Annual Report 2010
25 Years of Service to the Community
Contents
from the president 1 members 2 quality 6 technology 8 physicians & hospitals 10 market growth 12 employees 18 community 20
Dear Commu nity Member :
Twenty-five years ago, AultCare was founded on
the notion of creating a cost-efficient competitor to national insurance carriers. Focus-group participants told us that they just wanted their insurance company to charge them fair rates, answer the phone when they called, and pay claims accurately and quickly. So that’s what we’ve aimed for. The communities we serve have benefited from this price competition in the form of some of the lowest prices in the nation. In kind, you have supported us with appreciation for our efforts. AultCare’s goal of customer satisfaction pushes us for continuous quality improvement. This year, it resulted in AultCare’s HMO being recognized as the top-ranked health plan in the state of Ohio and one of the top 50 plans in the nation!* In addition to our Top Health Plan ranking, we now have NCQA accreditation across all product lines: PPO, HMO and Medicare Advantage. The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. So you can rest assured that you’re receiving benefits from a health plan that is being measured against the nation’s health care best practices. Our network physicians and hospitals have played a key role in this process as they are the ones providing our members with quick access to excellent clinical care.
a Reform Team in early spring last year. This enabled us to research, interpret and implement reform timely. We are still on the front lines of reform and will continue to keep you up-to-date about these provisions. Overall, 2010 was one of our best years at AultCare. We strengthened our financial standing with the Ohio Department of Insurance and maintained our B++ rating with AM Best. We had a great sales year, and client retention remained strong. Our renewals were issued at less-than-industry averages. We reduced staff through natural attrition to keep our administrative costs low for you. In summary, we’re looking forward to another great year here at AultCare. Thank you, for again placing your trust in us and allowing us to care for you and your employees. Please take a look inside this report for more information about our 2010 anniversary year and our commitment to you and our community. * NCQA’s Health Insurance Plan Rankings 2010-11-Private
Rick L. Haines President and Chief Executive Officer
In 2010, health care reform legislation gave us one of the greatest challenges in decades; and many of the law’s specifics remain outstanding. We formed FROM T HE PRESIDENT
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Help Me Get the Care I Need Members AultCare Wellness The goal of AultCare’s wellness team is to help you improve your health. In 2010, we continued our work to educate members – and the community – about healthy behaviors. We’ve seen a great increase in participation and some wonderful health results due to the AultCare Wellness Program. The per-member per-month medical cost of claims for wellness clients has decreased by 2.93% since 2008. In 2010, AultCare’s wellness team members took their skills into the community with 70 health fairs. They also staffed three community events: the Walsh University Health and Wellness Fair, Riverview School’s Black Bear Festival and the Lauren International Run, Walk or Bike Day. We also hosted a health and wellness day at Westfield Mall where we took blood pressures, weights, BMIs and shared healthy living information with the public to Lead Our Community to Improved Health.
AultCare’s dietitian – Suzanne Kim – adds a niche to our disease management team at AultCare. She provides person-to-person nutrition counseling to members by telephone. Any AultCare, PrimeTime or Aultra member can call and discuss their nutrition concerns with Suzanne for free – regardless of whether your health plan covers medical nutrition therapy. The most popular nutrition concerns tend to be weight, blood pressure, cholesterol and celiac disease. However, as long as your concern is nutrition related, Suzanne is happy to discuss it with you.
Our wellness team continues to look for ways to improve wellness initiatives. Going forward, we are pleased to report that in 2011, the blood draws at AultCare Health Screenings will be done by a simple finger stick rather than a venous blood draw. This will be a benefit to you because it’s less invasive and because you will receive immediate blood work results.
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AultCare strives to do what’s best for our members, providers and companies by exceeding their expectations, specifically through our personal customer service. Our staff is made up of very talented people who are unselfish with their time – giving and volunteering within our community, going beyond what is expected. I am very proud that I can say I have worked for AultCare for the last 20 years.
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Patty Gang, Insured Product Claims and Customer Service Manager, 20 Years of Service
Those immediate results can be used by the AultCare wellness team to educate you about what your results indicate and how those results can be improved. The Disease Management Team publishes biannual health booklets for a number of different health concerns that you may have. The topics include Chronic Obstructive Pulmonary Disease, Heart Failure, Hypertension, Cholesterol, Diabetes and Mental Health. They can be accessed at www.aultcare.com or www.PrimetimeHealthPlan.com. Just click on “My Wellness,” and select your topic of interest. If you prefer, a booklet can be mailed directly to you by calling us at 330-363-3282.
