achp marketplace systems inventory · 1825 eye street, nw, suite 401 | washington, dc 20006 | p:...
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1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Updated Spring 2014
ACHP Marketplace Systems Inventory The Alliance of Community Health Plans (ACHP) has developed an inventory among its member plans relating to their systems, capabilities and vendor relationships to enable networking and sharing of experiences. The next page lists the contact information of those who completed the survey and the following pages contain the compiled responses. The information is divided into three categories: Systems and Versions, Vendor Relationships and Plan Capabilities and Partners. ACHP likes to maintain this resource with current information, please send any changes or additions to Stephen Cox at the contact information below.
ACHP Contact Information
Adam Zavadil, Market Strategy and Analysis Director Stephen Cox, Senior Business Analyst
[email protected] [email protected] (202) 785-2247 (202) 785-2247
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 2 of 20 Updated Spring 2014
Plan Contact Information
Health Plan Contact Contact Information CDPHP Brian Morrissey, Chief Marketing Officer [email protected], (518) 641-5220 Capital Health Plan Polly White, Marketing & Admin. Services Senior VP [email protected], (850) 523-7266 CareOregon Stefanie Cao, Medicare Marketing Manager [email protected], (503) 416-5782 Fallon Health Danielle Hart, Sr. Proposal Management/Prod. Devel. Specialist [email protected], (508) 368-9652
Geisinger Health Plan David Jani, Strategic Business Development Director [email protected], (570) 271-7867
Group Health Elisabeth Buchman, Director, Product Development [email protected], (206) 448-4138
GHCSCW Allan Wearing, Sales and Marketing Director [email protected], (608) 251-4146 x4813
HealthPartners Linda Steinberg, Business Development Manager [email protected], (952) 967-6727
Independent Health David Rogers, IT Manager [email protected], (716) 635-3832
KP Georgia Pat Guerry, Product Dev. and Retention Director [email protected], (404) 364-4758 Presbyterian Health Plan Jana Burdick, VP & Chief Service Officer [email protected], (505) 923-5860
Priority Health Joan Budden, Chief Marketing Officer [email protected], (616) 464-8703
Rocky Mountain Health Plans Michelle Walker, Director of Sales Administration [email protected], (970) 244-7857
Scott & White Health Plan Lee Green, Sales and Marketing VP [email protected], (254) 298-3424
Security Health Plan Kara Johnson, Digital Strategist [email protected], (715) 207-8681
SelectHealth Jason Eckersley, Marketing Manager, Product Development [email protected], (801) 442-7958
Tufts Health Plan Tricia Trebino , Senior VP of Operations and CIO [email protected], (617) 972-9400
UCare Laurie Heyer-Dean, Operations Senior VP [email protected], (612) 676-3370
UPMC Health Plan Edward McCallister, CIO, UPMC Insurance Services [email protected], (412) 454-7710
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 3 of 20 Updated Spring 2014
Systems and Versions (Page 1 of 3) Health Plan Claims system and version Customer/member service system and version
System Version System Version CDPHP TriZetto Facets Moving to 5.x TriZetto Facets 4.81 Capital TriZetto QNXT 4.71 CP29 Home grown CareOregon TriZetto QNXT 4.71 TriZetto QNXT 4.71 Fallon TriZetto QNXT TriZetto QNXT Geisinger Amisys Advance 5 CSI (developed in-house) 2011.05.20.1 Group Health Internally built Internally built GHCSCW Epic Tapaestry Epic Tapaestry HealthPartners In-house (proprietary) N/A In-house (proprietary) IHA Health Edge 4.6.2 Siebel 8.1x KP-GA Epic Tapaestry (in house) Epic PHP TriZetto Facets 4.71 Siebel 8.1 Priority Health TriZetto Facets 5.0 TriZetto Facets 5.0 RMHP TriZetto Facets 4.71 Macess Exp 3.2 Scott & White Amisys 4.0.0.16 Macess 3.20.0117SP1 Security TriZetto QNXT 5.1 R3 TriZetto QNXT 5.1 R3 SelectHealth TriZetto Facets 4.81 TriZetto Facets 4.81 Tufts TAHPMaster, Diamond TAHPMaster, Diamond, Macess UCare Amisys 4 Macess UPMC MC400 - Owned source code MC400
