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TPA Briefing: September 2010
In this issue: On My Mind:
Will return next month.
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Are You Gaining any New Alliance Clients?
Keeping The Alliance abreast of third-party administrator (TPA) changes helps to ensure that claims continue to be forwarded to the appropriate party following repricing. Your prompt notification helps to contribute to a seamless transition to your organization resulting in no disruption in claims processing and payment.
As soon as you are notified that you will be assuming administrative responsibilities for an Alliance employer’s group health plan, please contact Jesse Oberloh, member services manager at 800.223.4139 x 6645 or via e-mail. Jesse will coordinate the transition with appropriate Alliance staff.
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Building Our Cooperative
Please join us in welcoming the following new members to the cooperative:
Waukesha County Technical College (WCTC)
Waukesha County Technical College (WCTC) is a non-profit, community college located in Waukesha and Pewaukee, Wis. Dedicated to student learning, WCTC provides lifelong learning opportunities that are high quality, affordable and accessible. As one of the 16 schools in the Wisconsin Technical College System, WCTC enrolls over 30,000 students and has specialized focus in technical education, occupational training, and enrichment programs. WCTC joined The Alliance in July.
Wisconsin State Telecommunication Association (WSTA)
Located in Madison, Wis., the Wisconsin State Telecommunication Association (WSTA) serves as a trade association that represents 83 local telephone companies, 31 Internet service providers, and 10 wireless carriers. The association interacts with its nationwide network of telecommunication experts and serves as a clearinghouse for the most accurate information for its members. WSTA serves as a unified voice for its members in matters of interest to legislators, regulators, and the public. WSTA joined The Alliance in July.
Mallery & Zimmerman, S.C. is an established law firm engaged in the general practice of civil law with offices in Wausau, Green Bay, Milwaukee, Mosinee, and Stevens Point, Wis. Mallery & Zimmerman, S.C. play an active role in the growth and welfare of businesses and non-profit organizations in their communities. Their employees are educated and experienced in various law practices from banking and finance, to divorce and adoption. Many of these employees are successful authors, lecturers and leaders in the legal field. Mallery & Zimmerman, S.C. joined The Alliance in August.
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Health Coaching for Healthy Participants
It is estimated that our formalized healthcare system affects only about 10% of our measurable health. The remaining 90% of health outcomes is determined by factors over which healthcare providers have little or no control, such as lifestyle choices, social conditions, and the physical environment.
Could health coaching build a bridge to a new system of healthcare? Alternative Therapies: 15(16-18)
Lawson, K. (2009)
Enter health coaching. The goal of health coaching is to enhance the well-being of individuals and to facilitate achievement of their health-related goals, regardless of the level of health. Individuals across the wellness spectrum can gain something from health coaching — even Olympic athletes utilize coaches to optimize their health and performance! Participants who have experienced successes from health coaching range from those with multiple risks, to those who are looking to stay on track by maintaining an already healthy lifestyle.
Optimal Health Coaches at our wellness partner, Health Solutions Ltd®, have a wide area of expertise and are ready to assist participants at all levels of health. Participants who are already maintaining a healthy lifestyle can work with health coaches to establish and stay on track with current or new goals, identify areas of improvement that may have been overlooked, and increase accountability to ensure that success is achieved.
The ultimate goal for participants who are already maintaining a high level of health is to work with a health coach to achieve a level of transcendence in which participants are able to help others achieve better health and wellness.
For more information about Health Solutions Ltd®, Optimal Health Coaching or information about our partnership with them, contact Bobbi Jones, product management specialist, 800.223.4139 x 6638. As a reminder, as part of our new partnership philosophy, The Alliance receives no commissions from Health Solutions, Ltd., instead passing on all the savings to members. You can learn more about how we chose Health Solutions, Ltd. here.
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Quantum Health makes the list! Recognized as a top Disease Management Organization
Quantum Health has just proven that bigger isn’t better (and small can be mighty) by making the Health Industry Research Companies’ (HIRC) list of leading disease management organizations. Until recently, size was a primary factor for making the list, according to HIRC’s Fall 2010 report on Health and Disease Management Service. But now, organizations must obtain auditors’ letters from respected third parties to vouch for the validity of their outcomes. Quantum Health is one of just seven companies to meet this new, highly stringent quality standard.