Helping Members With Information The future of health care is demonstrated in our ongoing transparency initiative. As the individual coverage mandates play out under health care reform, health plan and claims information may become more important to patients. And for members with high-deductible health plans, the cost of claims has been more visible and impactful to their wallets. You can call AultCare to find out what your network out-of-pocket costs will be for any procedure eligible under your health plan. Having that information will help members with planning for the price, timing and place of a procedure. We’re proud that we reside in one of the lowest-cost health care regions in the country.
Throughout 2010, AultCare processed 1.81 million claims with 99.6 percent accuracy and answered 271,363 phone calls from members and providers.
MEMBER S
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Bee Healthy Race In July 2010, Aultman and AultCare hosted our first Bee Healthy Ohio Subway Challenge Series Race – a new opportunity for our community to come together in fitness. The race included a Kids’ Fun Run, a 2- and 5-mile run, and a 2-mile walk. It was a hot day filled with 450 participants of all ages. Mark your calendar for the July 16, 2011 race. We look forward to your participation!
“The doctor looked over my results, which indicated I had high blood pressure – and my cholesterol was a little out of whack,” Mike shared. “He also said my PSA was in a ‘gray zone’ and that I should see a specialist.” Mike started taking medication for high blood pressure. He also made an appointment with a urologist regarding the elevated PSA number, which is a common indicator of prostate cancer. “After a second PSA test came back higher than the one I had at the wellness fair, I had a prostate biopsy,” Mike said. “When Pat and I met with the urologist to get the biopsy results, he said the words we weren’t really ready to hear: ‘You have cancer.’” The timing for Mike’s initial Bee Healthy Wellness Fair screening couldn’t have been more perfect. Mike was eligible for the PSA screening because he had just turned 50 years old. “I turned 50 in June 2008, and the blood test was the next month,” he explained. Pat and Mike met with a radiation oncologist and a surgeon to determine the best treatment method. Ultimately, Mike decided on surgery.
Bee Healthy Screenings Save Lives Mike Franzen rarely visited his primary care doctor. But thanks to the Bee Healthy program, he learned of a serious health problem and got the medical care he needed. Mike’s wife, Pat, works in the Aultman Medical Education Department. In July 2008, she made plans to attend a Bee Healthy Wellness Fair. Mike decided to go with her. Upon receiving their test results from the wellness fair, the next step was to have a physical at the family doctor.
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After the surgery, the pathology report of the prostate showed the cancer was aggressive – and there was also a microscopic breakthrough. Mike and Pat met with the surgeon, urologist and radiation oncologist. After testing, the cancer cells were located – and it was time for radiation. “I went through eight weeks of radiation treatment to ‘clean up the crumbs,’” Mike said. We wish Mike many more years of good health and clear tests in the future.
Health Care Reform The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 and created a multitude of changes that AultCare has implemented for its clients – with more to come. AultCare established a Reform Team, which is comprised of individuals with varying disciplines from within the organization. By utilizing the team approach and further breaking the team into three smaller subcommittees – Communication, Compliance and Strategic – we are able to focus on the regulations that are being released by the various regulatory agencies pertaining to PPACA and ensure that we are implementing those changes as intended.
The Reform Team offered AultCare clients and brokers an opportunity to hear about the reform changes by hosting a series of events in July 2010. The presentations highlighted the legislation’s immediate impacts such as understanding grandfathering, the role of essential benefits, the impact of annual and lifetime maximums, dependent age changes, pre-existing condition changes and tax credits for small employers. The first events we hosted saw more than 300 attendees representing 160 companies. Our Reform Team was called upon by local media for insight into health reform and how it might impact the community. The expertise of the team was also requested by local chambers of commerce and the broker community to explain these complex changes to their clients. These presentations continue to delve deeper into the legislation and look toward the nearterm impacts (2011-2013), as well as the long-term impacts (2014+) and the effect on AultCare clients. The Reform Team also initiated a communication campaign that reached out to clients, brokers and physicians with pertinent information regarding the immediate impacts of reform. The notifications, letters and e-mails continue to ensure that our stakeholders are made aware of developments as they occur. As an integrated health care delivery organization, AultCare is well- positioned to implement the PPACA changes and ensure our clients are afforded the quality health care coverage that we have been providing for more than 25 years.
