Annual Report
2013
From our President
3
Affordable Care Act
4
Quality
6
Service
8
Care Coordination
10
Wellness
12
Pharmacy Program
14
Year-End Review
16
Retention
18
Sales
20
PrimeTime Health Plan
22
Providers
25
New Claims Management System
26
Aultman Hospital
29
Community
30
From our President Change offers the opportunity for new beginnings. It challenges us to stay on top of the latest trends in the health care industry, and to adapt to the needs of our customers and providers. AultCare’s biggest challenge in 2013 was preparation of the roll-out of the Affordable Care Act (ACA) which went into effect January 1, 2014. On the following pages, you will read about how our team planned and developed new insurance plans for the Marketplace and formed a Select Network for those plans. And while the roll-out of Healthcare.gov had significant issues, you also will see that AultCare assisted the government in resolving those enrollment issues. In conjunction with developing new plans, AultCare held meetings at which we discussed health care reform and its effects with more than 4,000 local members, providers and customers. Meanwhile, almost every department within AultCare was impacted by the ACA, internally in areas such as Information Technology (IT) and Finance, and externally as it relates to care and service. To some extent, all of our departments adapted to the ACA while also staying focused on their own annual goals, which helped them improve on their previous solid performance.
Quality and service are the bedrock upon which AultCare builds its goal of customer satisfaction. We are proud of our nationally recognized plans and in the fact our customers hold us in high esteem. You can read about that recognition in this report. Of course, AultCare would not be a quality company without its quality people. Without them, we would not have affordable, high-quality insurance with excellent customer service. Their interaction with our members and customers is outstanding. Here are a few facts that bear that out: Our service centers received an average of 7,500 calls per week, claims were processed with 99.9% accuracy and our customer retention rate was 95%. These dedicated employees also find time to give back personally, volunteering more than 4,000 hours to community organizations. In business, they serve their neighbors; in the community, they serve with their neighbors. We are proud of our work in 2013 and we will not rest in 2014. Change is the theme of this Annual Report not only because it describes last year, but also because it signals that the only constant in health care is change. For example, our industry faces the continued implementation of the ACA and premium pressures. Changes also will continue to affect other areas of the health care delivery system, and AultCare must be prepared, with our vertically integrated partners - our doctors and Aultman Hospital - to adapt to those changes and to continue to be a leader in the health care field. It is our promise to the community we serve.
Rick L. Haines President and Chief Executive Officer
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Affordable Care Act In 2013, the Affordable Care Act’s Health Insurance Marketplace opened and AultCare was well prepared for that watershed year. Much of the groundwork had been laid in the years preceding, but long-awaited regulatory guidance for participation in the Marketplace finally arrived in the first quarter of the year. To enter the Marketplace, AultCare formed a Select Provider Network comprising Stark, Carroll and Tuscarawas counties. Applications were filed, comment periods followed and on September 10, 2013, AultCare received final approval to participate in the Health Care Marketplace for both Individuals and Small Groups. It was one of eight health insurance companies in Ohio to receive such approval. The well-documented rollout of Healthcare.gov began October 1 as individuals began to select plans for a January 1, 2014, effective date. Significant enrollment issues created daily challenges for our team, and we worked diligently to assist the Centers for Medicare & Medicaid Services to resolve the problems in their enrollment modules. At the same time, our Reform team was coordinating internal efforts to develop new processes, applications and strategies to accommodate all of the requirements and changes brought on by the Affordable Care Act (ACA). These changes impact every department in AultCare including but not limited to Service, Care Coordination, Finance, Information Technology (IT) and Retention.
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In particular, our IT staff was engaged re-engineering our Information Systems infrastructure to support all of the applications touched by reform. Among the IT initiatives was designing a health reform website, which employers and individuals can use to find up-to-date information about health care reform. The ever-changing rules and requirements of the rollout tested our team’s flexibility and resourcefulness as we faced new challenges on a daily basis. Meanwhile, we reached out to employers, brokers, providers, and the community by providing extensive educational information on the ACA and its impact. During the year, more than 4,000 people attended AultCare meetings about health care reform. Our team made nearly 100 presentations in the community, along with radio appearances that provided educational information. We ended 2013 with our unwavering commitment to help our community navigate the changing health care reform waters.
