Best Access to Best Care...
2011
ANNUAL REPORT
When You Need it
continuous quality improvement employees/community AultCaring in the Community
employees/community
the care you need
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from our members
continuous quality improvement
by the numbers
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doctors and hospitals you want
stay healthy
great benefits at competitive prices
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to our clients
Contents
2 to our clients
3 good benefits at good prices
7 doctors and hospitals you want
9 the care you need
1 2 4 6 8 10 12 14 16
Contents
To Our Clients:
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ach month, when I sign letters to renewing clients, I’m amazed at the length of time some of you have been with AultCare: 10 years, 15 years, 24 years… We are honored that you have chosen AultCare at each renewal; more so in knowing that many of you have been with us for so long.
Our model of integrated health delivery – where doctors, hospitals and insurance companies supply health care services through the health care spectrum – is an example of best practices in the health care industry. Combined with the fact that this geographic region has some of the lowest costs for health care services in the country, you have a unique opportunity; one that fits perfectly with our mission to pass along those low health care charges to you.
Our processes are set to help you get care quickly and efficiently. Not only does this result in a happier patient, it saves health care dollars. This year’s annual report will storyboard for you how an integrated health delivery system can keep you physically – and fiscally – healthy. Employers, members and the community benefit from AultCare’s continued engagement in health care trends. We will continue to invest in processes and opportunities that spur growth, enhance service and improve health care for those we serve.
Rick L. Haines
President and Chief Executive Officer
This past year, we launched exciting new initiatives to better coordinate patient care. We realigned our disease and case management operations into one. Now, those nurses will act as care managers assigned to specific patients. You will have the same nurse care manager for life. How better to help guide your care through the health care system?
Rick L. Haines, President & CEO, AultCare and John B. Humphrey Jr., M.D. Chairman of the Board, AultCare.
FROM THE PRESIDENT
Employers, members and the community benefit from AultCare’s continued engagement in health care trends and legislation. The U.S. population is aging – and expecting improving medical technology and longer life spans. Industry wide, this results in rising insurance rates. Health care reform was enacted to lessen these costs but we have not yet found that to be true. We recognize that it’s hard for you to factor these increased expenses into your annual budgets or pricing. So there are a number of actions we take daily to contain these costs for you.
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Great Benefits at Competitive Prices
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was so thankful that AultCare did a cost comparison for my daughter’s medications. In doing so, I found out that the medication was cheaper by mail order!” -a member
Health insurance is an extremely competitive marketplace, with perceptions that there are few differences between products and insurers. Your first experience with AultCare was probably one of numbers - - one where AultCare rates were shown to you in comparison to those of other insurers.
AultCare
Our vision has always been that we will be a low-cost option for employers. Contrast that with how other insurers quote and you will see the stability of our underwriting philosophy. The nature of our business – evaluating health risks – is one of uncertainty. No one can know when the next illness or accident will occur. What we can do is evaluate health risks, using nationally-accepted standards. This underwriting philosophy applies both initially and after you become a client. That is one of the reasons that nine out of ten groups renew with us year after year.
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AultCare vs. Benchmark Premiums
PPO: Family Rates Paid by Employer & Enrollee
2010 $16,000
$14,107
$14,000
$12,325
$12,000 $10,000 $8,000
$13,375
$7,573
$6,000 $4,000 $2,000 $0
AultCare
Ohio
Milliman Group Health Insurance Surveys 2010 Standard Plan _ Straight Average
Akron
Cleveland
Passing Along Low Charges
Keeping Costs Down
Our region in Ohio has some of the lowest health care costs and charges in the nation. Passing through the effect of those low charges to employers has always been our mission.
Beyond claims management, we also control our internal costs to be good stewards of our customers’ money. In 2011, we had a number of successes in this area.
Equivalent Hospital Charges**
Canton
$1.00
Cleveland
$2.35
Akron
$2.38
Columbus
$2.98
**Assumes differentials in pricing based on publicly reported data.
Knowing that patients like to have choices, we believe that care should be delivered in the best setting. That’s why we support a network of community hospitals that care for our members near their home and support our low-cost vision. We have referral arrangements with specialty facilities to care for the more complex cases, if needed. This helps us contain costs of care – and thus the costs of premiums – without compromising access.
Dedicated an employee to process improvement for the company. Six Sigma certified, she has already evaluated a number of processes, and completed or begun improvements to increase efficiency.
Reduced staffing by 48 people over the past four years. Annually, we review staffing to ensure appropriate ratios of staff to maintain service levels with concern to costs. Reductions were attained through attrition without replacement, reduction of overtime hours and through voluntary reduction of hours.
