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From Our President
4
Physician Leadership
5
Anniversary Celebration
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AultCare 30
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30 Acts of Kindness
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Team Spirit Awards
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Year-End Review
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Quality - PrimeTime Health Plan
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Care Coordination - Utilization Management - Patient Centered Medical Homes/Case Management - Disease Management - Wellness - Pharmacy
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Service - Customers - Transparency - Employers - Providers - Aultman Hospital - Brokers
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Workers’ Compensation - AultComp TPA - AultComp MCO
From Our President AultCare - 30 Years
Thirty years have come and gone and it is remarkable to have witnessed the growth and success of AultCare as a health care company. This year, our employees had the privilege to celebrate 30 years in the health care field. This occasion provided us with a unique opportunity to pause and reflect on all of our great accomplishments. Not only did we reminisce about the past, but we recognized the great achievements of the present. This annual report will bring to light the many successes of our anniversary year and how we hope to continue these traditions for the next 30 years. Teamwork has been a steadfast theme throughout our 30 years as an organization and it continues to remain an integral principle in our culture with nearly 500 employees. AultCare and its 30 years of
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leadership in health care have been built upon the teamwork and individual skills and talents of our AultCare team. The unity of our teamwork has allowed us to be at the forefront for offering efficient health care to our community. Additionally, our commitment to teamwork has helped us provide excellent customer service, quality and cost effective health care planning, which is at the standard core of our philosophy. As a competitor in the health care market, AultCare has grown to become an incredibly valuable asset to the Aultman Health Foundation and our community. We have continued to keep our costs lower than other areas in Ohio through our cost effective and high quality network. Our margins are smaller than national plans because we have accountability to our local community of individuals and employers.
Therefore, AultCare continues to focus on enhancing our networks and growing our enrollment, all while maintaining our quality service. While we have many milestones to celebrate, we realize that the market landscape creates new challenges. We will welcome these challenges and we will continue to emphasize our core philosophy and value proposition to our companies and individuals. As we strategically look forward to 2016, AultCare will use its data resources to support the integration of its service, care coordination and cost control models for employers and individuals to best manage their health and health care costs at the appropriate levels of care. In part of our initiative with Population Health, we will utilize the use of effective provider networks, transparency tools and an overall integration of
services in order to keep costs competitive in our market. We will work diligently to deliver this value proposition as we operate on smaller revenue margins than our national competitors. AultCare had a great anniversary season as we celebrated 30 years of successes, and we now look ahead to exciting times in the health care field. Inside these pages is our playbook of how AultCare, as a team, has remained a steadfast, national leader in the health care industry.
Rick L. Haines President and CEO
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Physician Leadership AultCare - 30 Years
AultCare’s Physician Leadership provides medical guidance, oversight and direction on our Care Coordination programs including Utilization Management, Case Management, Disease Management, Pharmacy and Quality programs.
DR.HUMPHREY
DR.FERGUSON
DR.ALFORD
DR.RICH 4
DR.HABAN
DR.SAMAAN
DR.MARVIN
DR.WAKULCHIK
DR.WYMYSLO
Anniversary Celebration AultCare - 30 Years
30 n n i v e r s a r y th
As we gathered to celebrate our 30th anniversary, AultCare was most proud to celebrate our outstanding employees. Since AultCare’s inception, our employees have remained faithful to our company as we have grown to become a respected and leading health care organization in the industry. It is because of our employees’ relentless efforts that AultCare has been privileged to receive many awards and accolades. AultCare opened its doors for business on May 30, 1985 and on May 30, 2015, AultCare employees and their families celebrated our 30th anniversary
in style. As the Pro Football Hall of Fame’s football legends welcomed our legendary employees, the stage was set to celebrate everyone who has made an impact with the success of AultCare. As employees enjoyed a picnic style lunch, children showed their athletic spirit as they played games of football, frisbee and corn hole with family and friends. As the day went on, everyone had the chance to explore the deep history of the National Football League as they toured the Pro Football Hall of Fame. It was a beautiful day filled with the celebration of AultCare’s deep roots and dedicated employees.