Over
4,000
people attended AultCare meetings on Health Care Reform
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Quality COMMERCIAL PPO
COMMERCIAL HMO
MEDICARE HMO
We were pleased to receive the renewal of our National Committee for Quality Assurance accreditation for our commercial HMO, commercial PPO, and Medicare HMO products for another three years. NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. In addition to our reaccreditation, we received NCQA’s Private Health Insurance Rankings 2013-2014 and NCQA’s Medicare Health Insurance Plan Rankings 2013-2014. AultCare HMO is the #3 private plan in Ohio and the #69 private plan in the U.S. among 484 private health insurance plans ranked. AultCare PPO is the #12 private plan in Ohio and the #190 private plan in the U.S. among 484 private health insurance companies. PrimeTime Health Plan HMO is the #2 Medicare plan in Ohio and the #38 Medicare plan in the U.S. among 405 Medicare Advantage plans. We are most excited about the fact that each of the three plans also received the highest possible rating of 5 out of 5 for consumer satisfaction.
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Service Two major projects received special attention in 2013:
Service One of the ways AultCare strives to distinguish itself in the market is through the service we offer to our enrollees. Sometimes, that service is very direct and personal such as a phone call or a face-to-face meeting. Other times, our service is demonstrated through timeliness and accuracy in processing a claim. Each year, we hold ourselves accountable to high service standards, in part, by the metrics we use. In 2013, some of the key service metrics were: • Claims Processing Time – the time between the date a claim is received to the date it is processed – was 7.39 days, compared to a goal of 8.0 days • Average time before a customer is connected to a dedicated Service Representative was 28 seconds, compared to a maximum goal of 30 seconds • Percentage of people abandoning calls to Customer Service was only 2.4%, compared to a goal of a maximum 3% • Same Day Call Resolution met the goal of 90%; this is the minimum goal for AultCare to resolve customers issues, questions or concerns in the same day they are received
The first initiative was our Claims Management System implementation project. This is a replacement of our software systems that when complete will allow us to offer more efficient customer service without sacrificing the personal touch our clients appreciate. Most of the time spent was in preparation of the actual implementation itself, which will begin later in 2014. The second initiative was formation of a dedicated Individual Service Unit. This separate unit contains employees from various departments such as claims, service, sales and eligibility. Health Care Reform and the Marketplace have significantly changed the way the insurance industry functions. We wanted to provide a resource to our individual enrollees that allowed them to call one location and find a great opportunity to get their questions answered and assist them with their needs. The individual market is a significant and growing market and we are planning for the expansion of the dedicated unit to include more functions and assistance in 2014.
Our Service Centers
Service is our culture.
received over
7,500
calls per week 8
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Care Coordination Advocating for our members The Care Coordination team serves as an advocate for members, helping develop a program of care, information and community services tailored to each person. Individual services of Utilization Management, Case Management and Disease Management are coordinated by a Care Coordinator who helps a member navigate through the health care system. Care coordination also includes education relating to Pharmacy and prescription drug formulary management. AultCare members, with the help of the Care Coordination team, can take greater control of their health status. With a telephone call, members can ask the team of registered nurses, licensed practical nurses and licensed social workers to assess, plan, facilitate and advocate for services and options to help our members meet their specific health needs.
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Integration of these traditional services within the Care Coordination team enhances member safety, well-being and quality of life while reducing total health care costs. By being advocates for our members and engaging them in the process of owning their health, AultCare and PrimeTime Health Plan continue to make strides in fulfilling our mission statement: “Leading our Community to Improved Health.” Patient Centered Medical Home (PCMH) AultCare’s Patient Centered Medical Home program focuses on quality outcomes and preventive measures for our members. By the end of 2013, there were eight PCMH offices with 41 primary care physicians. These PCMH offices serve approximately 30% of the PrimeTime Health Plan membership as well as a subset of our commercial plan enrollees. AultCare’s PCMH team communicates daily with our physicians in these practices, in addition to participating in routine monthly status update meetings with these physicians and their staffs.
