Our “Integrated” Service Model – What Does It Mean to Employers?

Our “Integrated” Service Model – What Does It Mean to Employers?

If you have taken the time to check out our new website, you will have found many different references to our ‘integration’ and our ‘connectivity’ to the UCHealth system of facilities and providers.untitled

But what exactly does this mean?  How does our integrated service model provide optimal value to partially self-funded employers?

Under a typical partially self-funded arrangement, the services provided through a third party administrator (TPA) are ‘unbundled,’ meaning network accessibility, medical management, pharmacy management, and other key services are outsourced to different vendors while the actual claims processing and administrative services are handled by the TPA.  The employer generally receives separate billings for outsourced services, and the multiple systems and infrastructures of various different vendors are not connected - which is not only administratively inefficient, but can have a negative impact on the overall quality of care received.

At UCHealth Plan Administrators, we remove the barriers of the typical unbundled arrangement and connect directly with the UCHealth system of facilities and healthcare providers.  Here’s an example:

  • Jane, an employee of ABC Company, is covered by UCHealth Plan Administrators through her employer’s partially self-funded health plan.  Her primary care physician is a UCHealth Plan Administrators Preferred Provider.  He documents all of Jane’s services, such as her appointments and labs, within the secure UCHealth system-wide electronic medical record.  She also uses the UCHealth Pharmacy to fill all of her prescriptions.
  • Jane is admitted into Poudre Valley Hospital (PVH) in Fort Collins.  PVH physicians and clinical staff review her electronic medical record to evaluate her history, her medications, and other important information to establish a treatment plan.  Meanwhile, Jane’s current condition, medications, and attending physician orders are chronicled within her medical record throughout her hospital stay.
  • Immediately upon notification of Jane’s admission, the UCHealth Medical Management team continuously reviews Jane’s electronic medical record online and works directly with PVH clinical staff to monitor Jane’s treatment and make plans for her discharge.
  • Unfortunately, Jane’s condition deteriorates, and her diagnosis requires that she seek additional treatment at University of Colorado Hospital (UCH) in Aurora.  Upon her admission, UCH clinical staff accesses Jane’s system-wide electronic medical record, which details her history, along with the course of treatment, her medications, her lab services, and the imaging services she received during her stay at PVH.  They see that Jane is allergic to a medication that would be appropriate for her treatment, so they provide an alternative medication, thereby eliminating complications to her care.  They also see that two of the imaging scans they need to evaluate Jane’s diagnosis have already been completed at PVH, eliminating costly duplicate services.
  • Meanwhile, the UCHealth Medical Management team continues to monitor Jane’s treatment and progress in conjunction with UCH staff while planning for her upcoming discharge.
  • Finally, Jane is discharged, but she must fill several prescriptions before she goes home.  Because her entire medical history is documented throughout her electronic medical record, her attending physician and discharge planners can verify that none of her newly prescribed medications will have adverse effects on the other medications she normally takes.
  • Shortly after Jane’s discharge, she follows up with her Primary Care Physician.  Within her electronic medical record, Jane’s physician reviews all of the events associated with her recent hospital stays, and the two of them collaborate on an action plan to move forward.  In the meantime, the UCHealth Medical Management team also works with Jane to identify her areas of elevated health risk and how she can most effectively mitigate those risks through a customized disease management program specific to her condition.
  • UCHealth Plan Administrators receives both claims for Jane’s services.  The coordination of her care was delivered efficiently through the use of the system-wide electronic medical record, so Jane’s claims are processed expeditiously and without reason for additional review.

The integration and connectivity between the UCHealth Plan Administrators Preferred Provider Network, the UCHealth Medical Management team, and the UCHealth Pharmacy provides efficient, safe, and high-quality healthcare delivery to our clients’ employees, which in turn allows UCHealth Plan Administrators to quickly and accurately process claims at extremely competitive rates.  This service model reduces costs and streamlines administration for our clients and takes their employees from healthcare to health.

To learn more about our integrated service model, contact UCHealth Plan Administrators today.