One of the most significant problems facing our society is the ever increasing cost of healthcare which continues to rise at three times the rate of inflation in US. By the year 2014 health care costs are expected to comprise 18.7% of the Gross Domestic Product. Spiraling healthcare costs have significantly and negatively impacted the cost of doing business. At UOP we have a documented track record of successfully reducing the cost of healthcare and at the same time delivering quality healthcare services in an efficient manner.
As part of our health management initiatives, we provide your benefit management staffs with a variety of products and services that are useful in the administration of your health programs. We help our clients address rising healthcare costs with advanced technological and clinical solutions and provide monthly reporting packages with access to an on-line review of your data. Through these services, we are able to work together to effectively manage and maximize cost savings for your plan.
UOP provides the following services to help you reduce and better control your health care costs:
Healthcare Management
Quality Care and Disease Management
Pharmacy Benefit Management
Corporate Wellness Programs
Healthcare Management
Providing high quality healthcare management is our primary goal. To meet this goal, we employ clinical professionals that provide a plan authorization and design reviews tailored to your needs as well as performance-related statistical analysis of provider performance.Plan Management
UOP has extensive experience in healthcare plan management in performing review and authorization of medical services. In order to effectively manage this process on a case by case basis, UOP is closely involved in pre-certification of treatment, and regularly conducts concurrent and retrospective reviews.
As part of this plan management authorization process, UOP brings the patient, physician and facility into a closer alliance while continuously arming each with the latest quality outcome medical evidence to optimize healthcare decisions.
During the authorization review process, treating physicians do not independently determine what is in a patient's best interest in terms of quality and cost; with the assistance of UOP clinicians, patients are closely involved in healthcare decision making and continuously informed as new information evolves.
Since UOP began managing the Oakwood Health System employee health plan comprising 15,000 employees and dependants, Oakwood has saved more that 9 million dollars per year.
Provider Utilization Review
UOP has developed an exclusive provider performance software package that allows us to effectively monitor physicians performance and behavior; both individually and network wide to find areas for quality improvement and cost savings. Moreover, our physicians are able to monitor their own performance via the provider performance software so as to be better aware of the impact of their decisions.
Using our physician performance software, UOP has developed an effective and technologically advanced utilization review process that allows us to examine health care provider behavior to exclude potentially large and unnecessary medical expenditures. Ultimately, UOP is able to employ a process to select its primary and specialty physician network that is based on quality, efficiency and affordability as opposed to which hospital with which they are affiliated.
In addition to monitoring physician performance, UOP has successfully focused on high cost procedure management. As part of our efforts in this area, UOP has established preferred relationships with select providers whose healthcare management philosophy is consistent with the UOP's mission to deliver quality healthcare at an affordable price.
Using its state of the art methodology, UOP has achieved significant cost savings having erased a 2 million dollar deficit in just one year for a major health plan in southeast Michigan.
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Quality Care and Disease Management
Our innovative health education and improvement programs help patients who are at high risk for future healthcare utilization.Chronic diseases, such as cardiovascular disease, diabetes and cancer, are on the rise. Control and improvement of chronic conditions and employee health can save employers millions of dollars in health care costs. It is proven that a healthier workforce results in lower healthcare costs and higher earnings.
Our offerings include individualized and comprehensive disease and chronic care management programs that consider the total health of the patient. The focus is to educate and assist providers in behaving in a manner to minimize adverse disease outcomes by focusing on those processes which most efficiently manage chronic diseases.
Integrating our state of the art provider performance software, we are able to effectively and accurately track physician compliance with HEDIS measures in order to increase the quality of healthcare and manage high cost diseases more effectively. The end result is a healthier community with lower health care costs.
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Pharmacy Benefit Management
Prescription drugs account for approximately 20% of total healthcare costs and this number is increasing rapidly. We meet the business and professional needs of our clients and patients, by managing retail and mail service dispensing, claims processing, plan design administration, personal account management, customer service and a full spectrum of clinical services. This includes extensive drug utilization review programs and formulary management. Upon selecting our organization as your PBM, we can provide you with the following services.The Patient First Program
This is a unique program where the patient is offered the opportunity to save costs by making a generic substitution at the point of sale. Patients receive advisory letters informing them of the option to try the generic equivalent for their current prescription. About 25% of our patients make the generic conversion, saving members and clients over 50% of the original brand drug cost.
