HEALTH BENEFIT PLAN MANAGEMENT SERVICES
Alliance Partners offers employers unmatched expertise in developing customized and innovative plan designs to keep benefit coverage affordable while meeting employees’ need for the highest quality healthcare. Understanding and managing the intricacies of health benefits gives management invaluable insights into effective plan design and access to resources to optimize the healthcare benefit for your employees and their families.
A Dedicated Staff with an On-site Medical Director Back to top
Being locally based, Alliance Partners’ staff becomes very familiar with the provider network and each client’s benefit plan, enabling them to coordinate care more effectively. Our dedicated Customer Service Team works closely with an on-site Medical Director and nursing staff to ensure that authorizations and case-by-case management occur promptly and cohesively across the system.
Accurate Claims Processing and Responsive Personal Service Back to top
Alliance Partners’ fully automated claims system produces processing accuracy and speed that are setting the pace for the industry. Our team of professional customer service representatives’ outstanding service record speaks for itself:
• A 98+ percent accuracy rate
• Processing time of less than 10 days
• Reporting and analysis of cost drivers
• More than 95 percent of all calls answered in less than 30 seconds
• Less than 1 percent call abandonment rate
Early Risk Identification and Intervention Back to top
Alliance Partners utilizes very effective diagnostic tools to assist with early identification to facilitate interventions that target cost-drivers in your plan and health risks for your members.
Preauthorization - Targeted Services and Medications Back to top
Alliance Partners believes that the best medical utilization management begins with benefit design and focuses attention on services that are driven by benefit criteria. Alliance Partners also concentrates on certain prescription drugs to ensure the most appropriate drug utilization. To make certain our clients and their associates medical reviews are based on objective clinical evaluation, Alliance Partners involves committees of physicians to review and establish criteria for specific high-cost procedures and new technology.
Utilization Review Back to top
Alliance Partners centers its reviews on high-cost, inpatient cases, readmissions and complications. Alliance Partners has integrated its medical management software with the Health Alliance system to allow direct access to member’s medical information when they are staying at any of the Health Alliance hospitals. This collaboration greatly increases the speed and efficiency that information is exchanged, facilitating better management of inpatient stays. Alliance Partners also reviews selected Emergency Room visits, so members can be educated on the appropriate use of emergency services and learn that there are often better alternatives, such as primary care.
Case Management / Care Coordination Back to top
Alliance Partners handles case management on an individual basis to ensure members receive access to the most appropriate level of care. The case manager arranges for the necessary resources and support needed in a timely manner; which includes acute-care hospitalizations, rehabilitation and transition to outpatient care.
Disease Management Back to top
Through interventions that measure and support the treatment necessary for effective disease control, Alliance Partners proactively manages patients with chronic disease. It has developed an extensive program for diabetics that tracks and supports treatment to improve patients’ health. Other similar programs have been created to meet the needs of its members.
An Online Health Risk Assessment Including Personalized Follow-up and Wellness Integration Back to top
Alliance Partners’ Wellness Program begins with a member participating in a health assessment survey. The Online Health Risk Assessment includes biometric data that provides a health status report, recommendations to the member and aggregate health status reports to the employer. The medical management team utilizes this information to help with early intervention and to recommend coaching where indicated.
Quality Management Back to top
Alliance Partners continuously strives to improve its members’ compliance using evidence-based medical initiatives derived from specific disease reporting and measurements. To ensure members receive the highest quality care from its providers, Alliance Partners also tracks complaints and reviews certain outcomes.
Health Education and Targeted Communications Back to top
Alliance Partners’ member web portal offers access to an extensive health knowledge resource. This knowledge resource is used in conjunction with the member’s medical claims history to pinpoint information regarding procedures, diagnoses and medications that provide insight into their individual situation.
Expansive Wellness Information Helps Members Improve Health Back to top
Alliance Partners provides online access to expansive wellness information, tracking tools and coaching to aid members in achieving their goals and improving their health. For easy access, the wellness tools are integrated into the Alliance Partners’ member web portal.
Work-site Preventative Services Back to top
Alliance Partners has the capability to provide on-site health screenings that include a Health Risk Assessment (Paper & Pencil Version) and biometric (cholesterol and sugar) screening to provide the member with a health-status report and health coaching. Other work-site interventions can be provided such as flu shots, mammograms and much more depending on the needs of the client.
Custom Programs and Incentives Back to top
Comprehensive wellness programs can be tailored to meet the individual needs of an employer. Alliance Partners can develop a plan containing incentives that will encourage members to actively participate in their own health management.
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