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Wellness
More than
4,200
people have had a screening at our Wellness Fairs this year The goal of AultCare’s Wellness team is to help our members improve their health. While our goal is simply stated, we wrap this initiative into a comprehensive variety of wellness programs that have a strong impact on engagement, participation and positive outcomes. More than 40 AultCare client companies access our Wellness team to manage their in-house corporate wellness programs, including our Bee Healthy program. Whether it’s participating in health fairs, conducting on-site health coaching, or leading other specialized programs, our expert staff of RNs, LPNs, Dieticians, Personal Trainers, Smoking Cessation Specialists and Wellness Online Support Representatives, are on-call. We provide our clients with a positive, healthy return on their investment. In 2013, more than 4,200 people had an AultCare Wellness screening at our various Health Fairs. Through Aultman Health Foundation’s own Bee Healthy program, employees have earned more than 450 Aultman branded trail bikes, $155,000 in Second Sole gift certificates and $440,750 in cash rewards. AultCare Wellness continues to be a major influence and community leader in work-site wellness programs.
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Pharmacy Program AultCare’s Pharmacy Benefit Management team promotes the use of high-quality, cost-effective medications. We achieved a low drug trend by decreasing costs through our formulary management strategies. This trend is measured by the number of medications our members’ are prescribed, the cost, and the mix of medications. Meanwhile, another positive direction is the increased use of generic, rather than brand name, medications. Our generic dispensing rate for AultCare pharmacy rose to almost 82% in 2013. PrimeTime Health Plan pharmacy plan’s generic dispensing rate reached a record high of 86%. We do this by offering and managing tiers of medications in our formulary, which helps direct members toward greater use of generic equivalent drugs. Our Clinical team manages pharmaceutical utilization, with a focus on traditional brand and specialty medications, to ensure appropriate use while alleviating potential waste. The end result is a win-win situation – we protect health care dollars while helping our members maintain healthier lifestyles.
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15
me PrimeTi Plan received
Year-End Review
H
2013
For more than a quarter century, AultCare has led the way in how local health care is delivered. AultCare is well positioned to manage the changing landscape of health care and continues our strong commitment to establish the standards for Service, Quality and Cost Control helping to improve the health of individuals we serve in Northeast Ohio.
Our Service Centers received over
7,500
4,000 hours
H3664_YER13_IA
$200,000 awarded in scholarships since 2002
4,200
calls per week
4,000
people attended AultCare meetings on Health Care Reform
99.9% Claims Processing Accuracy
people have had a screening at our Wellness Fairs this year
95%
Customer Retention Rate
COMMERCIAL PPO
COMMERCIAL HMO
MEDICARE HMO
5,400 2,200 20,000 More than
More than
Employers
PrimeTime Health Plan Members
Over
Employees have over
4St.a5rs
More than
g* n i t a R 4 01 for the 2
423,000 Covered Lives volunteered
O
an’s HM l P h t l a e
More than
Providers in our network
$728 Million in claims paid
* Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
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Retention
95%
Customer Retention Rate
AultCare’s Retention team is the communication pipeline between our company and approximately 1,800 commercial corporate clients. Our staff is in regular contact with our customers, providing answers to their questions, assisting in developing health plan strategies and providing guidance about new rules that may affect them. In particular during 2013, Retention focused on Health Care Reform education, making clients aware of the new regulations and pointing out options available to them. The unique challenge the Retention team has is to understand all of the many facets of AultCare’s operation and to be able to communicate them to a client in a meaningful way. AultCare’s customer service, positive communication and close relationship with its commercial corporate clients resulted in a 95% customer retention rate, compared to an approximate 75% retention rate nationwide.