MEMBER S
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Help Me Get Well and Stay Well Quality Quality health care is the extent to which you receive the care you need, in a way that best protects or restores your health. Common measures of quality care include having timely access to care, getting appropriate treatment and receiving care that meets nationally established guidelines for clinical effectiveness. Choosing a health plan – and provider – that achieves high marks for quality plays a significant role in healthy outcomes for you and your family.
Quality in All Products All three of AultCare’s health plan products now hold NCQA accreditation. We are immensely proud of this recognition. But what’s really important to us is that our members know we are working diligently to provide them with the best possible health care. To measure our performance against the national quality standards, and to come out with top scores, highlights our commitment to you.
Ohio’s Top-Ranked Health Plan AultCare HMO was recognized as the top-ranked plan in Ohio in NCQA’s Health Insurance Plan Rankings 2010-11-Private. We were also listed as one of the top 50 health insurance plans in the nation! The rankings are based on the voluntary submission of health care quality results, customer satisfaction and scores on NCQA accreditation surveys. These scores measure AultCare’s performance against the industry’s best practices.
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PPO Product
Continuous Quality Improvement
AultCare’s Quality Program monitors performance outcomes, comparison with past performance, internal goals and external benchmark standards for both clinical and non-clinical measures of care for our members. Ensuring you receive necessary services and are satisfied with AultCare and our network of providers is part of our quality plan.
• Monitoring access and availability of practitioners for primary care and behavioral health. • Individualized disease management programs to increase self-care and health management.
In keeping with our commitment to Lead Our Community to Improved Health, the Quality Program continued for members who may have needed preventive screenings or testing completed during 2010. Newly designed reminder cards were sent to members. We also conducted courtesy phone calls to members as a reminder to obtain their annual flu vaccine or to suggest members speak with their health care provider about the preventive testing they may need. Claims submitted by members’ health care providers determine what tests were completed and what tests a member may still need to discuss with their provider based on national practice guidelines. Some of our initiatives to increase satisfaction and performance include: • Website enhancements, making more information available on the Web. • Personalized reminder cards to help members be aware of appropriate screenings and testing.
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“I am proud to be part of the AultCare family and appreciate the level of quality that AultCare provides – both to the communities we serve and to the employees. AultCare has given me so many opportunities over the last 13 years and has exceeded my expectations of a career with the organization. It is a pleasure being employed by a company that truly makes it “a great place to work!”
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Ranada Schrock, Pharmacy Analyst, 13 Years of Service QUALI T Y
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Claims Paid Quickly and Accurately Technology Electronic Remittance AultCare doubled, again, its Electronic Remit participation in 2010, from 36 to 80 providers. Nearly 40 percent of payments to providers are now made electronically. The remit program eliminates the need to print paper checks and vouchers by replacing them with electronic payments and remittance advice. It reduces waste, fraud and abuse, and pays your providers faster and more accurately.
Claims System Conversion We are in the midst of a substantial claims system enhancement. The product and functionality are changing little, but the underlying technology is new. This technology positions AultCare for the anticipated analytics required under health care reform. Testing is in process now. The conversion will be completed in mid-2011.
Website A new AultCare website was introduced in 2010. Security and privacy were strengthened to assure safety and security of your claims information. A foundation was built to accommodate the addition of new functions for members, employers and providers. Additional functionality will be rolled out in 2011. You will be pleased with the resulting ease of use.
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I have yet to see an employer like AultCare so caring about the well-being of its community. Even though we are a big company, the environment is similar to that of a family business.
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Raza Fayyaz, IT Development and Support Manager, 4 Years of Service
A Leader for Simplification and Efficiency Health plan administration cost reduction is front and center in health reform. Key to this is administrative simplification, to enable providers and members access to health data quickly and simply. Bob Schleichert, associate vice president at AultCare, was asked to speak in Washington, D.C. to a subcommittee of the National Committee on Vital and Health Statistics about electronic remittance advice and payment. We have always successfully maintained some of the lowest administrative costs in the nation as one of our self-imposed responsibilities to our clients. We continue to leverage our electronic data interchange capabilities to reduce cost.
We remain committed to the adoption of technology to help physicians and hospitals access patient insurance information and history at the time of care to facilitate best practice outcomes. Along with CAQH, AultCare presented “Voluntary & Mandatory Operating Rule Interdependency: Industry Perspective on Transition to a New Operating Rule Environment� to a national audience. Payers and providers from around the country subscribed to this event to plan and prepare for upcoming rule changes related to information exchange. We are proud to have led and participated in this event.