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Anniversary Celebration AultCare - 30 Years
AultCare kicked off the anniversary year by celebrating our quality measure recognitions. All of our employees worked tirelessly to meet the standards set forth by The National Committee for Quality Assurance (NCQA) and The Centers for Medicare & Medicaid Services (CMS). All employees were treated to lunch served by the executive staff and directors. In the midst of good company and our appreciation, employees had fun dressing up to show their enthusiasm for their co-workers and workplace.
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The sun hadn’t risen yet, but AultCare employees eagerly gathered early in the morning to participate in a one of a kind celebration: The TimkenSteel Grand Parade! In conjunction with the Pro Football Hall of Fame Enshrinement festivities, AultCare employees proudly wore their AultCare football jerseys as they walked down the parade route guiding a giant helium birthday cake as we continued to celebrate our anniversary. The atmosphere was electric as employees waved at the football enthusiasts and ran around, spinning the balloon, to please the many loud chants from the spectators.
Our 30th anniversary was one that held special memories for all of our employees, as it was a time to step back and recognize the great compilation of work that has been appreciated by so many. AultCare looks forward to the next 30 years as we continue to applaud our employees for their outstanding contributions.
AultCare 30 AultCare - 30 Years
“A simple act of kindness can make a tremendous impact on a person’s life.”
In continuing with our 30th anniversary theme, AultCare wanted to recognize community advocates who embody the values of service, dedication and commitment, all of which AultCare deeply values. For 30 weeks, nominations were accepted and a total of 30 community men and women were acknowledged for their outstanding contributions to our community. The AultCare 30 honorees were treated to a special luncheon where their efforts and contributions were recognized. A sense of inspiration filled the room as honorees shared their inspiring journeys and
stories. Our honorees were nothing short of persistent as they educated kids on the importance of anti-bullying through music and provided hundreds of Thanksgiving Day meals to deserving community members. Others distributed backpacks full of school supplies to every student in select elementary schools, opened doors as a safe haven for women in need and hosted a non-profit fair for students to learn about the significance of giving back to their community. AultCare congratulates these community members who always go above and beyond to help make our community a better place.
30 Honorees Cyndi Morrow Judge Frank Forchione Velma Bridges Holly Bantum
Dave Smithberger Elsa Cave Cliffie Thompson Heather Rhiel
Heather Craig
Jenifer Hill
Angi Shumate
Jim Motley
Sarah Kropf
Cindy Bishop
Kevin Nisly
Paul Toalston
Alivia Hershberger
Tricia Dever
Elec Simon Madelyn Sweeney Debbie Hailstone Larry Thorne
Dr. Brady Kail Bev Riske Dale Batdorff Lisa Vitale Arnold
Margaret Reaves
Jill Miller
Donald Schenck
Lisa Warburton-Gregory
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30 Acts of Kindness AultCare - 30 Years
“Over 250 employees teamed up for volunteer projects.” AultCare’s philanthropic efforts have remained an integral part of our company’s principles and for our anniversary, we wanted to express our immense gratitude toward our community in a grand way. Throughout the entire year, AultCare’s 30 Acts of Kindness initiative teamed up with non-profit organizations across Stark County to show our appreciation for their support. Over 250 employees volunteered their efforts in a large variety of volunteer projects. Suited up in their 30th anniversary football jerseys, employees had a great time giving back to the community. Employees served meals and distributed groceries at the Canton Calvary Mission, set up craft
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activities and games for First Friday in conjunction with United Way of Greater Stark County and landscaped the beautiful gardens of Sippo Lake. Employees also collected donations for the eighth annual AultCare Wishes Can Happen Wish-A-Thon, painted outdoor facilities at Pathway Caring for Children and they ended the year with a fierce Thanksgiving food drive competition for the Stark County Hunger Task Force.