Prospective, Concurrent, and Retrospective Drug Utilization Review (DUR)
Our three-tiered DUR program allows you to strike a delicate balance between care and cost objectives. When combined with a thoughtful care management plan, the DUR programs can save clients up to 10% of drug costs while improving the quality of care for members.
Formulary Savings
We have developed a model formulary designed to select the least costly medication within each therapeutic class that achieves the most favorable clinical outcomes. UOP focuses on potential formulary savings by intervening in each instance of non-formulary prescribing in both the retail and mail service environment.
Comprehensive National Pharmacy Network
Our program offers an expansive retail network, comprised of nearly 58,000 pharmacies nationwide, that provides excellent geographic coverage and access for your participants.
Electronic Claims Adjudication & Plan Design Administration
Our centralized claims processing unit adjudicates retail and mail service claims on-line in less than one second. All transaction data captured on-line in both the retail and mail service environment is maintained in a single database, which determines eligibility, compensability, drug utilization review and statistical information for reporting purposes. Through the claims system, we have the flexibility to administer a variety of plan designs, depending upon group needs. This allows your company to extend various co-pay and deductible options to different employee groups and to evaluate them independently.
Retiree Benefit Cost Management
Over 12% of all prescriptions now being billed under Medicare Part D plan sponsors lack fully integrated prescription benefits facilitated by a benefit management company.
By forming a strategic partnership with Universal American Financial Corporation to offer Part D Prescription products, we are in a unique position to offer your organization Medicare Part D group products in 2007 and beyond by creating the opportunity for you to use a single vendor for both insured Part D drug plans and fee-for-service drug plans. This program enables us to comply with the e-prescribing program described in the new Medicare Modernization Act for Part D beneficiaries and will increase the economic benefit of the subsidies associated with Part D by decreasing the administrative filling requirements, capping exposure by transferring catastrophic risk cost to the public sector, and using private re-insurers to immediately increase saving and cash flow rather than the standard approach of waiting for federal reimbursement. The average saving is in excess of 200% over the standard industry approach using only the direct subsidy method.
Controlling GASB Liability
The new GASB 43 & 45 requirements mandate that all employers account for the cost of their employees other post-employment benefits (OPEB) as they are earned rather than as the employer pays them out. As your employee pharmacy costs rapidly increase so will your OPEB obligations. Uncontrolled growth in OPEB costs could have significant potentially negative impact on your balance sheet which could lead to unappealing alternatives down the road such as the inability to provide the current level of benefits to future retirees, or the inability to borrow new moneys to fund other priorities.
We can help you significantly cut your OPEB costs without cutting your employee benefits. Rather than paying the full cost of your employees prescription costs and trying to offset them partially with Medicare Part D subsidies, which, by the way, you can't count as contributions toward your OPEB plan obligations, let us help you with the innovative stop-loss insurance products that wrap themselves around Medicare Part D to cap your per employee prescription costs well below the levels of traditional plans, all the while avoiding the notorious Part D -donut hole.
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Corporate Wellness Programs
UOPs network physicians truly understand how to manage the problems of escalating costs while improving patients health. Our group has designed specialized wellness programs for enterprises to reduce overall healthcare costs while improving employee productivity and overall employee health.As a whole, employees are exercising less and eating more. More than 75% of employers health care costs and productivity losses are related to employee lifestyle choices. These trends are causing an increase in healthcare costs to which employers and employees are paying a premium not only in increased healthcare costs but also in lost productivity and a lower bottom line. The entire economy is negatively impacted by unhealthy lifestyles.
The good news: many of these costs can be prevented by simply detecting problems early, exercising more, eating healthier and having immunizations. According to the Centers for Disease Control, studies have shown that effective corporate wellness programs can reduce claims costs by 27.8%, physician visits by 16.5%, hospital admissions by 62.5%, disability costs by 34.4%, and incidence of injury by 24.8%. Each $1 investment in wellness programs saves $3 in health care costs.
Below is a list of some of the wellness services offered by UOP:
Specialized Programs |
Health Screenings | Immunizations |
| • Health Consultations & Referrals • Program Design & Management • Health Tracking & Reporting • On-Site Clinics |
• Cholesterol • Diabetes • Blood Pressure/Hypertension • Osteoporosis • Allergy • Obesity / Body Composition • Asthma • COPD • Skin Cancer & Condition |
• Influenza (FLU) • Pneumonia • Tetanus/ Diphtheria • Meningitis • Hepatitis A • Hepatitis B • Rabies • Travel Vaccinations • Measles, Mumps, Rubella (MMR) |
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