AultCare received CORE Phase 2 certification in 2010 from the Council for Affordable Quality Healthcare (CAQH). CORE operating rules are streamlining eligibility, benefits and claims data by allowing providers to submit a request, using the electronic system of their choice, to obtain a variety of coverage information for any patient and from any participating health plan. This gives providers quicker, more consistent and predictable data. CORE allows providers to exchange claim and eligibility information electronically with AultCare. The availability of information in real-time at the point of care can reduce medical errors, allow physicians and their patients to make informed decisions about treatment options, and reduce administrative costs.
T ECHNOLOGY
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Doctors and Hospitals I Want Physicians & Hospitals AultCare now offers you in-network access to 4,000 providers across more than 7,800 locations. We have always believed it is best if you can receive care in your own community. Our ever-increasing network provides you more choices than ever for receiving the care you need.
4,008 Providers 32 Hospitals
Provider Quality Programs AultCare and our network providers recognize the importance of providing high-quality, compassionate care for our members. Healthcare Effectiveness Data and Information Set (HEDIS)* is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service1. HEDIS is designed to provide consumers with the information they need to reliably compare the performance of health plans. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts. Included in HEDIS is the CAHPS® 4.0 survey, which measures members’ satisfaction with their care in areas such as claims processing, customer service and getting needed care quickly.
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HEDIS and Physician Quality Reporting Initiative (PQRI) measures are identified according to specialty to ensure AultCare members receive current standards of care with a focus on prevention. AultCare’s staff then works closely with providers to ensure they offer treatment in support of each measure. Adherence to high standards for clinical guidelines enabled AultCare to achieve NCQA certification in all product lines. Care gap reminders are tools we offer enrollees and physicians to focus on preventive care. Twice a year, we run an analysis through our claims system data, creating a list of patients who are overdue for preventive care. The member receives a postcard reminder. Simultaneously, providers can access a patient registry on the AultCare Provider website showing which tests their patients need to complete. This practice encourages timely identification of disease processes such as cancer, while in an early, more treatable stage. 1 HEDIS® is a registered trademark of the National Committee for Quality Assurance
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
During the past year, AultCare employees were encouraged to participate in a day of volunteering. Along with several of my co-workers, I volunteered at a child day care center. It was a long day of physical work that was just as long in rewards and gratification for me! The children and the staff were most appreciative of what we had done to help them. As a result, I have “adopted” this center to be one of my personal charities to contribute to on a regular basis. Had AultCare not reached out to this organization, I would not have had the opportunity to continue to help.
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Cyndia Newburn, RN, BS, Director, Clinical Services AultCare, PrimeTime Health Plans, Aultra Administrative Services, 9 Years of Service
Provider Relationships AultCare establishes and maintains strong relationships with providers through regular office visits and telephone contact. As the health care industry faces health reform, AultCare serves as a resource to providers in understanding new regulations, time lines and reporting requirements. The AultCare Provider website offers tools to ease the burden of managing a practice. Annually, providers are given the opportunity to offer feedback on AultCare’s strengths as well as opportunities for improvement. We value the opinion of our providers and use this information to improve our processes.
Physician Office Manager Meetings AultCare hosted 12 office manager meetings throughout our service area to provide office managers with the latest information on AultCare and the marketplace. Presenters included a nationally recognized motivational speaker and content experts from within AultCare. These sessions allow attendees to network with their peers while meeting key staff members from AultCare.
Aultman Hospital In keeping with our commitment of quality for the community, Aultman Hospital was named one of the nation’s 50 Top Cardiovascular Hospitals® by Thomson Reuters. Also, for the fourth time,
Aultman has been identified as one of the 100 Top Hospitals® in the country by Thomson Reuters. Aultman Hospital has also been granted Magnet® status again by the American Nurses Credentialing Center (ANCC). This award recognizes nursing excellence, an achievement shared by only 6.47 percent of hospitals in the nation. Aultman first achieved recognition in 2006 from the high-level Magnet Recognition Program® and remains the only organization named in Stark County. In 2010, Aultman completed a major renovation of the Medical Intensive Care Unit (MICU). The new unit includes 20 patient rooms that are 80 percent larger than before. Expanded family space within the patient rooms adds to visitor comfort. Every room includes updated technology such as portable dialysis hookups, and two rooms include overhead patient lifts. Aultman’s Compassionate Care Center, opening in the spring of 2011, will be Stark County’s first inpatient hospice center. The facility will feature a 12-bed inpatient hospice to provide end-of-life care in a comfortable, peaceful environment with many of the amenities of home. Each patient’s private room will be large enough to accommodate several visitors and will feature an eating area and a sleeper sofa.