Started several Go Green projects to save environmental resources and dollars.
These include:
Flexible spending reimbursement by way of direct deposit for the AultCare employee group; Conversion to electronic performance evaluations for our staff; Electronic Explanation of Benefits (EOB) forms to replace paper ones, with or without email notification;
Additional increases in electronic remittance participation with providers. The remit program eliminates the need to print paper checks and vouchers by replacing them with electronic payments and notice. It reduces waste, fraud and abuse, and pays providers faster and more accurately.
GOOD BENEFITS AT GOOD PRICES
Region
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Doctors and Hospitals You Want out all with s goe me lps er elps k he r he wo eh ase ME. Sh and s ment c t n “My ELP rea the go t n H i o g More than 97% of of ave to t’s h and pe our physicians wha he ty gh. I ence d me t e id ou on are accepting new thr conf s help s me o n l I g test he ha patients. We have a tel usa s ea he r.” -S s r y g very broad selection wa ce hat the and t ut can across multiple specialties. abo This gives you many choices. You can find a listing of our
AultCare continued the expansion of our high-performing Xasdfklasjdfokasdjflkasdj network of quality physicians and hospitals.
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In 2011, we added 709 new doctors to the network. AultCare members now can choose from more than 4,800 doctors at more than 9,000 locations and 33 hospitals. Our network now reaches 44 Ohio counties and part of West Virginia.
AultCare
In our network, we have the hospitals in Tuscarawas, Holmes and Wayne Counties. We also have two of the four Stark County hospitals in network for AultCare customers, and three of those four hospitals for PrimeTime members. In Summit County, four of the six hospitals are in the AultCare network.
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current providers at www.aultcare.com.
AultCare continues to establish and maintain strong relationships with network physicians. The provider relations staff is dedicated to providing personal communication with doctors through office visits, telephone contact and provider office meetings. As health care continues to evolve, we recognize the many challenges our doctors face, and aim to be a resource for their practices.
709 new doctors more than 4,800 doctors
more than 9,000 locations and 33 hospitals
DOCTORS AND HOSPITALS YOU WANT
44 Ohio counties and part of West Virginia
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By the Numbers
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ultman Hospital Highlights. In 2011, Aultman launched new services and surgical procedures, completed renovations and invested in advanced technology aimed at continuously improving patient care.
New surgical procedures available at Aultman include total ankle replacement, best suited to less physically active patients with severe ankle arthritis, fractures or other serious injuries. New heart procedures include minimally invasive and transfusion-free (bloodless) surgery.
AultCare
In 2011, Thomson Reuters named Aultman among the 100 Top Hospitals® and 50 Top Cardiovascular Hospitals®. Aultman also earned its 16th consecutive “Most Preferred Hospital for Overall Quality and Image” award from National Research Corporation.
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Aultman brought inpatient hospice care to Stark County with the opening of the Women’s Board of Aultman Hospital Compassionate Care Center in October 2011. Located on the Aultman Woodlawn campus, the facility features 12 private hospice suites where patients receive end-of-life care in a comfortable, peaceful environment with many homelike amenities. Each patient suite is large enough to accommodate several visitors and features an eating area, sleeper sofa and patio.
The board chairs of Dunlap Community Hospital and Aultman Health Foundation signed a definitive agreement to make Dunlap a subsidiary of Aultman Health Foundation. The new arrangement builds on a 15-year relationship between these two hospitals through the Independent Hospital Network, which was established with the mission of maintaining local, not-for-profit hospitals. Dunlap Community Hospital is now Aultman Orrville Hospital and will continue to operate as a not-for-profit community hospital offering a variety of inpatient and outpatient services.
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“ y AultCare case manager has been so wonderful to me. She followed me all the time at another hospital and all the times at rehab centers and at Aultman Hospital. She handled the mess when a distant hospital kept billing me for stuff that shouldn’t have been. I can see doctors without worry. She has been an angel to us during the most horrific medical time of my life and we are forever indebted to her. This may have been her job, but she went way above and beyond and is still doing that. God bless her.” - Mary
586 Open Heart Surgeries 2,368 babies delivered
89,954 emergency room visits
By the Numbers
60,599 Immediate Care Visits
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From Our Members
AultCare
At AultCare, we are proud of our progress to improve the health status of our members. The dedication of AultCare staff is easily seen in the positive feedback we receive from members.