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Sales AultCare Sales Monthly commercial sales for employer groups reached the highest point in the last six years, with approximately 2,200 new lives added to the AultCare insurance program in December for coverage beginning January 1, 2014. The previous single month’s high was 1,017 lives in December 2009. The AultCare Sales team collaborated with our occupational partners at AultWorks in order to offer products, services, and educational opportunities to both the arriving and existing oil and gas companies in our region. The AultCare Sales team worked closely with the region’s insurance brokers in order to design an educational series for those brokers that enhances their knowledge of our insurance product lines, enhances our relationships with the brokers and enhances communication between our sales division and the broker’s company clientele. Over the course of the year, 10 broker round-table breakfast meetings were held. This new initiative drew an audience of 60 brokers. Two broker education sessions were held, with 160 brokers attending.
PrimeTime Health Plan Sales Each year, from October through December, AultCare’s PrimeTime Health Plan participates in the national Annual Enrollment Period (AEP) for Medicare beneficiaries. Educational and informational meetings are held throughout the community; in addition, customers can personally visit our PrimeTime Health Plan offices during this enrollment period. Just before AEP AultCare’s Sales team implemented a comprehensive lead generation program in order to attract people who are aging into Medicare. Our aging-in strategies are designed to notify people about our products and services as Medicare coverage options. We have also contracted with Field Marketing Organizations (FMOs). These are companies that offer Medicare products through private exchanges. AultOne/AultCare Individual Product Sales The transformation of AultOne to AultCare Individual Product began in 2013. This change signifies that the plans meet all requirements of the Affordable Care Act (ACA). Our Individual Product also is offered in the Marketplace on the website Healthcare.gov. By using Healthcare.gov, individuals can research qualifications for an Advanced Premium Tax Credit (APTC), otherwise known as a subsidy. They also can learn about Cost Sharing Reduction plans, which can reduce deductible amounts. If applicable, either of these programs can assist with out-of-pocket costs. AultCare Individual Product has two different network selections. The Select Network is a smaller AultCare network, which consists of Aultman Hospital, Alliance Community Hospital, Union Hospital, Akron Children’s Hospitals, and the various providers associated with those hospitals. The standard PPO Network is a more expansive AultCare Network.
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PrimeTime Health Plan AultCare’s PrimeTime Health Plan is a Medicare Advantage program offered locally to Medicare beneficiaries who are seeking high-quality health care services, nurse-driven coordination of care and disease management, comprehensive Medicare pharmaceutical benefits, and premier personalized customer service. For 17 years, PrimeTime Health Plan has been a popular choice among Medicare beneficiaries who reside within our service area. We’re proud of our high retention rate, proving that PrimeTime Health Plan continues to be an attractive option for individuals seeking an alternative to Medicare coverage. Our sustained high-level of performance has been evidenced again this year by our award of a 4.5 Star Rating in our HMO product, and a 4 Star Rating in our PPO product for 2014, by the Centers for Medicare & Medicaid Services (CMS). CMS created the 5 Star Rating system for Medicare Advantage Plans to allow consumers to more effectively compare health plans, and to allow health plans to benchmark themselves against best practices. Medicare evaluates plans based on a 5 Star Rating system. Star ratings are calculated each year and may change from one year to the next. These ratings are cumulative indicators across a broad spectrum of measures, and represent the quality of care provided, health care access, plan responsiveness and member satisfaction.
As the 5 Star Rating system has evolved since its inception, CMS continues to raise the bar for further improvement, and PrimeTime Health Plan has responded by building a dedicated team and establishing a comprehensive management program to focus on each specific star measure. Our positive outcomes and final Star Ratings (4.5 for HMO; 4 for PPO, respectively) continue to confirm our high-value for our current members and provide a benchmark for prospective customers who are seeking an alternative to their Medicare coverage. PrimeTime Health Plan is a Medicare Advantage organization with a Medicare contract. Enrollment in PrimeTime Health Plan depends on contract renewal.
