UK employees by county
– 96% reside in CHA Health service area
Warren
Logan
Hickman
Carlisle
Ballard
Graves
McCracken
Calloway
Marshall
Livingston
Lyon
Trigg
Crittenden
Caldwell
Christian
Todd
Hopkins Muhlen- burg
Union
Webster
Henderson
McLeanOhio
Daviess
Grayson
Hancock
Brecken- ridge
Hardin
Meade
Larue Marion
Bullitt
Nelson Wash-ington
Spencer
Shelby
Oldham Henry
Trimble
Carroll
Butler
Simpson Allen Monroe
Edmon- son
Barren
Hart
Met-calfe
Adair
Taylor
Russell
Wayne
Casey
WhitleyBell
Knox
Lincoln Rock- castle
Clay Leslie
Boyle
Jackson
Garrard
Mercer
PerryKnott
Pike
Harlan
Letcher
Laurel
Owsley
Lee
Estill
Breathitt
Floyd
WolfePowell M
agoffin
Madison
Cumber- land
Jefferson
Pulaski
McCreary
Green
Clinton
Martin
John- son
Morgan
Menife
eClark
Montgom
ery
Lawrence
Greenup
Elliott
Carter
Lewis
Rowan
Fleming
Bath
Nicholas Bourbon
Mason
Bracken
Harrison
Pendleton
Scott
Fayette
Jessa-mine
Owen
Grant
Frank- lin
Wood- ford
Anderson
Gallatin
Boone Kenton
Campbell
Robertson
86
65
8,723
4
4
2
4107
20
9
22
12
3
10
951
16
3
5
6
10
8119
15
9
5
12
466
78
4
7
11
6
14
6
5
6
3
4 2
3
4
2
4
4 20
6
157
12
23
16
9
7
22 96
19
773
129
41
17
24
10
2
79
13
304
81
57
5
19
641
66
226
253
17
62
26
20
11
6 4
13
9
8
86
36 8
5292
24
853
2710
12
2
3
21
3
24 210
2 45
17184
99
13
4
13
4
12
3
76
166
12
20
Fulton
Boyd
Future Relationship
Partnership
Questions & Answers
YOUR KIND OF PEOPLE.YOUR KIND OF CARE.