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 4 of 20 Updated Spring 2014
Systems and Versions (Page 2 of 3)
Health Plan Data warehouse system and version Sales technology/customer relationship management system and version
System Version System Version CDPHP Oracle based Salesforce.com
Capital Developed using Microsoft SQL 2008, Business Objects Crystal reports 11.5, Microsoft Analysis Services and Microsoft Reporting Services
Home grown
CareOregon SQL Server Oracle On Demand Fallon TriZetto QNXT Avenue Geisinger Microsoft SQL Server 2008 Consona-Onyx 6 Group Health Teradata Pega Systems GHCSCW McKesson CRIMS Microsoft CRM HealthPartners In-house (proprietary) In-house (proprietary) IHA Kalido 9.02x Salesforce.com Current KP-GA Oracle Salesforce.com
PHP Internally developed using Oracle 11g DBMS and Business Objects Xlr3 sp2 None
Priority Health Business Objects 14.04 Commercial: Tuo; Medicare: IKA Medicare Gateway
5.0; 4.5.0.0
RMHP Oracle 10G Onyx 5.50.150
Scott & White SQL Server 2005 Business Objects XI R3 Maximizer 10.5
Security Netezza Twin Fin Appliance & Med Insight SalesForce Enterprise SelectHealth Oracle In-house Tufts Oracle based Lotus Notes, Siebel on Demand UCare Internally developed Cisco UPMC EDW - Internally developed Oracle DB ikaSystems
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 5 of 20 Updated Spring 2014
Systems and Versions (Page 3 of 3) Health Plan Additional comment on any system changes
CDPHP Implementing an Encryption Gateway in front of Salesforce.com Capital CareOregon Considering new CRM products. Fallon Geisinger Group Health Currently in a health plan business systems transformation and migration to ikaSystems over the next 18 months. GHCSCW
HealthPartners
Upgrading to Connecture-- Microsoft Dynamics CRM in 2012. Over the next 24 months, HealthPartners will continue to implement enhancements to our health plan administrative systems platform in areas that include, but are not limited to: New product capabilities Enhanced provider contract reimbursement methodologies; New state or federal regulations; Enhanced customer experience; In conjunction with this software, we have developed clear, comprehensive business processes to manage all aspects of the claim adjunction function.
IHA We also use El Dorado from ECI and RxClaim from SCA (Catamaran). KP-GA PHP Priority Health We will be upgrading the Tuo 6.0 in the near future. RMHP Facets will be upgraded to 5.01 in 2012. Scott & White Security SelectHealth Tufts UCare Upgrade to Amisys UPMC
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 6 of 20 Updated Spring 2014
Vendor Relationships (Page 1 of 5) Health Plan Pharmacy benefit manager Behavioral health Rental network
CDPHP CVS/Caremark Administered in-house MagnaCare (NYC, NJ) and First Health (National)
Capital Prime Therapeutics None None CareOregon Catamaran Medicare – Administered In-House. None.
Fallon
CVS/Caremark provides adjudication of PBM services. CVS/Caremark administers the pharmacy benefit for all pharmacies and is responsible for processing claims.
Beacon Health Strategies, LLC (since December 1, 1999)
PPO network features a network via MultiPlan’s Private Healthcare Systems.
Geisinger MedImpact Optum Health MultiPlan/PHCS
Group Health MedImpact Internal First Choice Health, First Health Network, MultiPlan
GHCSCW SXC In-house Health EOS
HealthPartners MedImpact; Walgreens Specialty Pharmacy Internal Partnership with CIGNA HealthCare.
IHA We are our own PBM, through Pharmacy Benefit Dimensions. Internal First Health, PHCS and
others.
KP-GA MedImpact, HealthTrans and Prescription Solutions Internal PHCS
PHP SXC Commercial/ASO/Medicare: In-house Medicaid – Optum/United MultiPlan
Priority Health Argus In-House PHCS RMHP ESI Welldyne Life Strategies PHCS/Multiplan
Scott & White SWHP owns its own PBM. Multidisciplinary mix of BH providers under contract including: Psychiatrists, Psychologists, Social workers, Addiction counselors
SWHP's network is owned. A wrap network is provided by PHCS Primary.