PHYSICIANS & HOSPI TAL S
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Good Benefits at Good Prices Market Growth AultCare We are pleased to announce that we achieved our 2010 sales goal in spite of significant challenges in the health care marketplace. Our dedicated team of sales representatives committed themselves to a redefined sales strategy for 2010. We focused on a number of initiatives that included extensive sales training, cross-selling initiatives, staff realignment and teamwork. Staff took the task in hand to strong results, adding 8,500 new lives to the AultCare family. AultCare values our relationships with our clients and community. These relationships, and our desire to exceed customer expectations, are demonstrated through an industry-leading client retention rate of 95 percent. We have become a leading source of health care reform information, and we take pride in being able to offer affordable health care solutions. Through our continued efforts to adapt to the growing needs of the changing economy, we have added additional plan designs to meet your needs. In 2010 we added two more high-deductible plans and a limited network plan design – both directed at cost containment and premium savings for our employer clients. We also installed capability to process claims for e-mail office visits at price savings to members and employers. Few providers are set up to see patients via e-mail at this time, but we know that this is an attractive benefit in other areas of the country.
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Aultra Administrative Group Aultra Administrative Group markets health plan administrative services outside of AultCare’s service area, including outside of Ohio. Health care reform was the top concern for clients in 2010. We quickly organized our team to become a resource to employers as they sought to understand the impact to their current benefits and plan for future requirements of the legislation. The year also saw technology upgrades at Aultra. These included a new phone system with advanced information systems that allows us to monitor our phone calls more closely. We generate reports that give us greater diagnostics about phone delays and customer service processes. Callers to our phone system now have an audible sign of our upgrade because they are informed of the average hold time during a call. Hold times improved significantly following the system’s installation. Wait times dropped by 25 percent, and caller abandonment rates (the number of times callers hang up before talking to someone) declined 22 percent. Aultra’s 2010 sales efforts resulted in net growth exceeding 10 percent in our administrative services (TPA) product line. Sales increase was steady in our Ohio region. We also added new clients in Pennsylvania, West Virginia, Maryland and Georgia. We continue to develop network relationships across our service areas so that clients have contracts with hospitals and doctors that meet the needs of their employees and families.
competitive rates we have offered, and our strong provider network, we expect this level of growth to continue into 2011.
AultOne AultOne has been crucial in fulfilling a community need for affordable, high-quality health plans for those without employer coverage. In these difficult economic times, where layoffs have occurred and where businesses have closed, there remains a demand for individual coverage options. AultOne sales continue with steady growth. The sales staff realignment and cross-selling initiative included PrimeTime Health Plan sales representatives taking on AultOne sales responsibilities. This gave us additional sales strength as well as efficiencies for the product, as often an individual policy is often needed for the under-age spouse of a PrimeTime enrollee. We look for increasing opportunities in the individual market as health care reform positions this product for public attention.
We rolled out the Aultra Insured Dental Product to new and existing clients this year. Sales exceeded our expectations. Coupled with the Aultra Dental Network™ of providers, our dental product expanded quickly from zero clients in 2009 to nearly 100 clients and 2,600 covered lives by the end of 2010. With the
MARKET GROW T H
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AultComp MCO Certified statewide, AultComp MCO is a Workers’ Compensation Managed Care Organization (MCO). The MCO works with employers to get medical management and care for injured workers covered by the Ohio Bureau of Workers’ Compensation (BWC) Health Partnership Program.
The 2010 Open Enrollment period ran from May 3 - May 28, 2010 with a successful outcome. Enrollment has grown by 9 percent since the last open enrollment period.
