Zelis Healthcare. Cypress Benefit Administrators April 11, Copyright 2017 Zelis Healthcare. All Rights Reserved 1

Transcription

1 Zelis Healthcare Cypress Benefit Administrators April 11,

2 Agenda Who is Zelis Healthcare? Zelis Solutions Complex Cost Management Claims Lifecycle Travel Network Access Case Studies Performance Overview 2

3 Zelis Vision Be the leading healthcare information technology company driving efficiency and effectiveness by delivering superior healthcare claim solutions to payers, providers, and individuals from prepayment through payment. Network Solutions Claims Integrity Payments 3

4 Zelis at a Glance 4

5 Networks Partnerships with specialty, regional and national leading PPOs give our clients access to extensive networks. We deliver local and proprietary group health, dental and workers compensation networks in every state. 5

6 Why Clients Choose Us SERVICE PERFORMANCE PRODUCTS INTEGRATION Our client-first focus drives industry-leading client loyalty We generate maximum savings from every claim and deliver efficient, timely payments We deliver integrated and modular cost management and payment solutions across the claims lifecycle We combine leading-edge technology, analytics, clinical expertise and adjudication systems integration to deliver superior savings Better Service + Better Performance = The Z Factor 6

7 Complex Cost Management Vendor Landscape 7

8 Zelis Simplifies Management of the Claims Lifecycle Our integrated platform driven by leading-edge technology and analytics delivers better coordination and greater efficiency when managing multiple vendors. NETWORK SOLUTIONS Provides Discounts and Access to Networks CLAIMS INTEGRITY Ensures Appropriate Reimbursement for Care PAYMENTS Enables Efficient and Timely Payments and Data 8

9 Zelis Network Solutions 9

10 Experience Zelis Network Solutions Our Strength Our Network Products Our Savings Tools Local Expertise and Relationships National Reach Expert Network Design Primary Specialty Wrap/Travel Orchestrated Routing Data-Driven Results The Zelis experience begins with local expertise and national resources, combined to create custom solutions that deliver value for payers, providers and individuals. 10

11 National & Regional Network Access 11

12 Travel Network Access (National Access) Key mix of local, regional, and national networks Provides members with seamless access to the best networks outside of their primary PPO service area. Pay as you go, Percentage of Savings. Developed to address the most significant concerns of healthcare payors Successful competition against national carriers Seamless national program Deepest discounts and highest hit ratios Real marketing value Expansion of client branding 12

13 Travel Network Access (National Access) Value-add Zelis uses a sophisticated analysis program to identify the network offering with the deepest historical savings and coverage for each market Program Features Private labeled card for your brand Key mix of local and primary networks Single-source steerage regardless of network accessed No prepaid access fees 13

14 Travel Network Access (National Access) FRONT Use your own logo to expand brand awareness Enjoy a unique mix of regional and national networks designed to provide competitive access to providers, no matter where members are located BACK Dial Zelis toll-free customer service for help locating providers in your area View a private-label directory for the network in a selected state to find providers when traveling 14

15 National Access Case Study Case #1: Member Home State: Colorado Primary Network: Cofinity Hospital Stay: Providence Alaska Medical for 3 days generating a $116,187 claim National Access Network: First Choice Health Network Discount: 52% discount, resulting in over $60,000 in savings. Case #2: Member Home State: Wyoming Primary Network: First Choice of the MidWest Hospital Stay: Presbyterian/St. Luke's Medical Center in Denver, CO for 32 days generating a $425,735 claim National Access Network: Cofinity Discount: 43% discount, resulting in over $183,000 in savings. 15

16 National Access Case Study Case #3: Member Home State: Florida Primary Network: PHCS Hospital Stay: University of Colorado Hospital for 18 days for organ transplant generating a $640,441 claim National Access Network: Cofinity Discount: 74% discount, resulting in over $473,000 in savings. Case #4: Member Home State: Florida Primary Network: HealthSmart Hospital Stay: River Oaks Hospital in New Orleans, LA for 49 days generating a $101,675 claim National Access Network: PHCS Healthy Directions Discount: 61% discount, resulting in over $62,000 in savings. 16

17 Network Solutions ( ) Cypress Benefit Administrators Claims Received 201, , ,891 Repriced Claim Count 174, , ,932 Billed Charges $171,789,681 $186,754,357 $209,144,643 Repriced Billed Charges $151,755,498 $161,151,332 $176,436,411 Turnaround Time (days) Gross Savings $38,556,850 $42,659,886 $48,136,600 Hit Ratio Billed Charges 88.34% 86.29% 84.36% Billed Charges by Product Primary $143,478,036 $156,390,168 $171,009,319 National Access $8,277,462 $4,761,164 $5,427,092 Gross Savings by Product Primary $35,848,504 $41,253,424 $46,411,542 National Access $2,708,346 $1,406,462 $1,725,058 Average Discount by Product Primary 24.99% 26.38% 27.14% National Access 32.72% 29.54% 31.79% 17

18 Network Solutions: Discounts by Quarter ( ) Average Discount by Quarter, Product Q Q Q Q Q National Access Avg Disc Primary Avg Disc Q Q Q % 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 18

19 Why Zelis? Extraordinary value created throughout the claims lifecycle, from network through claims management through payments. Our unwavering pledge: to ensure appropriate cost of care and efficient, accurate and timely payment for care. Seamless integration with your existing workflows, from joining our networks to leveraging our Questions? payments solutions. Future-proof solutions that consistently evolve to changes in technology and billing rules and regulations, so you can navigate the future of healthcare with confidence. An extraordinary experience that results in the highest client satisfaction score in the industry. 19