Team Spirit Awards AultCare - 30 Years Courtnay Cruise
Chris Fearon Strasburg
New Philadelphia
Hunter Goudy
Jennifer Hamit
Shelby Harp
Tiffany Hildebrand
Madeline Jones
Matthew Kennell
Allison Kenney
Bryar Knight
Noah Lee
Zachary Livengood
Connor McCready
James Miller
Kennady Miller
Alex Mills
Ryan Morr
Jordan Myers
Caleb Pasiuk
Torrie Romigh
Adrienne Sarbaugh
Andrew Savage
Triway
AultCare was proud to recognize 40 graduating, high school seniors in 2015 through our scholarship program. The AultCare Team Spirit Scholarship embodies the impor tance of teamwork, leadership and dedication in our future leaders. AultCare believes these qualities exemplify the true spirit of what is takes to become a leader in our community. For the 30th anniversary, AultCare was able to expand its scholarship program and present a scholarship to one high school senior from every high school in our five county service area.
Fairless
Indian Valley
Timken
Northwestern
Benjamin Badock
Ashley Caldwell Claymont
Rittman
Minerva
West Holmes
Carrollton
Dalton
McKinley
Perry
Darnell Crider-Harris Newcomerstown
Central Catholic
Lake Center Christian
Nathan Smith
Maurine Speight Northwest
Brennan Coil Hiland
Wooster
St. Thomas Aquinas
Hannah Tesch
Katie Truxall
Delaney Vahila
Marshall Vick
Evan Walsh
Zachary Zablo
Nicholas Zaccone
Mollie Stokes
Darian Covey
Orrville
Alliance
Lake
Canton South
Hoover
Sandy Valley
East Canton
Dover
David Bates
Chippewa
Riley Benson
Garaway
Massillon
Marlington
Malvern
Miranda Crowl Tuslaw
Louisville
Tusky Valley
Jackson
GlenOak
“Forty high school seniors received a scholarship.� 9
PrimeTime Health Plan’s HMO Plan received Year-End Review
2015
For over 30 years, AultCare has been a leader in the field of health care for our community. Our founding principles of superior customer service, quality and low cost remain an integral part of our philosophy as we continue to move forward in the ever changing health care field. This keeps AultCare positioned to pioneer the way health care is delivered to those we serve in Northeast Ohio.
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Local Scholarships Awarded
4.5 Stars for the 2016 Rating*
433,000
Covered Lives
Over
1,000 Employee Volunteer
Hours
10
Our Service Centers received over
358,000 Calls
More than
$680 Million
in Claims Paid
99.8%
93%
Customer Retention Rate
25
Patient Centered Medical Home Offices
Claims Processing Accuracy
More than
20,900 PrimeTime Health Plan Members
COMMERCIAL PPO
COMMERCIAL HMO
5,500 Providers in our Network
MEDICARE HMO
EXCHANGE PPO
* 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 NCQA seals represent NCQA Health Plan report card year 2015-2016.
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Quality AultCare - 30 Years
Throughout the many changes of the health care system, AultCare’s commitment to quality standards remained steadfast as was evident through our multiple accolades and recognitions. The National Committee for Quality Assurance (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. HEDIS® is a registered trademark of the National Committee for Quality Assurance.
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All four of the organization’s product lines held NCQA Accreditation, including Commercial PPO, Commercial HMO, Marketplace (Qualified Health Plan) and Medicare. Our Medicare product earned the highest Accreditation status of Excellent. Our Commercial PPO and Commercial HMO products earned the Accreditation status of Commendable and are only 2 of 4 commercial plans in the state of Ohio to have that designation or higher. Our Marketplace (Qualified Health Plan) earned the Accreditation status of Accredited, which is the highest Accreditation status possible for a Marketplace plan for the 2015-2016 Accreditation year.
In addition to Accreditation, NCQA annually releases the NCQA Private Health Insurance Plan Ratings and Medicare Health Insurance Plan Ratings. NCQA’s Private Health Insurance Plan Ratings rated our Commercial HMO (AultCare HMO) plan a 4.5 out of 5, and is the only private (commercial) plan in the state of Ohio to be rated a 4.5 or higher for 2015-2016. NCQA’s Medicare Health Insurance Plan Ratings rated our Medicare HMO-POS (AultCare Health Insuring Corporation) a 4.5 out of 5 for 2015-2016, and is only 1 of 3 Medicare plans in the state of Ohio awarded a rating of 4.5 or higher.
