Authoritative Information for Self-insured Employers, MEWAs, Labor Unions and Association Health Plans
Services for Self-insured Employers
The Center for Health Tourism Strategy has worked with a number of employer-sponsored Center of Excellence programs for employee and dependent health benefits.
Following the completion of the preliminary research to understand the needs of the covered population, past claims, lasered claims, and predictive modeling output reports, we narrow down the list of options based on our clients' preferences and savings opportunities. Experience teaches us that a narrow list of covered procedures and conditions is best for a pilot program. Through the pilot program, we help design the benefit and documentation, wrap coverage, candidate provider selection criteria, model contract and delegated credentialing documents, inspection criteria, and prepare a short list of candidate suppliers. We accompany you to the candidate health facilities to meet the executive team, relevant medical staff, and examine the destination hotels, ground services and other suppliers for the program. We discuss the contract terms, rates, and other specifics as your advocate.
In light of fiduciary responsibilities under ERISA, we generally encourage a pilot program with contracted, turnkey case management and logistics for HIPAA compliance and contracted outcomes assessment and measurement. We also attempt to mitigate fiduciary liability by kickstarting a narrow program at a minimum of three Centers of Excellence or destination providers to afford plan participants the options to choose where they would like to travel for treatment.
Medical Travel Options for Union Health & Welfare Benefit Programs
Similar to our work for self-insured employers, Center for Health Tourism Strategy experts are frequently retained by union health and welfare benefit plan managers to help develop and organize medical and dental travel benefits for union members and covered dependents. We are deeply familiar with ERISA, Taft Hartley, MEWA and Association Health Plan regulations and plan participant benefit satisfaction issues.
Following the completion of the preliminary research to understand the needs of the covered population, past claims, lasered claims, and predictive modeling output reports, we narrow down the list of options based on our clients' preferences and savings opportunities. Experience teaches us that a narrow list of covered procedures and conditions is best for a pilot program. Through the pilot program, we help design the benefit and documentation, wrap coverage, candidate provider selection criteria, model contract and delegated credentialing documents, inspection criteria, and prepare a short list of candidate suppliers. We accompany you to the candidate health facilities to meet the executive team, relevant medical staff, and examine the destination hotels, ground services and other suppliers for the program. We discuss the contract terms, rates, and other specifics as your advocate. We then help you develop your pilot program with contracted, turnkey case management and logistics for HIPAA compliance and contracted outcomes assessment and measurement. For union health benefit plans across America we generally limit candidate providers to those located within the USA.
Services for Freelance Workers
Freelance workers make up one-third of the U.S. workforce - a figure that may rise to 50% in the next year, according to some forecasts. Many gig workers and part-time employees do not have access to benefits through their employers. The Bureau of Labor Statistics also estimated that around 10.6 million workers cite contract work as their primary source of income, but who also lack access to traditional benefits. As of 2018, the BLS reported 128.5 million full-time and 27.2 million part-time workers are in the U.S.
Portable benefits may be a solution to this problem and could be a growing option for the nontraditional employee. The Center for Health Tourism Strategy's experts work with TPAs and AHPs to provide access to select health travel providers and destinations around the USA and abroad.
Under new regulations established under Association Health Plans and MEWAs, portable health benefits provide various solutions and share three attributes:
- They’re portable – individuals can take form job to job as they’re connected to individual, not the employer.
- They’re prorated – meaning contributions to benefits funds can be made on the basis of hours worked or other productive units (such as per trip if it’s a ride-share program) and multiple employers can support these benefits at the same time or over time.
- They’re universal – available to workers regardless of the work arrangement.
Our experts don't refer individuals for care and medical travel unless you know them personally and they make a casual recommendation to a provider or destination well-known to them. For health travel patient referrals, we work with employers, unions, TPAs and other group health network organizers in a B2B engagement to develop their program, documentation and operational framework for extra-contractual network arrangements under a group health benefit plan.
How We Work
Although price is the driver of higher and lower healthcare costs in most geographies, utilization is the determinant in overall healthcare costs.
Many employers ask their TPAs and ASOs "why" their costs are what they are and get little more than a few pretty charts and infographics back that have data about their healthcare spend but it is neither informative, nor actionable. Do you need an unbiased independent opinion from a consultant that's not there to sell you a different TPA or ASO and has no commission or other financial interest in what you decide to do?
Initial analysis: (flat fee one-time consultation)
Let us review the data you've received. We'll look at what they supplied, ask deeper probing questions about your active and retired plan participant utilization, provider rates, quality and value, their recommendations for cost containment using their solutions, and then show you some options outside their offer. We'll see if we come to the same conclusions and recommendations as your broker or TPA sales rep. We'll help you formulate deeper, more detailed information. If they cannot or will not share the data at the level you ask for, perhaps you should find a solutions provider that will. Let's get the data and formulate the right questions so you can make better decisions before you go shopping. If your current solutions provider can answer those questions to your satisfaction (and ours, as your behind the scenes coach) stay with them and carry on.
Other options to consider:
Let's see if we can come up with some "extra-contractual" solutions such as direct-with-local-provider contracting for certain high-cost, heavily-utilized services. After all, you live and work in the same community. We'll accompany you to a meeting with your local health facility executives and specialists to offer them a chance to sharpen their pencils. But if they won't, we'll fly over the top of them or drive right past them for select high-cost procedures utilized by your unique employee and retiree population. Sometimes, the solution is to leave the majority of your routine health access the way they it is, with no change in TPA or ASO but create a narrow network of 3-4 specialized healthcare facilities and surgeons eager to deliver high-value, excellent quality, and lower prices in a cost containment pilot program with a minimum utilization threshold of fewer than 10 high-cost surgical cases per year.
Our only loyalty is to you, our client.
Our consultants work on a prepaid, retained-hourly basis under contract for a specific scope of work and deliverable. We don't interfere in or automatically try to switch you away from your current broker, agent or TPA/ASO. Our value proposition actually works to squeeze more out of what you pay them to do for you. If this sounds intriguing to you, let's chat. The initial introductory call is complimentary.
Please call us to learn more. +1 (800) 727.4160.