Security Currently working with Catamaran, Transitioning to RxEdo/Argus in summer 2014.
None
SelectHealth None None MultiPlan/PHCS Tufts CVS/Caremark In-house PHCS UCare ESI BHP None UPMC ESI Community Care Behavioral Health
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 7 of 20 Updated Spring 2014
Vendor Relationships (Page 2 of 5) Health Plan Dental/vision Wellness
CDPHP Delta - dental; Vision - administered in-house.
Health Dialog; Healthwise Knowledgebase; Healthways (Complementary & Alt Medicine); EBSCO (My Online Wellness); WellTok (CafeWell); Map My Fitness (inMotion)
Capital Delta Dental (Pediatric) None CareOregon Dental: DCO (Medicaid); Vision: VSP Healthwise
Fallon Dental Benefits Providers; Eyemed Associates. Cemer (online HRAs)
Geisinger Dental - Delta (Medicare), Guardian (Commercial), Dentaquest (CHIP). Vision is in-house
ASHN/Healthyroad value add programs, Healthways-Silver Sneaker and Forever Fit
Group Health Delta Dental, United Concordia Redbrick Health GHCSCW Dental Health Associates (local) In-house
HealthPartners Dental - DentaMax Hooper Holmes: on-site biometric screenings and wellness seminars, Hallmark Insights: incentive fulfillment, HealthWise: virtual coaching, PureWellness: challenges/trackers
IHA Dental – Delta; Vision - Eyemed In-house KP-GA Delta Dental Health Dialog
PHP Delta & Dental Source (Commercial); Dentaquest (Medicaid) Vision Services Plan
WebMD
Priority Health Vision - Eyemed WebMD RMHP Dental - Delta; Vision: VSP Healthways, Inc.
Scott & White MetLife: Dental. SWHP provides its own vision care.
Health Dialog: disease and condition management, health coaches, nurse advice line, shared decision-making resources, HealthMedia: health risk assessment and lifestyle management programs such as smoking cessation, weight loss, and stress management
Security None
HealthMedia: used for Online health assessment and digital health coaching programs; Krames/Staywell: used for patient education materials, interactive quizzes, and health information library; Accordant: used for management of 17 rare, complex conditions, Constant Contact: used to create/send monthly newsletters via email; Health Enhancement System: multi-week health behavior modification programs; Healthwise: shared decision making and health conversations
SelectHealth Dental: None; Vision: EyeMed WebMD Tufts Dental – Delta; Vision - Eyemed Alere UCare Dental - Dentaquest Cardiocom UPMC Internal WebMD
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 8 of 20 Updated Spring 2014
Vendor Relationships (Page 3 of 5) Health Plan Health savings account/banking Internet/web hosting/e-
commerce Printing/ID card
CDPHP Mellon Bank is partner for HSAs. Metavante is debit card vendor. In-house. Newkirk (printing, fulfillment and ID cards)
Capital None ThinkCreative & 3W Incepture CareOregon None Internal; Godaddy.com FSI Data Management Fallon Wells Fargo and Sterling HSA None Clarity
Geisinger ConnectYourCare (HRA) and ACSBNY Mellon (HAS) Clarity
Group Health HealthEquity e-health insurance Legend Data Systems GHCSCW Employee Benefits Consultants Corp. In-house Garvey Group HealthPartners Wells Fargo Internal IHA MBI. M&T Bank Internal Clarity, Red Card, ABF & ABS
KP-GA Wells Fargo and Evolution Internal but some hosted by Campbell Ewald Harrington Health
PHP HealthEquity None
ID Cards: Internal Clarity prints commercial/ASO member packets. Several local vendors for newsletters and other mail campaigns
Priority Health In-House with a partnership with local banks- Fifth Third & Lake Michigan Credit Union In-House FSE, will be switching to Health Logic in April
2013
RMHP Bancorp Rackspace; ViaWest; Amazon EC2; HealthTrio FSI
Scott & White Health Equity In-house. Contracts with Vitasio for technical work.
Clarity prints ID cards and new member booklets. Several other local vendors for printing.