PrimeTime Health Plan AultCare’s PrimeTime Health Plan division continued to sustain a high-level of performance by being recognized with a 4.5 Star Rating in our 2016 HMO-POS product by the Centers for Medicare & Medicaid Services (CMS) for the third consecutive year. PrimeTime Health Plan is an HMO-POS plan with a Medicare contract. Enrollment in PrimeTime Health Plan depends on contract renewal. 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.
CMS created the 5 star rating system for Medicare Advantage plans. CMS 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 based on specific indicators across a broad spectrum of measures and they represent the quality of care provided, health care access, plan responsiveness and member satisfaction.
Created to allow consumers to more effectively compare health plans and to allow health plans to benchmark themselves against best practices,
For the second year in a row, U.S. News and World Report recognized AultCare’s PrimeTime Health Plan as one of the best Medicare Advantage Plans in
Since its inception, the 5 star rating system has evolved and CMS continues to raise the bar for further improvement. PrimeTime Health Plan has responded proactively by building a dedicated team of knowledgeable Medicare specialists and establishing a comprehensive management program to focus on specific star measures.
the state of Ohio. U.S. News and World Report gathered information from CMS to assist in determining its Medicare award recipients. In order to be recognized, Medicare Advantage plans needed to have earned at least a 4.5 star rating and all of the insurer’s plans in the state had to earn at least 3 stars. These criteria assured that all companies maintained consistent quality standards throughout all plans. This award is not affiliated or endorsed by CMS.
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Care Coordination AultCare - 30 Years Through a collaborative approach, AultCare’s Care Coordination Department combines Utilization Management, Case Management, Disease Management, Wellness and Pharmacy to provide a comprehensive approach to health care. Our team offers management of individual complex cases, tracks and manages utilization of medical systems and coordinates disease and pharmacy management. Our proactive approach toward patient-centered care utilizes available resources to promote quality and cost-effective outcomes. In 2015, the Care Coordination Department had 197,652 member interactions which encompassed services such as: prescription referrals, Case Management and Disease Management referrals, evaluations and mail and phone correspondence.
Utilization Management AultCare’s Utilization Management Department continued to evaluate the necessity and efficiency of health care services and facilities. The Utilization Management Department started to prepare for the implementation of Clear Coverage™. This product
is a point-of-care platform that will allow providers to submit authorization requests online to receive real-time approval or the request will be queued for clinical review. By streamlining the prior authorization process, the Clear Coverage™ program will assist with the medical review process as well as eligibility verification. Medical staff will be able to focus their efforts on other tasks as the clinical and coverage guidelines will be transparent to providers in real time. This product is in the early stages of configuration and it is set to rollout in April 2016. In an effort to streamline Utilization Management, Case Management, Disease Management and Pharmacy workflows through the configuration of business rules, the Clinical Care Advance medical management systems were implemented to allow for the automation of processes and the integration of data in separate systems. Greater cost control and care management improvement are all possibilities through this medical management application.
The Utilization Management Department continued to be committed to educating our members through education outreach initiatives. Utilizing an educational program called EMMI, our team reached out to members with chronic illnesses, as well as, those members that may have been acutely ill or may have had routine procedures performed. This outreach opportunity gave our employees the chance to issue educational articles pertaining to a member’s specific health care needs, thus empowering members to take ownership of their care. Of t h e member education that was sent via email, 99% of the m ater ial s were acces s ed and completed by the member.
Patient Centered Medical Homes/ Case Management Through our Patient Centered Medical Home (PCMH) and Case Management Programs, enrollees have access to Case Managers who support and act as a resource to assist with navigating the complex health care system. Our Case Managers provide education on chronic and acute conditions as well as provide assistance with community resources to ensure our enrollees’ needs are being met.