me PrimeTi Plan received O
4St.a5rs
an’s HM
Pl Health
*
ing 014 Rat 2 e h t r fo * 5 Star Rating system
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Providers AultCare continues to establish and maintain effective relationships with our network providers. The Provider Relations team communicates with physicians and their respective office staffs through individual visits, by telephone, email and at provider meetings. As health care continues to change, we recognize the many challenges our physicians face and strive to be a resource for them and their practices. The Provider Relations team meets one-on-one with network physicians and their staffs to address their inquiries and to provide educational materials regarding AultCare and insurance industry trends. The Provider Relations team also coordinates provider meetings throughout our local five-county area. Our network physicians and their staffs receive information regarding insurance industry updates, quality initiatives and AultCare operational updates. In 2013, AultCare held six provider meetings in Stark, Tuscarawas, Holmes and Wayne counties. An additional seven meetings specific to health care reform were held throughout Stark and Tuscarawas counties. These health care reform meetings were a great resource for our provider community as the reform deadline approached. Approximately 350 physicians and office staffs attended provider and health care reform meetings.
5,400 Providers in our network
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New Claims
Management System
Following a year-long comprehensive search for a new claims management system, AultCare received Board approval in 2013 to purchase three integrated pieces of software through Trizetto Corporation and began implementation planning. This software replaces AultCare’s systems. Health care reform, regulatory requirements, accreditation commitments and member health management present new technological challenges that require this approximately $10 million investment. AultCare expects to see benefits from automation, improved integration, and enhanced fraud, waste and abuse controls. This system will allow us to develop and administer products quicker, easier and more efficiently, thus improving our member care management. We plan to start converting by business product line in the fourth quarter of 2014 and continue into early 2015. This phased approach permits us to fine tune our business processes. It also provides flexibility in meeting customer needs.
More than
$728 Million in claims paid
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Aultman Hospital In 2013, Aultman Hospital launched services and enhanced collaboration to make our community Healthier, Together. The physician practice and employees of North Canton Medical Foundation joined Aultman Health Foundation; the physician practice was subsequently renamed Aultman North Canton Medical Group. Aultman Hospital welcomed the Akron Children’s Hospital pediatric inpatient unit, expanding on a five-year collaboration on outpatient pediatric specialty clinics at Aultman. Aultman also introduced its new retail space – The Shoppes at Aultman – featuring flower, gift and uniform shops, a retail pharmacy and convenience store. In addition, The Shoppes includes an image recovery boutique with skin care items, scarves, wigs and breast prostheses for patients fighting cancer – with private consultations and fittings available. The Shoppes is a project nearly nine years in the making, jointly funded by Aultman Hospital and The Women’s Board of Aultman Hospital.
Aultman Orrville Hospital has now been with the Aultman Health Foundation family for two years. Throughout 2013, Aultman Orrville increased efficiencies, improved care coordination through information technology, integrated programs and services, and added new physicians and practitioners to provide specialized, close-to-home care. Aultman Hospital received many accolades for the exceptional care it provides for patients in Stark and surrounding counties. For the 18th consecutive year, Aultman Hospital earned the “Consumer Choice Award” and was named Canton’s “Most Preferred Hospital for Overall Quality and Image” by National Research Corporation. U.S. News & World Report recognized Aultman Hospital as a high-performing facility in categories ranging from cardiology to orthopedics to cancer care. Aultman hospital received the 2013 Get With The Guidelines® Heart Failure Gold and Stroke Gold Plus Quality Achievement Award from the American Heart Association. These awards recognize Aultman’s commitment and success in implementing higher standards of heart failure and stroke care.
The Aultman Cancer Center started a survivorship program to support patients completing cancer treatment. The free service includes: a customized survivorship care plan including a treatment summary, follow-up instructions, information on long-term side effects of treatment and educational resources.
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The Patients’ Voice advisory council launched in 2013. The group, which includes Aultman Hospital patients and family members who volunteered to participate, meets monthly to provide feedback on delivery of care. The council is part of Aultman’s ongoing efforts to enhance the patient experience.
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Community Community Relations The thread that weaves together all AultCare divisions is the staff. Together they form the fabric that makes our business strong. This common thread has an uncommon quality – its source is the communities it serves. It is important, to AultCare employees that they and their company give back to the community in which they live, and they do this generously and frequently.