Security Host internally SelectHealth Health Equity In-house Clarity
Tufts None Rackspace (public web site), Edocs, Connecture, Benefit Focus
Emdeon, Metavante, NEPS
UCare None Internal Healthlogix UPMC ACS Mellon Medevante
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 9 of 20 Updated Spring 2014
Vendor Relationships (Page 4 of 5) Health Plan Digital strategies Consumer Cost and Quality
Transparency CDPHP Fair Health Capital None CareOregon None Fallon Geisinger Group Health Prism Analysis underway GHCSCW In-house HealthPartners Partner with local printing company for print-on-demand communications services. IHA Gelia and Blizzard Labs Treatment Cost Advisor
(WebMD) KP-GA Campbell Ewald and Digitas
PHP None Priority Health Marketing: Currently In-House RMHP Volumn 9 (SEO); MixTape (PPC and display advertising) Scott & White Healthation (web initiative) and HCB Health (ad campaign)
Security
Constant Contact: use for emailing agents and possibly use for emailing other groups in the future; Space150: use for web and mobile app development; DRX: used for Medicare plan purchase; Connecture: used for commercial individual plan purchase; SiteCore: used to manage our website content.
Change Healthcare Cost Look Up, Healthcare University and Ways to Save
SelectHealth Gartner Tufts None UCare UPMC
ACHP Marketplace Systems Inventory
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Page 10 of 20 Updated Spring 2014
Vendor Relationships (Page 5 of 5) Health Plan Actuarial Patient communication
services Risk adjustment Subrogation
CDPHP Milliman; Marjos Business Consulting In-house
Lawrence & Russell, a law firm out of Memphis, TN; MedRecovery
Capital Milliman None DxCG Risk Smart Retained counsel CareOregon Wakely Consulting Internal; Text4Baby None Clint Simpson Fallon None Discovery Health Partners
Geisinger Milliman and Wakely Consulting Socrates, Inc.
Group Health Milliman Eliza Milliman Internal
GHCSCW Huttleson and Associates In-house None Ingenix
HealthPartners Internal Internal Internal
IHA Milliman Internal, Eliza, Warm Health, Text4Baby and Optum. Cognisigh, Verisk, Treo, DxID. Internal
KP-GA Milliman None None None PHP Milliman (Medicare) None Internal (underwriting) Internal Priority Health Milliman Silver Links Censeo and The Coding Source RMHP Milliman Healthways, Inc. Milliman None
Scott & White Milliman Care Call SWHP has its own underwriting department providing risk adjustment services.
Ingenix
Security Milliman Eliza IVR System Innovation SelectHealth Milliman Eliza Milliman Socrates, Inc. Tufts Milliman Wilde, IMN Ingenix LRCMS, Rawlings UCare Ingenix Internal Ingenix Ingenix UPMC Milliman
ACHP Marketplace Systems Inventory
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Page 11 of 20 Updated Spring 2014
Plan Capabilities and Partners (Page 1 of 3)
Health Plan
Third Party Administrator/Administrative Service Organization services Value-based insurance design products
Yes/No If so, do you partner with other organizations to do this? What is the smallest group you will self-fund?
Yes/No If so, do you partner with other organizations to do this?
CDPHP Yes In-house. Will self-fund down to 250 subs. Yes No
Capital No No CareOregon No No
Fallon Yes Provides TPA services as well as utilize subsidiary, Ultrabenefits, Inc. Yes
Intended to encourage the appropriate use services, adopt a healthy lifestyle and utilize high performing providers. Include: $0 copayments for preventive care, $400 family fitness reimbursement, gym memberships, dance classes and more, 24 hour nurse line, Comprehensive disease management programs that assist members manage their illness better, Step therapy for certain drugs
Geisinger Yes 250 eligibles/175 contracts Yes Group Health Yes About 500 Yes Internally designed GHCSCW No No
HealthPartners Yes Self-fund groups of 100 or more employees Yes Internal
IHA Yes Internal. Smallest group is 100 for medical. Yes Limeade
KP-GA No No PHP Yes Smallest group is 100 No Priority Health Yes Self fund down to 100 employees. No RMHP Yes No Scott & White Yes No partner. Yes No Security Yes No No SelectHealth Yes No partner. Smallest group is 200. Yes Tufts Yes No Yes No
UCare Yes Small TPA business for Portico and Health Traditions. No self funded business.