“Our team offers management of individual complex cases, tracks and manages utilization of medical systems and coordinates disease and pharmacy management.” 14
The PCMH program is a primary care model of health care that facilitates partnerships between patients, primary care physicians and other health care providers and AultCare. Improving the quality of care and the health of patients are some of the goals the PCMH program strives toward. Our program is focused around the concept of providing primary care that is patient-centered, comprehensive and coordinated. Additionally, the program is committed to high standards of quality and safety. In 2015, the PCMH program expanded to include 25 physician offices with over 75 participating physicians. In 2015, the Patient Centered Medical Home and Case Management programs offered outreach to thousands of our enrollees. The Case Management Department typically works with members who may have a newly diagnosed cancer, a catastrophic illness or injury or a complex case requiring an out-of-network specialist. Other programs offered through the Case Management Department include Home Safety, Welcome Home Baby and the PrimeTime Post Discharge Visit.
Disease Management The Disease Management Department continued to move forward with initiatives to educate our members and community on the services available to improve their health. Disease Management focused their efforts on three tiers: Bi-Annual Disease Management mailings, preventive outreach and active disease management. Through their first initiative, Disease Management nurses reviewed claim information, searching for a targeted diagnosis. Different diagnoses may have included diabetes, mental health, congestive heart failure and COPD. Members identified with these health concerns received a mailing introducing the disease management opportunities available to them. Members were encouraged to call one of AultCare’s Care Coordination nurses to inquire about more information concerning our programs. In the second tier, AultCare nurses used a proactive approach by contacting members about preventive
care reminders. Nurses discussed the multiple education programs available, which may have consisted of preventive screenings, adherence follow-up, medication follow-up and improved overall outcomes. In this tier, Care Coordination nurses worked closely with our Patient Centered Medical Home offices. PCMH offices have already established close relationships with their patients and through this initiative, we were able to educate another section of our population. Lastly, the third tier consisted of active disease management practices. Nurses took a referral and identification based approach to identify members who were candidates for our telehealth Disease M a n a g e m e n t p ro g ra m s. O u r C a rd i o C o m ® , GlucoCom® and Chronic Care Improvement Program (CCIP) programs are designed with an integrated and comprehensive approach to manage conditions, reduce complications, improve quality of life and decrease costs. These educational programs are an extension of the multiple resources available to our members to help improve their health.
“The Case Management Department typically works with members who may have a newly diagnosed cancer, a catastrophic illness or injury or a complex case requiring an out-of-network specialist.” 15
Wellness
Pharmacy
AultCare’s Wellness Program is an example of Population Health Management at the employer level with a focus on prevention and care management of all enrollees. The AultCare Wellness Program is supported by effective outreach, education and collaboration with physicians and hospitals, plan design control and integrated systems. With the added support of our Care Coordination program, Wellness participants are educated on the importance of primary care physician engagement and adherence.
New to AultCare’s Pharmacy Department was the Medication Therapy Management (MTM) service. Offered to both AultCare and PrimeTime Health Plan members, MTM is a patient-centered, comprehensive approach to improving medication use and medication adherence and reducing the risk of adverse events by alleviating potential drug interactions.
Our Wellness program was designed in such a way that our Wellness clients are able to choose the options that are best suited for their unique needs. The foundation of our program provides all participants with the care coordination essentials they need, while the education programs and consulting and coaching levels give members the opportunity to choose from many different options. Through our one-of-a-kind, personalized experience, we have a team of clinical and non-clinical staff including professional consultants, a registered dietician, a personal trainer, a tobacco cessation specialist and registered nurses.
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T h e M T M s e r v i c e, o f f e re d t h ro u g h c o m mu n i t y pharmacists and individual meetings, is held where members bring their prescription medicines, over the counter medicines and herbal medications. During these one-on-one visits, the members’ medications are assessed and members are able to take away a new medication list and an action plan to fit their lifestyle. As part of AultCare’s Care Coordination program, AultCare’s Pharmacy Benefit Management team continued to strengthen through its integration of medical and pharmacy management. Additionally, members on specialty medications received direct referrals to our Case Management Department and to other sectors of our Care Coordination program based upon their needs.