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Email from a New Member: “If you don’t mind, I would like to take a minute to tell you how impressed I am with the commitment to customer service in your organization. I retired three years ago from managing customer contact call centers for over 28 years. I have had the pleasure of setting up call centers for companies such as Apple Computer and QVC as well as working for some of the largest catalogers in the US. In addition, I have been a guest speaker at professional organizations such as the International Customer Service Association and the Society for Consumer Affairs Professionals. Needless to say, I have preached the customer service message over and over only to be frustrated in finding so few companies who truly embrace the mission AND empower their employees to take ownership for the customer experience.
I look forward to a long-term relationship with your company. If my present experiences are any indication, then I’m sure you will have a loyal customer for a long time. And, one who will tell others about how good you are.” -George
“The welln ess rece pr ived by th ogram is They well e e are v iewin mployees bene fit. M g a any e this as a t Combi. a con n add mploy sciou s ef ed lifes fort ees are ty makin to ma the w le change g ke po s e sitiv visit llness pr with the e s o Combi uppor gram . posit o t of ive b n a mont Having an hly ba enef R N for t it an sis is d is he a a rea part successf son icipat ul em ploye ion.” -Bar e b
FROM OUR MEMBERS
I have been very impressed with the professionalism and dedication to customer satisfaction that I have experienced with your organization. Congratulations on a job well done.
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The Care You Need
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“
would like to give a round of unabounding praise to AultCare. When my husband was seriously ill and I was trying to handle everything myself, someone let me know about AultCare’s Case Management Program. Immediately the Case Manager put my worries to ease. What a difference that made during such a difficult time.” -a member
In evaluating our clinical resources to best serve your needs, AultCare took dramatic changes to our case and disease management areas in 2011. The industry norm is to have one area of clinical staff to manage cases as they occur, and another area to manage patients with on-going or chronic diseases. The result is that up to six different clinicians might touch the same patient’s file as that patient progresses through the health care system (including in-network, out-of-network, rehab care etc.) To better serve patients, coordinate care and increase quality, we combined our clinical areas. Our nursing staff are now “Care Coordinators” who will follow the same patient’s care through all episodes of illness. This means that you will be talking to the same nurse care coordinator for the illness you have today or two years from now. There will be no need to pass along a patient’s file and treatment history to a new nurse – one nurse will coordinate it all. This will better help us identify opportunities to enroll patients in disease management, will increase efficiency, better manage claims, and improve the patient’s experience.
AultCare
In addition, we made the following enhancements to our care management processes:
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Implemented three Medical Home offices, a team-based model for care, extending this concept to nearly 20% of our members.
This puts an AultCare registered nurse right in your physician’s office, to best care for AultCare members. Medical homes arrange various aspects of patient care – from preventive visits to chronic illnesses or end-of-life issues – with qualified professionals. This approach enhances communication, care coordination and safety. By the end of 2013, we expect to have 15 medical homes in place. Launched a prescription program to help our PrimeTime Health Plan members follow their doctor’s instructions consistently and save money. Working more closely with pharmacists, we can more effectively decrease medication costs, increase the number of times the patient follows doctor’s orders for their medication, address patient medication safety concerns, discuss drug interactions and contribute to better health for our members.
THE CARE YOU NEED
MEDICAL HOME NURSES
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Continuous Quality Improvement
Q
uality might be defined differently by different people. In the health care industry, the standard is set by NCQA, which defines quality as “the extent to which patients get the care they need in a manner that most effectively protects or restores their health. This means having timely access to care, getting treatment that medical evidence has found to be effective and getting appropriate preventive care.” NCQA report cards; http://www.ncqa.org/tabid/60/default.aspx
Accreditation
Data Analysis
AultCare Corporation and AultCare Insurance Company are proud to have maintained National Committee for Quality Assurance (NCQA) Accreditation levels of Excellent for all three of our product lines – AultCare PPO, AultCare HMO and PrimeTime Health Plan Medicare Advantage HMO.
In a constant effort to keep costs low while improving care for members, AultCare partnered with InforMed, an information management and service company. InforMed provides AultCare with cuttingedge medical management technology and powerful data analysis tools. These tools give AultCare’s care coordinators the ability to effectively manage members’ care, predict which patients may have potentially serious medical situations in the future, and track the care members are receiving compared to evidence-based standards. With these enhanced tools, AultCare can more effectively guide patients through the health care system, ensuring they get the proper care in the most appropriate way. This translates to lower premiums for our clients.
NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system in order to continuously improve the quality of care and services provided to its members. We have completed thorough on-site reviews of our processes to obtain and maintain these nationallyaccepted standards of care.