The BWC holds open enrollment for Ohio employers once every two years. This is the only time frame when MCOs are permitted to directly market to potential clients so we put substantial planning into our approach each time. Total Lives 95,000
90,728
92,796
85,514
85,000
80,322
78,243 75,000 2006
2007
2008
2009
Total Employer Groups 8,500
8,248
8,000 7,500 7,000
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2010
8,436
7,774 7,113 2006
7,302 2007
2008
2009
2010
AultCare truly believes in each and every employee. Over the last seven years AultCare and AultComp MCO have given me several wonderful opportunities to grow as a person: from continued education and career advancement, to providing me with many unique ways to volunteer and give back to my community. At AultCare, we are like one big family and I am extremely proud and thankful to be working for such a caring and compassionate organization.
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Deb Schlabach, Account Coordinator, AultComp MCO, 7 Years of Service
In the fall, AultComp MCO applied for BWC recertification and completed negotiations with the BWC to renew our Health Partnership Program contract. The recertification process enables an MCO to contract with the BWC for the next two years. The Health Partnership Program is the managed care program for Ohio employees. AultComp MCO scored as one of the top MCOs on the 2010 BWC Report Card. This report card helps employers evaluate the performance of MCOs by measuring aspects of the program that contribute to the quality of medical management – including safe return-to-work strategies and timely First Report of Injury reporting services. In 2010, we scored top in Ohio for First Report of Injury Timing and First Report of Injury Turnaround. The sooner a claim is filed, the sooner an injured worker can receive medical treatment and benefits and return to work safely. So we’re helping you save money by getting this process started and completed expediently.
AultComp received full reaccreditation from URAC in Case Management through April 1, 2013. Our URAC accreditation offers you the assurance that your injured workers are receiving appropriate standards of care for positive outcomes. Today, AultComp MCO serves 8,500 employers in the state of Ohio. Looking ahead to 2011, our projects include working with vendors to upgrade our current computer and telephone systems to enhance and assist in further improvements to our quality and service. The AultComp MCO team is committed to continuously improving our processes exceeding the expectations of our employers, injured workers and providers.
MARKET GROW T H
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PrimeTime Health Plan PrimeTime Health Plan has become the local leader in the Medicare Advantage Plan marketplace. Now operating in a nine-county service area surrounding Stark County, PrimeTime boasts more than 21,000 members and continues to have one of the lowest voluntary disenrollment rates in the country. The enactment of the Patient Protection and Affordable Care Act (PPACA) brought into renewed focus a Medicare Advantage organization’s Star Rating. Originally used as a benchmarking tool, the Star Ratings are now being used to improve the performance of Medicare Advantage plans. The number of stars (on a scale of 1 to 5, where 5 is Excellent), offers a glimpse into the quality of a health plan’s service, quality outcomes, providers and benefits. The Star Rating is assigned by the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program. The Star Ratings summarize how PrimeTime performs based on our quality and performance on various measures across five categories. These categories are: • Staying Healthy: Screenings, Tests and Vaccinations
• Managing Chronic Conditions
• Health Plan Responsiveness and Care
• Health Plan Complaint, Appeals & Voluntary Disenrollments
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• Health Plan Telephone Customer Service
We are proud to share that PrimeTime Health Plan has attained an overall rating of 4 (out of 5) stars, and there are no other health plans rated higher in our market. This achievement also makes us part of the top 13 percent of Medicare Advantage plans nationwide. The following are several examples of measures where PrimeTime has earned a 5 (out of 5) Star Rating:
• • • • •
Overall Rating of Plan Overall Rating of Health Care Quality Getting Needed Care Without Delays Customer Service Call Center Information Accuracy
Our growth, combined with these important results, tell us that members continue to be happy with PrimeTime Health Plan’s level of service, coordination of health care and access to our expansive network of providers.
.02%
AultCare 25-year margin: Pricing to break even.
95%
Client Retention. We do what we say we will do.
450
Employees working to help you.
4,000
Network providers to choose from.
$11,000,000 Economic impact through taxes paid.
$750,000,000 In claims paid through AultCare.
MARKET GROW T H
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A Great Place to Work Employees Our employees celebrated AultCare’s 25th Anniversary by bringing our service commitment to action and providing a visible sign of support to our community. The bulk of the 3,000 hours of service our employees donated occurred on company-paid time and were performed during April, just shy of AultCare’s birthday in May. AultCare encourages community involvement in our employees not only because we want to be a good corporate citizen, but because our employees like having the opportunity to serve as a component of their jobs.
Service Culture Within our organization, responsiveness to customers remains primary. From the quick answering of phone calls to providing thorough answers to questions, we want you to know that we’re here to help. Always alert to opportunities for improvement, we developed a new training program for claims analysts and celebrated Compliance Week reviewing HIPAA rules. We continued our celebration of AultCare’s 25th Anniversary into our annual Customer Service Week celebration in October with a motivational speaker and information sessions.