The Pharmacy Department accomplished many milestones for both the commercial and Part D lines. Our Pharmacy Benefit Management team processed approximately 970,000 claims in our commercial line and 670,000 claims in our PrimeTime Health Plan line. Also, our Generic Dispensing Rate (GDR) was >85% in commercial and >88% in Part D. The Pharmacy Benefit Management team continued to encourage generic utilization with appropriate brand and specialty utilization to best serve our members with a high value of health care. AultCare’s PrimeTime Health Plan Part D plan was awarded a 5 star rating from the Centers for Medicare & Medicaid (CMS). The Part D plan was rated in four categories: customer service, member complaints, member exper ience with dr ug plan and dr ug pricing and patient safety. 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. In addition, our commercial plan launched a customer select specialty network. Also, both teams added formulary management tools to help ensure appropriate treatment regimens throughout all product lines.
Service AultCare - 30 Years Customers
Transparency
AultCare understands that the administration of health benefits becomes more complex each year for both individual enrollees and employers. In some cases, the more choices customers have, the more difficult it is to make a decision. It is a part of our corporate culture to help customers understand their choices. All of our employees strive to provide an extra, personalized touch through all of our member interactions, whether it is on a phone call or a visit with us in person.
As the health care industry continues to evolve, AultCare continued to look for opportunities to provide new ways for our members to get the most from their health care. Our newest tool, the AultCare Medical Cost Estimator, was designed to give members an estimate, with the consideration of their deductible/out-of-pocket expenses, as to what members can expect to pay for a wide variety of services and procedures in-network. Additionally, the Medical Cost Estimator was designed to empower our members to take control of their health care decisions as they compare physicians, hospitals and facility charges. Currently, the Medical Cost Estimator is available to our commercial members. As we continue to improve, AultCare will expand the usage of the tool, adding different procedures and services for a cost comparison.
AultCare’s Retention Department is the main contact point for our employer groups and brokers. The Retention Department’s main function is to direct the communication between clients and AultCare to ensure we are providing the greatest possible value to our customers.
• Percentage of people abandoning calls to Customer Service was 2.5%
Employers
Providers
•
Over 2,000 employer groups, covering 130,000 medical lives, rely on AultCare to provide group health plan products and guidance on those products. It is an organization-wide effort to meet the daily needs of these employer groups along with their employees and dependents.
AultCare continuously strives to maintain respected relationships and that commitment is carried out to our network providers. Through individual visits, telephone and email correspondence, provider newsletters and provider office meetings, AultCare’s Provider Relations staff offered individualized communication outlets as a health care resource.
AultCare’s commitment to customer service is also demonstrated through a number of metrics which we monitor daily. Here are a few results from our customer service metrics from 2015:
• Average time a member was on hold was 28 seconds
Same day call resolution was 90%; this is the minimum goal for AultCare to resolve members’ issues, questions or concerns in the same day they were received
In 2015, the implementation and application of the Affordable Care Act continued to be a major focus for our clients and our Retention Department. Population Health, Care Coordination and Patient Centered Medical Homes continued to evolve requiring ongoing education, communication and strategy development. These ongoing initiatives and our ability to demonstrate value in the forms of service, outcomes and cost control helped AultCare achieve a 93% retention rate in 2015.
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With each day, new health care topics and initiatives were brought to the forefront and our Provider Relations staff was available to provide educational materials. The staff also offered to meet with physicians and staff one-on-one to help relieve any challenges that may have presented themselves with new AultCare initiatives or new insurance industry trends.
making sick people better. Aultman is collaborating with its network of health care providers and community resources to offer patients seamless, coordinated care. Aultman also encourages community members to take active roles in their health and wellness by providing everything from free health screenings to educational classes to online risk assessments.
