Nevertheless, if it wanted to keep its client happy, explains Ryan Bohy, chief administrative officer for Sanford Health Plan, his company needed to find an effective, innovative way to deliver coverage for that relatively small, but important, employee population in Connecticut, New York and New Jersey.
Sanford found that solution with VIIAD Systems' Health Ticket, an electronic alternative to the traditional health insurance identification card. VIIAD's patent-pending Health Ticket technology allows Sanford members to log on to a secure Internet site, find a provider and print out a single page that details their health benefits and clearly lists the co-payments and deductibles for which they are responsible. The site also lets Sanford plan members know when they are seeking care from a provider outside the Sanford provider network, and how that affects financial obligations.
A physician-directed, non-profit health plan, Sanford offers insurance for employer groups (fully insured and self-funded), individuals and families, and Medicare recipients. It offers HMO, PPO and consumer-driven plans, with both health savings accounts (HSA) and high-deductible plans, as well as health reimbursement accounts (HRA). Finally, Sanford offers dental and vision plans, as well as flexible benefit accounts (both premium conversion and flexible spending accounts).
According to Bohy, when Sanford agreed in 2008 to provide coverage to that east coast population (for a January 1, 2009 starting date), it knew it might need something it had never tried before.
"We really are a regional health plan, so when we picked up a group on the East coast, we realized how complex it could be, with a lot of network options and people crossing borders to use providers," Bohy says. "We needed to learn how to best handle a messy situation."
Sanford had already known about VIIAD and the firm's ability to specify networks for individual needs, so a dialogue between Sanford and VIIAD, which is based in Bucks County, PA, outside of Philadelphia, took place.
"As we started to talk, we realized that not only did VIIAD offer a solution, but a very innovative solution as well," Bohy says. "There was not a lot of work on our end, and our members have access to all these different networks. With VIIAD Health Ticket solution, it's a much easier process than dealing with a tangle of local networks.
"When we out to bid for national network needs, VIIAD came back to us with different approach and it intrigued us," Bohy adds. "Their response time and willingness and to be flexible has continued throughout the relationship, so it was more than just a good first impression."
VIIAD CEO John Zubak describes Health Ticket as a combination of ATM card and the electronic boarding pass an airline customer can now print at home. Using Health Ticket technology, Sanford plan members can log onto a secure website, find a provider within the Sanford network, and print out a single page that details their health benefits and clearly lists the co-payments and deductibles they must pay.
According to Zubak, the site also lets Sanford plan members know when they are seeking care from a provider outside their plan's provider network and how that would affect financial obligations.
"Sanford's situation on the East coast is fairly complex, even though there are not that many covered lives. So it can be difficult for members to understand what their coverage is," Zubak explains. For example, a Sanford member might be in a doctor's office and get asked what lab they have to go to for approved care, and they might not know.
Health Ticket makes that data and much more available to Sanford plan members, as well as medical care providers.
April Stiles, VIIAD's chief operating officer, says Health Ticket also lets providers process claims more efficiently, and helps payers like Sanford navigate the myriad networks established to ensure they are getting the best managed care discounts for their clients. Health Ticket also removes fraud (works only with current members), controls out of network claims, and ensures compliance with state mandates regarding ID and payment.
VIIAD's customers include health insurers, third-party health plan administrators and employers, particularly those who self-fund health benefits. VIIAD launched its electronic health ticket in late 2007. Since then, it has added vision, dental and pharmaceutical benefits to the Health Ticket print out. Most recently, it has expanded into the workers' compensation arena and has created a Health Ticket product to explain medical coverage to people injured on the job. We're providing transparency that's never been available before in both group healthcare and workers' compensation," Stiles says,
"Health Ticket benefits all three facets--patients, providers, payers--of the healthcare system," says Stiles, noting that by year's end, VIIAD expects 10 million people with access to electronic Health Tickets. "It is a very simple, but elegant, solution."
She won't get any argument from Bohy.
"We obviously needed to find a way to secure the entire group, and we even brought this particular employer in to talk to VIIAD," he says. "It is a real value add for us; VIIAD's solution closed the deal for us.
"Since we have started using Health Ticket with this population, we can see it works wonderfully," he adds. "It's an innovative approach, almost making the traditional healthcare ID card a dinosaur. We can turn on a dime, VIIAD can make the changes, and our members can print out the Health Ticket. The process provides a lot more information than an ID card."
On the technology and implementation side of the house, VIIAD implemented the Health Ticket platform in an amazing 30 days.
"They were on time, right on the money," Bohy says. "We never looked back."
VIIAD's solution is a hosted application, housed on and distributed via VIIAD servers, which helps keep IT costs to a minimum for Sanford and other VIIAD customers. Being a Web-based product means neither providers nor insurers have to buy new technology. In fact, using Health Ticket can reduce administrative/call center costs by 10 percent to 25 percent--largely by minimizing confusion over benefits and claims that can generate multiple phone calls and letters to correct.
"We quickly realized it was the only solution available to us, so if it didn't work, we would be out of luck," Bohy says. "But that didn't come close to happening. We are very happy with VIIAD and the Health Ticket."
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/.)
August 26, 2009
Copyright 2009© LRP Publications