Regional Care currently administers health benefits for several dozen hospitals representing thousands of covered employees and their families.  Our success in this area is based on recognition of the extreme level of competition facing

hospitals for high quality employees and the need to provide competitive benefits while focused on managing utilization.  We have also been successful in helping our clients integrate the use of a wide range of domestic services into the benefit plan.  Some of our capabilities with hospitals include:

• Administering a 3-tier benefit plan with domestic utilization as the highest level, a PPO as the second level and an out-of-network benefit level;
• Related to the domestic benefit level, direct contracting with highly utilized providers;
• Special rules for pre-certification if using the domestic benefit and/or use of the hospital’s discharge planners as the primary source of managing admissions at the hospital;
• Coordination of wellness, prevention and disease management programs with the hospital’s health educators;
• Working with the hospital to create an “urgent care” benefit for low intensity use of the hospital’s emergency room;
• Receipt of electronic claims directly from the hospital;
• Issuing of remittances only for claims within the hospital system, versus standard checks and explanations of payment;
• Working with the hospital to use the hospital’s outpatient pharmacy as the primary source of obtaining prescriptions for the employees.  This includes use of a pharmacy benefit manager and “pass through” pricing for drugs; and
• Special management reporting detailing use of the various benefit levels and types of care received outside the hospital.