2014
Health Alliance Medical Plans —Not Just Another Payer When it comes to insurance carrier relationships for your organization, we’re not just a payer.
Health Alliance Medical Plans is your Strategic Partner. Health care systems across the nation are seeking an insurance strategy that will help mitigate shrinking government reimbursements and facilitate a smooth transition from fee-for-service payment to value-based payment. Health Alliance Medical Plans is a leader in fostering partnerships that allow providers greater control over costs and revenue while creating value for the provider, the payer and the patient.
History
We are Rooted in Health Care Delivery Health Alliance started as a commercial HMO established in 1980 by Carle Clinic Association, a multi-specialty physician group practice in east central Illinois. These physicians had the foresight to understand that managed care and risk-sharing were their best opportunities for determining their own destiny. The State of Illinois saw the value of working with Health Alliance to advance its managed-care strategy for state employees. By creating joint ventures with dominant providers in locations with large numbers of state employees, Health Alliance grew its membership and locked in a patient base for its provider partners. From there, provider systems in other states saw the wisdom in aligning with a health plan that understands the provider viewpoint. Seeing the growing influence of government payers on the health care industry, Health Alliance and its provider partners took a leadership role in being selected to participate in the first Medicare+Choice managed care demonstration project, which led to the current Medicare Advantage program. By sharing risk, providers can increase their opportunities when they manage care and revenue carefully. The Affordable Care Act (ACA) and resulting expansion of Medicaid has further strengthened government payer influence, and Health Alliance continues to pursue strategic opportunities in this area. Today, Health Alliance is known nationally for quality, innovation and successfully helping providers navigate the unsettled waters of health care payment. As Health Alliance grew and evolved, so did its parent company. Carle Clinic Association and Carle Foundation Hospital formed a fully integrated health system in 2010, and ownership of the health plan was transferred to The Carle Foundation. This has reinforced the strategic goals of partnering with other like-minded provider systems.
Leadership
Executive and Clinical Leadership Health Alliance has an outstanding leadership team with more than 150 years combined experience in every area of health insurance and health system administration. Jeff Ingrum has served as CEO for Health Alliance since 1997, and several members of our senior management team boast more than 25 years with us. With expertise in care management, risk stratification, technology systems, pricing, network contracting, pharmacy benefit management and more, Health Alliance partners have a team of experts at their disposal who can help align clinical and financial outcomes for the benefit of all stakeholders.
We Embrace Innovation Health Alliance has a reputation for breaking new ground. This can take the form of new product development, new lines of business, clinical interventions or unexpected partnerships. Our guiding philosophy is aligned incentives, which fosters quality care, provider success and patient satisfaction.
Diverse
Adapting to the Environment The ACA has significantly changed the marketing environment for health plans. Health Alliance has quickly adapted by taking advantage of new distribution channels. The traditional broker relationships have been augmented by development of a proprietary private exchange, participation in public exchanges, participation in select third-party private exchanges and captive agents.
Diverse Offerings Keep Us Current Health Alliance offers multiple products, lines of business and opportunities for all kinds of insurance buyers.
Individual HMO POS PPO QHPs ASO Dental
Coming soon
Vision
Coming soon
Medicare Advantage HMO Medicare Advantage PPO Stand-Alone PDP Medicare Supplement Medicaid
Small Group
Large Group
Coverage
Our Reach Extends Beyond Our Boundaries Health Alliance has created provider partnerships well outside the borders of its parent health system. We supplement our reach with rental provider networks like HealthLink, Encore, Midlands Choice and PHCS.
Illinois
Champaign-Urbana is the location of our headquarters, and we have created relationships with health care providers throughout the state. Health Alliance is synonymous with quality health insurance in Illinois.
Iowa
We’ve been a presence in Iowa for the last decade, offering small and large group plans in various counties. And significant expansion is planned for the coming year.
Washington Our partnership with Wenatchee Valley Medical Center (now Confluence Health) in north central Washington got off to a great start this year with Medicare Advantage. We look to move into other lines of business, including groups and individual plans, in the coming years.
Nebraska Our entry into Nebraska began with Alegent-Creighton Health in the Omaha area, offering Medicare Advantage, individual and group plans. Further expansion of the service area is planned for the coming year.
Satisfaction
Stakeholder Satisfaction Matters The key to our success is our stakeholders’ satisfaction. From providers to members to employer groups, we exceed expectations and deliver on our promises.
Consistently High Provider Satisfaction We’re a health plan that understands provider expectations.
Satisfaction: Percent Satisfied/Very Satisfied with Health Alliance 2014
2009
92.4%
2010 2011
91.5%
2012 2013 2014
90.4%
91.5%
92.4% 92.3%
Members have ranked us in the top 10 percent nationally for nine of the last 10 years. Satisfaction: Members’ Rating of Health Plan 2014 Health Alliance
80.2%
National Avg.
66.2%
90th Percentile
78.3% Percent rating 8, 9 and 10 on a scale of 0–10
Employer Groups drive a large part of our business and their satisfaction is important.