Knowledge We’re continuing the process improvement initiative of licensing our PrimeTime service representatives with an Ohio Health License. This enables prospective PrimeTime members to proceed from information gathering to application with the same person,
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The Exploring Leaders program continues, expanding the growth opportunities for employees who are already demonstrating their potential, and giving them opportunities to develop additional skills as leaders. This program offers a one-year schedule of classes and projects to nominees. It includes quarterly lunches with executives and a community service project. Through employee feedback, we learned that teamwork and communication were areas for improvement. During our Culture of Safety training, we focused on this. Sessions reinforced the need to create and maintain good communication among departments and between care areas. For example, clarity between service representatives and good customer notes entered in our system are important in creating seamless customer assistance.
AultCare is an organization that has a strong sense of the importance of community involvement. Not only do we try to make the community a better place by providing valuable and affordable products, but a healthier one by offering unique wellness programs. AultCare is a company that cares about people and as an AultCare employee for four years, I am inspired to provide the best customer service possible.
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eliminating the need to turn a prospective member over to a licensed sales representative. Something so simple is already resulting in increased customer satisfaction.
Michael Martini, Account Executive, 4 Years of Service
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Efficiency AultCare has a 25-year history of managing our expenses to ensure you receive the most value for your health care premiums. Because we are a nonprofit corporation, we operate solely to provide affordable health care to our members and the employers who purchase our plans. Consequently, we monitor our operations for quality and efficiency.
We also saved salary costs through a Summer Hours Program. This voluntary program allowed employees to choose to reduce their work hours over the summer - spend more time with family and go back to regular work hours in the fall. Summertime tends to be slower-paced for our industry. This allows us to provide flexibility to employees while reducing our FTE ratio and saving money.
A large part of our overall administrative expenses comes from staffing, so we historically track our ratio of Full-time Equivalents (FTE) per 1,000 members. As with most businesses, we’ve challenged ourselves to do more with less. During last year’s economic tightening, we were successful in reducing staffing levels through natural attrition and through a voluntary retirement program.
EMPLOYEES
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Give Back Community AultCare employees volunteered hundreds of hours across 30 community agencies in 2010! Our corporate culture encourages volunteerism and service to the community. This adds another dimension of value to our employees’ work experience while supplying much – needed resources into the community. Approximately 46 percent of our employees volunteer in the community. Here are some highlights.
Caring Employees • Through numerous fundraisers, volunteer activities and personal contributions, AultCare employees donated $73,000 into the community.
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In addition to time and money, our employees donated school supplies, clothing, toiletries, food, computers and holidays gifts to those in need.
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During National Customer Service Week (First week in October) AultCare incorporated a “Make a Difference Day, Ohio” service project. Through fundraisers and donations during the week, $700 was raised for the Family Life Center BackPack program. The BackPack program provides food to children to take home to ensure they have something healthy to eat over the weekend.
Helping Employees. The unit had a contest to encourage employees to donate food and toiletry items to help stock the shelves in the in-house food pantry.
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Each year, numerous AultCare departments participate in the Community Christmas Adopt-A-Family program. Throughout the year, these departments hold their own fundraisers (such as bake sales) to be able to purchase gifts for families in need.
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For the fourth consecutive year, AultCare participated in the Community Christmas Giving Tree. The AultCare Giving Tree is placed in our Service Center and employees and/or departments select tags and grant the Christmas wishes of area children and senior citizens.
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A total of 75 percent of our employees donated to United Way. Their contribution exceeded $56,000.
• The Timken Claims and Service Unit had a community outreach project called Employees
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Growing up with parents who are actively involved in the community, I inherited a strong passion to serve. AultCare makes that possible – by encouraging me to volunteer. Employment here also allows me to work with more than 500 companies each year, providing affordable health care coverage. This gives me an opportunity to help people by matching those businesses with the plan that meets their needs. When I think of community, I think of the group that does the most – AultCare! Michael Lemon, Account Executive, 3 Years of Service
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AultCare employees donated 210 units of blood to the Aultman Blood Center.