A large part of our network provider outreach consisted of coordinated provider office meetings throughout our service network. This opportunity allowed network physicians and their staff to become acclimated to new information regarding insurance industry updates, quality initiatives and AultCare operational updates. For 2015, key communications included our PrimeTime Health Plan system conversion and ICD10.
Brokers
Aultman Hospital Aultman Hospital continued its transition to a model of health care delivery and care coordination called Population Health. In its simplest terms, Population Health aims at keeping healthy people well and
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Despite the ever changing health care climate, our broker relations remain consistent due to our constant communication channels. AultCare broker liaisons frequently organized meetings, roundtables and mid-year reviews to educate our brokers and consultants on the latest health care topics and AultCare advancements. A new service AultCare introduced to our broker community was the Online Quote Tool. As defined by the Affordable Care Act, small businesses are identified as employer groups with 1 to 50 eligible employees, which have a predetermined rating structure. In a few short steps, these employer
groups and their brokers can review Qualified Health Plan (QHP) pricing quickly and efficiently with the Online Quote Tool. Now groups can easily enter their information online and our resource tool will provide small employer group premium calculations. Additionally, employer groups can be directed to the federally facilitated Marketplace to determine if they qualify for insurance affordability programs including premium tax credits and cost sharing reductions. Furthermore, we initiated a new product as an option for employer group sizes 25 to 99 under a fully insured plan. For new small employer groups to AultCare, the Small Cap Product was constructed specifically for these groups who would like to take advantage of self-funding options. The Small Cap Product was designed to have a low risk maximum plan cost with multiple safeguard protections built in, making this product appealing for small employer groups.
Workers’ Compensation AultCare - 30 Years
AultComp TPA
AultComp MCO
AultComp TPA is a workers’ compensation third party administrator (TPA) that incorporates AultCare’s core principles of personalized customer service, quality and low cost. AultComp TPA represents group-rated, state-funded and self-insured employers, including the management of claims amongst Stark County’s largest employers. With an average of more than 18 years of experience in the industry, our claims managers work diligently to provide services to these employers. Services include indemnity processing, medical bill payment and government reporting. Additionally, AultComp TPA offers case management, hearing attendance and repor ting services to help state-funded employers become eligible for a group rating.
For 18 years, AultComp MCO has been committed to assisting employees with their workers’ compensation claims. AultComp MCO is a workers’ compensation managed care organization, contracted with the State of Ohio Bureau of Workers’ Compensation (BWC). Our statewide certification allows us to manage claims for employers located in all 88 Ohio counties, working with any provider that is enrolled as a BWC certified provider.
Over the past three years, the number of group rating clients served by AultComp Administrators has grown about 70%. Additionally, our pharmacy program enables self-insured clients to save, on average, more than 35% on prescriptions in com p ar ison t o t h e B u re a u o f Workers’ Compensation fee schedule.
AultComp MCO received full accreditation from the Utilization Review Accreditation Commission (URAC) in Case Management version 4.0. This URAC accreditation confirms to our injured workers and employers that they are receiving the best standards of practices through their workers’ compensation claims. Currently, AultComp MCO is in a reaccreditation process for URAC Case Management version 5.0. AultComp MCO’s persistence and commitment to deliver excellent service was recognized by the annual BWC report card for 2015. AultComp MCO was recognized as the best managed care
organization to assist injured employees in their return to work after an injury.1 Additionally, AultComp MCO was rated number one in First Report of Injury Timing (FROI).2 AultComp MCO encouraged employers and injured workers to file claims quickly, which resulted in a quick turnaround time for the injured workers to receive medical treatment and focus on their safe return to work. This efficient turnaround process saved our employers money as we started the process quickly and completed it in an efficient manner. Looking ahead to 2016, AultComp MCO’s recently completed system conversion for the claims management process will greatly enhance claims management and billing. As part of this conversion, AultComp MCO will have more efficient reporting and audit capabilities. Additionally, AultComp MCO will be able to provide more proficiencies in the treatment pre-certification and bill payment processes. 1
2015 BWC Report Card
2
2015 BWC Report Card 19
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