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When Michael Ritacco, superintendent of schools for Toms River Regional Schools, in Toms River, N.J., began looking at health insurance renewals last year, he was discouraged. The school district was facing double-digit premium increases of approximately 15 percent. It was becoming increasingly difficult to continue offering employees the same level of benefits at a reasonable cost, and the idea of leaving their "traditional" health insurance provider was daunting.

"In the past 20 years, we have changed healthcare carriers twice," says Ritacco. "We were originally with the Blues--Blue Cross and Blue Shield--then we switched to CIGNA for nine years and later returned to the Blues for another 10 years. Unfortunately, with the way the economy is today, we realized that we needed another alternative to fit our budget constraints and keep employees within the same level of healthcare benefits."

"Public and private sector employers have grown increasingly frustrated with the rising costs of health premiums, lack of transparency with regard to claim data and limited focus on early care to promote wellness," says Douglas Forrester, president of Integrity Health. "The main goal of a health insurance plan should be to keep people healthy in the workplace. Rather than limiting access to healthcare providers in order to control costs, employers need to arm employees with information--detailed knowledge about their healthcare options, coverage and claims, and access to early care to promote wellness. The more information you give people, the more transparency you can bring to the process, which results in better outcomes."

VIIAD has contractual relationships with a broad network of local and regional providers around the country which, when used together, creates a "quilt" of county, regional and/or provider-owned networks that gives plan members access to national coverage, while achieving superior discounts. In addition, VIIAD uses state-of-the-art technology to ensure that patients see the appropriate provider, pay the appropriate copay and understand their healthcare benefits.

Integrity Health used VIIAD's technology to customize a network of providers for the school district and provides employees with instant access to all of their medical and benefits-related information via an automated Health Ticket. Similar to an airline eTicket, the Health Ticket provides employees with a gateway to their healthcare services. Members go to Integrity's website; input their user ID, password and zip code; select from a list of providers; and print a healthcare ID card. The employee can then print out the Health Ticket and present it to their doctor when they need medical care.

Each printed Health Ticket contains personalized, member-specific information such as copay instructions, preferred labs and pharmacies, remaining deductibles, HSA balances, benefit plan information, directions, and visit instructions. In addition, the Health Ticket clearly states, prior to printing, whether a chosen provider is in or out of network. Members must okay a disclaimer before printing a Health Ticket for an out-of-network provider, which clearly states all member financial responsibilities.

"This technology gives patients, payers and providers access to healthcare information on an on-demand basis," says John Zubak, chairman and CEO of VIIAD, which stands for Virtual Interactive Identification and Direction. "The Health Ticket becomes a virtual insurance card that improves compliance, eliminates fraud, provides administrative savings to providers and physicians, and offers simplicity for consumers."

VIIAD customers have reported savings of 5 percent to 15 percent on administrative costs, and 20 percent to 40 percent on claims costs. The Health Ticket eliminates the need to print and mail a new medical ID card every time healthcare contracts change--which can cost between $5 and $10 to mail a single card. In addition, a unique Health Ticket is created for each patient/provider encounter, which verifies identity and member eligibility prior to service delivery, which greatly reduces fraud. Members' benefits are described right on the Health Ticket, which also makes it impossible to accidentally go out-of-network for healthcare services.

"The Health Ticket brings transparency to health benefits," says Zubak. "Any questions members may have are answered on the Health Ticket, including an explanation of benefits and provider information, leading to less confusion and greater ease of use."

While Toms River Regional Schools has only been using the new benefits program since July, Ritacco is already reporting positive results. "This program has given us an opportunity to keep our healthcare budget under control, while providing employees with the same level of benefits and confidence in their healthcare program that they have come to expect," he says. "Employee feedback has been positive, and our daily administrative workload has been greatly reduced. In addition, we've been able to promote early care and wellness within our working family and have improved employee communication and understanding with regard to their health insurance benefits."

"It's a win-win situation for all involved," says Harvey Mitgang, VIIAD's president. "Plan members have access to a broad network of providers. Clear, consistent communication between members and providers becomes the norm. Administrative costs are reduced for payers and providers. And fraud and noncompliance are eliminated. Everyone benefits."

(The above piece is part of our continuing Insights series designed to highlight key products and services to our readers. This paid-for Insights was written and edited by Risk & Insurance® on behalf of our marketing partner. Additional Insights can be found on our Web site at www.riskandinsurance.com/.)

October 29, 2008

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