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Our employees logged more than 3,300 volunteer hours from their personal time to organizations such as:
Adopt-A-Need Program American Cancer Society American Heart Association Aultman In-House Food Pantry Aultman Pastoral Care Big Brothers / Big Sisters Boy Scouts Brownie Scouts Child and Adolescent Behavioral Health Community Services of Stark County Girl Scouts J.R. Coleman Outreach Services JDRF - Walk to Cure Diabetes Junior Achievement Leadership Stark County Louisville Area Chamber of Commerce Marlboro Volunteer Fire Department Meals on Wheels of Stark and Wayne Counties Monroe Community Center Multi-Development Service of Stark County Ohio Reads Pathway Caring for Children Pegasus Farm Equestrian Center for the Disabled Planned Parenthood Affiliates of Ohio Pro Football Hall of Fame Project Solutions Safe Kids Coalition St Bernard’s Soup Kitchen Stark County Board of Developmental Disabilities United Way of Greater Stark County Impact & Women Leadership Councils Wilmot Fire and Rescue Wishes Can Happen
Week of Caring Service Projects
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Serving Our Commu nity for 25 Y ears In celebration of AultCare’s 25th Anniversary, we had a “caring in the community” project. The project consisted of 125 employees volunteering over the course of three weeks in April. Each of the service projects is shown below.
Interfaith Child Development Center (Alliance) A group of employees helped clean the center’s gym. The cleaning included mats, equipment, and kitchen and storage areas. Volunteers also helped sort and organize items for the center’s annual rummage sale.
COMMUNI T Y
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The Wilderness Center (Wilmot)
Stark County Humane Society (Louisville)
AultCare employees “Adopted a Trail� at The Wilderness Center. Employees cleaned the trail and pulled weeds.
Employees provided extra love and attention to the animals at the shelter. Volunteers walked dogs and groomed cats and dogs.
Goodwill ComputersAgain Program Goodwill Community Campus Our employees helped lift and move donated computers and equipment. Volunteers also helped clean out the hard drives of the donated computers.
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Stark Parks Lock IV Park In preparation for an upcoming Stark Parks event, our employees volunteered to clean Lock IV Park located in Canal Fulton. Employees pruned, mulched and pulled weeds in the park. They also removed trash.
Akron-Canton Regional Foodbank (Akron) On two separate occasions, employees repackaged bulk food items into smaller quantities at the AkronCanton Regional Foodbank.
Canton Preschool Childcare at Canton YWCA Employees cleaned storage areas at the center.
Helping with Seniors in Adult Day Care Center at J. R. Coleman A group of employees spent a day at the J.R. Coleman Center assisting the staff with senior citizens in their Adult Day Care. Employees assisted with daily activities and played games with the clients.
Canton Calvary Mission A group of employees helped clients shop in the food pantry. Our employees distributed produce and other food items. Volunteers also assisted clients with grocery carts and taking food to their cars, served hot meals at the mission, assisted with food preparation, setting up the tables and cleaning up after the meal.
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Corporate Donations •
AultCare donated more than $125,000 back to the community through United Way and other corporate community sponsorships and initiatives last year. Donations supported the following organizations. American Heart Association The Arc of Stark County Big Brothers/Big Sisters Boy Scouts of America, Buckeye Council Canton Christian Home Canton Community Christmas Canton Regional Chamber of Commerce Clearview Legacy Domestic Violence Project First Tee of Canton J. Babe Stearn Community Center Jackson-Belden Food Festival Junior Achievement Masonic Learning Center Massillon Chamber of Commerce Orrville Area Boys and Girls Club Pathway Caring for Children Perry Township Rotary Pro Football Hall of Fame Quest Recovery Services Senior Golf Association Stark County Foster Parents Fund Trillium Family Services The Wilderness Center Wishes Can Happen YMCA
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AultCare was a sponsor of the Wishes Can Happen radiothon. Many employees volunteered to answer calls and assist donors at the site.
Scholarships •
AultCare honored 12 area high school seniors with $2,000 scholarships called the AultCare Team Spirit Award.
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For the first time, AultCare awarded scholarships to students attending the Aultman College of Nursing and Health Sciences. Two $5,000 scholarships were awarded.
Members’ Savings Program •
Many area businesses offer special discounts to AultCare members through the AultCare “For YOU!” Discount Card Program. For a current list of participating businesses, visit our website. The program’s information is listed under the “Member’s” tab.
COMMUNI T Y
2600 Sixth St. S.W. / Canton, OH 44710 Phone: 800.344.8858 / www.aultcare.com