• Assisting teachers and reading to children at Interfaith Child Development Center
In 2013, AultCare employees:
• Donated $52,000 to United Way
• Raised more than $11,000 for the Junior Achievement Bowl-a-Thon • Donated 166 pints of blood to the Aultman Blood Center, the equivalent of about $33,000 in cost savings • Donated over $3,500 for Wishes Can Happen Radiothon - which corporate matched • Donated nearly 200 pounds of non-perishable food during the Thanksgiving Food Drive • Conducted a toiletry drive for Samaritan’s Table • Served hot meals at Samaritan’s Table - a division of Community Services of Stark County • Donated shoes for homeless men at the Refuge of Hope Shelter • Donated clothes to benefit children attending Massillon City Schools
•
Participated in and raised money for community health walks: American Cancer Society Relay for Life, Juvenile Diabetes Research Foundation Walk to Cure Diabetes, American Heart Association Heart Walk and Susan G. Komen Making Strides
• Made monthly donations of personal care items for underprivileged individuals in Canton • Participated in National Make A Difference Day • Operated snack shops throughout the year to raise money to adopt families and individuals for Christmas
• Participated in the United Way Day of Caring
• Painted at Alliance Domestic Violence Shelter • Painted shelter dining room and playroom, and disinfected toys at Domestic Violence Project, Inc. • Adopted 16 families from the Community Christmas Adopt-A-Family program
AultCare culture encourages volunteerism and service to the community.
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During the Fourth Annual AultCaring in the Community Campaign, 157 employees participated in 18 projects, volunteering approximately 450 hours, including:
• Assisting clients in preparing for annual Mothers’ Day Fashion Show at J.R. Coleman Adult Day Care • Trimming shrubs, weeding and mulching the playground at Exploration Gateway (Stark Parks) • Repackaging bulk food for distribution to area food pantries at Akron Canton Regional Foodbank • Serving hot meals and helping with clean up at Canton Calvary Mission • Providing love and attention to animals at Stark County Humane Society • Weeding and mulching the grounds and painting picnic tables at The First Tee of Canton
AultCare and its employees care for the community. They spent their personal time volunteering for such organizations as the American Heart Association, Louisville CARES Walk, Boy Scouts of America, Louisville YMCA, Boys’ and Girls’ Clubs of Massillon, Making Strides Against Breast Cancer, C.O.O.L. organization, Marlboro Volunteer Fire Department, Canton Challenger Baseball League, Meals on Wheels of Stark and Wayne counties, Canton Palace Theatre, National Multiple Sclerosis Society, Child and Adolescent Behavioral Health, Pathway Caring for Children, Pro Football Hall of Fame Festival, Domestic Violence Project, Inc., Stark County Humane Society, Girl Scouts of America, Stark County Board of Developmental Disabilities, Greater Stark County Urban League, The First Tee of Canton, Habitat for Humanity of Greater Stark and Wayne Counties, Tuscarawas County Humane Society, Hammer and Nails, United Way of Greater Stark County, Hope Remains, Wishes Can Happen, Junior Achievement of East Central Ohio, yStark!, in addition to a host of local churches and schools. AultCare is Where You Matter to each one of us.
• Painting floors and walls at The Stock Pile Reuse Store • Prepping and serving hot meals at Massillon Salvation Army • Painting a mural at Independent Living Center for foster children at Pathway Caring for Children • Crocheting hats and scarves to donate to Monroe Community Center •
Adopting the Multi-Development Services of Stark County (MDS) at Christmas time, raising over $600 during a Penny War and using the funds to purchase food for their Christmas party, as well as purchasing discount store gift cards to distribute to the families, and purchasing Christmas gifts for clients’ children
Employees have
volunteered over
4,000 hours
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We help our communities become stronger
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and healthier by giving generously!
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2600 Sixth St. S.W. • Canton, Ohio 44710 330-363-6360 • 1-800-344-8858 www.aultcare.com 015/13