AultCare
Star Rating
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PrimeTime Health Plan proudly maintained a four-star Medicare rating on its HMO product and received a five-star rating for customer service. The centers for Medicare & Medicaid Services (CMS) created a five-star rating system to help consumers compare health plans. Ratings are cumulative indicators of quality of care, access to care, responsiveness, and member satisfaction.
New AultCare Website An updated AultCare website was opened to members, providers and employers in late 2011. More information is available online now, and it should be easier for users to move around the site to see it. Noteworthy features include enhanced
care plans. The majority of the elements of the ACA will go into effect January 1, 2014 – but incremental changes are occurring regularly as new regulations are published by the federal government. As these modifications have occurred, AultCare’s reform team continues to evaluate ongoing legislative issues and provide recommendations. AultCare held informational seminars for clients, providers and brokers – along with radio and television outreach in an effort to assist the public in understanding the impact of the law.
Service Excellence The foundation of AultCare’s service commitment to customers remains strong. Maintaining excellence in this area led to goal attainment in the metrics we believe reflects that service promise.
security, online access to claim vouchers for providers, and online Explanation of Benefits (EOBs) for members. Availability of these documents on the Web will provide 24-hour access for members and users and helps AultCare reduce paper waste and postage. Prior Authorization is now offered interactively through the provider portal and will improve turnaround times for prescription drug authorizations.
Health Care Reform AultCare produced communication pieces to keep customers apprised of the requirements of the Affordable Care Act (ACA) and their health
Processed claim payments within 5-7 days for AultCare clients, meeting goal.
Paid claims to a 99.7% accuracy level, meeting goal.
Maintained our low phone call abandonment rate – the percentage of time that a caller hangs up before talking to a service representative – at 2.7%. Our service center fields an average of 6,000 calls per week!
Retained 96.6% of our clients through renewals.
son’s r u o h wit elped both y p p a e so hr. She has hng illness. d r a e “W manage g his lo ional an case f us durin is profess so kind, o t on ly she is e feel She nowledgeable,ly helpful. Was should kno personal ave her - fany and essed to h are!” -Tif bl AultC
CONTINUOUS QUALITY IMPROVEMENT
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Employees
Participated in and raised money for the following community health walks: American Cancer Society Relay for Life, JDRF Walk to Cure Diabetes and American Heart Association Heart Walk
Employees
Made monthly donations for personal care items for underprivileged individuals in Downtown Canton
Raised and donated $74,000 to the community
Donated supplies for annual school supply drive
Donated $54,000 to United Way
Donated 210 pints of blood to Aultman Blood Center- saving the hospital approximately $42,000
Operated snack shops throughout the year to raise money to adopt families and individuals for Christmas
Volunteered at the Bee Healthy Race
Raised nearly $4,000 for the Junior Achievement Bowl-a-Thon
Monthly collection of various baby items for area mothers in need
Donated $2,860 for Wishes Can Happen Radiothon
Volunteered approximately 3,500 hours in the community
A department started a knitting club and donated 16 scarves and 12 hats to area children in need
Sold extra volunteer t-shirts and donated proceeds to the Blessing in a Backpack program helping provide food for students at Dueber Elementary School to take home for the weekend
Adopted Agency- Stark Social Workers Network
Donated 11 boxes of non-perishables food during the Thanksgiving Food Drive. The donations were delivered to Canton Calvary Mission.
Donated 45 blankets to go to single fathers and grandparents raising grandchildren
Participated in the JA in a Day at Cedar Elementary School
Raised nearly $600 during a Penny War, using the funds to purchase gift cards to area grocery and discount stores for Stark Social Workers Network.
Employees delivered meals during the annual Health Care Heroes for Nutrition campaign
Donated personal care items, school supplies, food, bedding and blankets
Purchased Christmas gifts for clients’ children
Donated gently used jeans and pants for area children through the Massillon AHEAD program
Raised over $7,000 for the American Heart Association Heart Walk
AultCare
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Community
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EMPLOYEES
COMMUNITY
AultCaring in the Community 105 employees volunteered during the Approximately campaign which had a total of 10 projects. Projects consisted of: Caring for Children
Spring cleaning their gym so they can play at Interfaith Child Development Center
Raising money to make their wishes come true during the Wishes Can Happen Radiothon
Caring for Senior Citizens
Assisting with daily activities and serving lunch at J.R. Coleman Adult Day Care
Doing minor home repairs with Hammer & Nails
Caring for Nature
Trimming shrubs, weeding and mulching at Exploration Gateway (Stark Parks)
Caring for the Hungry
Repacking bulk food for distribution to area food pantries at Akron Canton FoodBank
Helping in the food pantry and serving hot meals at Canton Calvary Mission
Caring for Asset Building
Doing data entry and preparing reports of low income individuals who receive services from Family Economic Success Program
Caring for those Seeking Comfort
Making their environment prettier by painting at Domestic Violence Project, Inc.