79.6%
75.1%
Satisfied overall with Health Alliance
Two or more years served
69.8%
76.9%
Likely to recommend
Likely to renew
Quality
Efficient and Accurate
We focus on using scalability to create efficiency with our claims processing. More than 4 million claims adjudicated annually 99.8% financial accuracy 82.2% member satisfaction 91.5% provider satisfaction
With smart technology, our call centers maintain a reputation for being accurate and timely because we set high standards of service. 81.8% of our employer clients say their Health Alliance account representative quickly resolves any problems. 80% of calls are answered within 30 seconds, with less than 4% abandonment rate. 99.6% of the time, our Customer Service reps resolve member issues on the first call.
Provider-Payer partnership ensures quality that stands the test of time and change. The National Committee for Quality Assurance (NCQA) is the gold standard of accreditation across all health plans. Health Alliance ranks high year after year. #1 Private HMO/POS in Illinois and Iowa* #55 of 474 plans nationally, ranked by NCQA #1 Medicare PPO plan in Illinois** #33 of 395 plans nationally, ranked by NCQA • Three-year “Excellent” accreditation granted in October 2012 for HMO/POS and Medicare HMO • Highest possible accreditation since March 1997 for HMO/POS plans * Based on NCQA’s Private Health Insurance Plan Rankings 2013-2014. ** Based on NCQA’s Medicare Health Insurance Plan Rankings 2013-2014.
Technology
We Invest in the Technology Needed to Succeed Along with more than three decades of experience in the health insurance industry, we have the technology to meet ever-changing customer and regulatory demands. We make judicious investments in our technology, always weighing the value of buy vs. build. Our core-managed care system is highly customizable. To that, we add third-party solutions from trusted vendors. In the past two years, to better position ourselves for success under the new ACA mandates, we implemented new technology across several areas of our organization. We’ve invested in Salesforce, an integrated CRM system that sets the standard in many industries; SupportPoint, a knowledge-base tool giving our call center teams quick, consistent access to important member, group and provider information; and VITAL care management platform, which includes utilization, disease and case management workflow software that interoperates with InterQualŽ clinical content and decision support tools for point-of-care authorization, notifications and medical reviews.
Stability
Financial Stability Health Alliance always strives to meet or exceed reserve requirements, based on the calculations set forth by the National Association of Insurance Commissioners. In the past four years, we have far exceeded the Authorized Control Level for Risk Adjusted Capital reserves.
Risk Adjusted Capital as a % of ACL 628% 558% 544% 467%
Fiscal Year 2010
2011
2012
2013
Partnership
You'll be in Good Company We go where providers want us. In 2013, Health Alliance entered into several new ventures, and we maintain a variety of risk/ reward agreements.
Health Alliance Northwest We formed a relationship with Wenatchee Valley Medical Center and Confluence Health in north central Washington. Through this venture, we created a new insurance company with shared ownership between the parties to ensure a long-term commitment. After thorough investigation into the surrounding market, including competitors, the partners chose to enter the market with Medicare Advantage products and a self-funded plan for their own employees. We outlined a full plan for future years, and in coming years we expect to expand into individual and fully-insured group plans through the public exchange and in the private market.
Health Alliance Midwest Partnering with Alegent-Creighton Health–part of the Catholic Health Initiatives (CHI) hospital network we expanded our Health Alliance Midwest offerings from Iowa to the Omaha and Lincoln areas in Nebraska. The initial offering included Medicare Advantage and the public exchange market. Joint risk-sharing will occur at various levels of enrollment.
Health Alliance Connect Although not an expansion to new geography, Health Alliance Connect represents our foray into the Medicaid market. Working with a care management company, Core Health, we are creating a new organization, Health Alliance Connect. In 2013, we entered into contracts with the State of Illinois for an Integrated Care Plan for Seniors and Persons with Disabilities and the first downstate Medicare-Medicaid Plan. In 2014, we will extend our reach in Medicaid by serving as the TPA for the Illinois Partnership for Health, Inc., an Accountable Care Entity, formed by a consortium of Illinois health systems. We are also considering Medicaid managed-care programs in Iowa, Nebraska and Washington.
Partnership Built Your Way We don’t just lay down a template. Your needs and the needs of our other provider partners are not identical. We work with you to build the structure that works best for you. From global capitation to shared risk, from Medicare Advantage products to the public exchange, we strive to design a plan to help you achieve market share growth, provide effective care management and keep the rewards for your efforts. In general, the risk level assumed by each party helps guide who controls what we sell and how we market those products.
Kick-Start Your Health Plan Health Alliance Medical Plans is ready to work with you to build a health plan to set you apart from your competitors, give you more control over costs and help you transition your organization to value-based payment in a measured approach that fulfills your long-term vision.
Corporate Headquarters Health Alliance Medical Plans 301 South Vine Street Urbana, IL 61801
com-provpartbrch-0214