In the same report, HIRC also recognized Quantum Health’s Coordinated Health/Care™ solution as a Leading Employer/Third Party Administrators (TPA) Disease Management Program. Of the eight self-insured employers cited by HIRC as having a leading employer/TPA disease management program, two are Quantum Health clients: City of Savannah and Oshkosh Corporation.
The Alliance has been partnering with Quantum Health for about a year to offer their Coordinated Health/Care™ program to Alliance member companies with 200 or more employees across all networks. Even if a portion of these employees are in The Alliance network, the contract and savings can be applied to all employees. For more information, contact Bobbi Jones, product management specialist, at 800.223.4139, x 6638. You can also learn more here.
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Delta Dental Earns High Marks from Dentists
Delta Dental of Wisconsin not only has the largest network in the state – they also have the most satisfied dentists. In a recent survey of all dental offices in Wisconsin, 93 percent of dentists who responded said they were “very satisfied” or “satisfied” overall with Delta Dental, well above any other carrier. In fact, the percentage of dentists who said they were “very satisfied” with Delta Dental was more than five times higher than the next highest-rated insurance carrier.
On the other side of the scale, only 2 percent of dentists said they were dissatisfied or very dissatisfied with Delta Dental, compared to nearly 50 percent of dentists who felt that way about one leading carrier and 20 percent for another.
Dentists and dental office staff gave Delta Dental high marks in virtually every category measured. In all, more than 30 separate aspects of performance were examined, including:
- Customer service
- Commitment to promoting oral health
- Claims administration
- Services provided specifically to dental offices by Delta Dental’s Professional Relations team
Narrative responses to open-ended questions in the survey provided additional insight into the reasons why dentists and dental office staff favored Delta Dental over other carriers. Survey respondents criticized other carriers for slow response to phone inquiries, inadequate answers to questions, and overseas handling of customer service inquiries, while praising Delta Dental’s Wisconsin-based call center for its performance.
“I wish all our insured patients had Delta Dental,” said one respondent. Another said “Delta Dental of Wisconsin is the best carrier of all we deal with at our office. We have even recommended to other carrier reps to contact Delta to get hints and tips on all levels. We just love Delta Dental of Wisconsin!”
The Alliance offers members a preferred relationship with Delta Dental as well as Delta Vision. For more information, see our product sheet, or contact Bobbi Jones, product management specialist, 800.223.4139 x 6638.
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Alliance Provider Update
The Alliance encourages employers to distribute the monthly Provider Update listing to their employees.
Just a reminder: Always check the online provider directory for the most current provider information!
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QualityCounts™ for Employees
The Alliance encourages employers to distribute the monthly QualityCounts for Employees informational piece to their employees.
This month, with the release of the 2010 QualityCounts Outpatient Tests and Procedures Report comes a new QualityCounts for Employees.
Here, each month, members will find materials they can print out directly and share with employees. This month, we’ve included a flyer to let employees know that the new report is available and how to access it. They simply print out and make copies and hang up around the workplace. Get your copy here.
Members can also find the complete QualityCounts toolkit in the Employer Resource Center under Employer Tools. They will need to log in first. If they do not know their log-in, they can contact Tierney Jensen.
The Alliance is available to come and give a presentation about QualityCounts to member organizations. For information, contact Bobbi Jones, 800.223.4139 x 6638.
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News You Can Use
Each month, The Alliance highlights health care and benefit management news for employers in News You Can Use, with a link to take you to the original story or report.
The annual National Business Group on Health Survey focused in on employer actions related to PPACA. Read more.
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About The Alliance TPA Briefing
Each month, The Alliance TPA Briefing delivers the latest news to third-party administrators about Alliance services, programs and events as well as information on health benefit trends, issues and ideas of interest to our mutual clients.
Subscriptions are available on a complimentary basis. To subscribe, please send an e-mail with your name, title and organization to the marketing and member services department.
Reader comments, suggestions and topics are always welcome.
Cathy Lanser, Editor
Tierney Jensen, Design
Carlene Boehmer, Manager of Claims & Customer Service
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