AultCare
Caring for Animals
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Providing love and attention to those at Stark County Humane Society
- Akron Canton Foodbank
- Growing Healthy Habits
- Alzheimer’s Association
- Hammer & Nails, Inc.
- American Cancer Society
- J. Babe Stearn Center
- American Heart Association
- J.R. Coleman Outreach Services
- ArtsInStark Arts Splash
- Junior Achievement
- Bee Healthy Race
- Juvenile Diabetes Research Foundation
- Big Brothers / Big Sisters
- Louisville YMCA
- Boy Scouts of America
- Making Strides Against Breast Cancer
- Canton Calvary Mission
- Marlboro Volunteer Fire Department
- Canton Chamber of Commerce
- Massillon Public Library
- Child & Adolescent Services
- Meals on Wheels of Stark and Wayne Counties
- Community Christmas Adopt-a-Family
- Multi-Development of Stark Country
- CureSearch
- North Canton YMCA
- Domestic Violence Project, Inc
- Pathway Caring for Children
- Family Economic Success
- The First Tee of Canton
- Power of the Pen, Ohio Writing Program for Students
- Fulton Parkside Neighbors
- Girl Scouts of North East Ohio
- Pro Football Hall of Fame Enshrinement Festivities
- Greater Stark County Urban League
- Rubber City Warthogs
- Seatbelt Challenge
- Stark County MRDD
- Run for Home Race (Dover)
- Tuscarawas County Humane Society
- United Way of Greater Stark County
- Wilmot Fire & Rescue
- Wishes Can Happen
- ystark!
COMMUNITY
EMPLOYEES
Our employees volunteered their personal time at the following organizations:
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Corporate
Awarded two $5,000 scholarships to Aultman College of Nursing and Health Sciences students
Awarded twelve $2,000 scholarships to area high school seniors
AultCare
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Donated 140 pounds of hamburger meat to Stark County Hunger Task Force
Distributed free health information and wellness items at the Stark County Fair
Implemented a dental hygiene program called the AultCare Smile Program and distributed dental health education and hygiene kits to area 3rd graders
Sponsored the annual Wishes Can Happen Radiothon to raise money to grant wishes of area ill children
Raised approximately $400 via Facebook to be distributed to Stark County Hunger Task Force, Pathway Caring for Children and Stark County Humane Society
Major sponsor of American Heart Association 2011 Heart Walk
Contributed approximately $150,000 back to the community in the form of sponsorships and donations to area non-profit organizations
Adoption of Stark Social Workers Network agency for the year, supporting with employee volunteerism, corporate sponsorships and various collection drives
Corporate sponsorships and donations were made to the following organizations: - Akron Canton Food Bank - Alliance Area Development Board - American Heart Association - Big Brothers / Big Sisters - Buckeye Council BSA - Canton Ballet - Canton Regional Chamber of Commerce - Perry Township Rotary - Canton Christian Home - Canton Community Clinic - Child and Adolescent Services - Clearview Historic Golf Course Legacy Foundation - Coming Together Stark County - Cuyahoga Valley Scenic Railroad - Domestic Violence Project, Inc. - Early Childhood Education (Alliance) - Stark County Agricultural Society - The First Tee of Canton - Folds of Honor - Greater Stark County Urban League - Hammer & Nails, Inc - Healthy Tusc Summit - J. Babe Stearn Community Center - Junior Achievement - Massillon Chamber of Commerce - Massillon-McKinley Prayer Breakfast - Muscular Dystrophy Association - North Canton Medical Foundation - North Canton YMCA - Orrville Area Boys and Girls Club - Pathway Caring for Children - Pegasus Farm - Pro Football Hall of Fame - Project Rebuild, Inc. - Reinbows at Serenity Spring - Siffrin, Inc - Senior Golf Association - Special Olympics - Stark County Foster Parents Fund - Stark County Board of Developmental Disabilities - Stark County Hunger Task Force - Stark Parks - The Fallen Firefighters Fund - The Ohio Foundation of Independent Colleges - The Wilderness Center - Trillium Family Solution - United Way of Greater Stark County - Meals on Wheels of Stark & Wayne Counties - United Way of Tuscarawas County - YMCA Strong Kids Campaign
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EMPLOYEES
COMMUNITY
2600 Sixth St. S.W. / Canton, OH 44710 Phone: 800.344.8858 / www.aultcare.com