No
UPMC Yes No. Yes No
ACHP Marketplace Systems Inventory
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Page 12 of 20 Updated Spring 2014
Plan Capabilities and Partners (Page 2 of 3)
Health Plan Narrow network products Multiple year
premium contracts
Stop-loss insurance
Yes/No If so, about what percent of your total network is in your narrow network? Yes/No If so, do you partner with other
organizations to do this?
CDPHP Yes Limited Rx network for individual market segment. Limited to Walmart, CVS, Price Chopper
Yes Yes HCC Life Insurance Co.
Capital No No No CareOregon No No Yes Purchase reinsurance from broker Fallon Yes No No Geisinger No Yes Yes HCC Life Insurance Company Group Health No No Yes Highmark, Companion Life GHCSCW No No No HealthPartners Yes Small percent, custom networks Yes Yes No IHA Yes Yes Yes Internal KP-GA Yes 3% but soon to be 70% Yes No PHP No Yes Yes Dubraski and Associates Priority Health No Yes Yes RMHP No No Yes Scott & White No Yes Yes Yes Security Yes Yes Yes Yes
SelectHealth Yes 25 – 30% No Yes RBS Re, HCC, Summit Re, IISI, Symetra
Tufts Yes 5-10% No Yes Yes UCare No No No UPMC No No Yes
ACHP Marketplace Systems Inventory
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Page 13 of 20 Updated Spring 2014
Plan Capabilities and Partners (Page 3 of 3)
Health Plan National consultants relationships National human resources recruiting services Yes/No If so, with whom and for what? Yes/No If so, who?
CDPHP Yes Primary Research; Harris/Nielsen No Capital No No CareOregon No Yes National Online Niche Positing
Fallon Yes Various consulting organizations depending upon the size and scope of the initiative. Yes Several different recruiting organizations as it varies
depending of the type of position.
Geisinger Yes Deloitte for a core claim system upgrade, Pelorus for Medicare consulting, and Bella Gorman for actuarial services.
Yes Slayton Partners, Furst group and others
Group Health No Yes Various vendors for hard to place executive positions GHCSCW No No HealthPartners Yes Ingenix actuarial and data analytics services. Yes Online services, like CareerBuilder.
IHA Yes Oliver Wyman, HTMS, CTG, NTT Data. Yes TEK Systems, Executive Staffing Solutions, Monster, Dice, LinkedIn and CTG
KP-GA Yes Oliver Wyman No
PHP Yes Syntro LTD for NCQA and Care Management Yes Executive Staffing Solutions, Etech Hi, Bloom Group, GLC Healthcare, Reeder & Assoc., TEK Systems, Red Sky Consultants, Robert Half International, Sabio Systems
Priority Health No Yes Multiple RMHP No No Scott & White Yes McKinsey & Co. Yes Executive Staffing Solutions Security Yes Milliman No SelectHealth No Yes Monster, HealtheCareers, Dice, LinkedIn Tufts Yes Deloitte Consulting No UCare No No UPMC No Yes
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 14 of 20 Updated Spring 2014
Appendix A: Listing of Vendors Vendor Names Types of Services Provided Website
Huttleson and Assoc. Actuarial www.hddesign.com
Marjos Business Consulting, LLC Actuarial www.marjosconsulting.com Wakely Consulting Actuarial www.wakelyconsulting.com
Milliman Actuarial; Risk Adjustment www.milliman.com
Ingenix Actuarial; Risk Adjustment; Subrogation; Consulting www.ingenix.com
Beacon Health Strategies Behavioral Health www.beaconhealthstrategies.com
Behavioral Health Providers Behavioral Health www.bhproviders.com
Community Care Behavioral Health www.ccbh.com
Life Strategies Behavioral Health www.lscihelp.com Optum Health Behavioral Health; Patient Communication www.optumhealth.com
Amisys Claims www.amisys-tech.com
DST Health Solutions Claims www.dsthealthsolutions.com
Health Edge Claims www.healthedge.com
Epic Claims, Customer/Member Service www.epic.com
HPTi Claims, Customer/Member Service www.hpti.com
ITEL Corp. Claims, Customer/Member Service TriZetto Claims; Customer/Member Service; Data Warehouse www.trizetto.com
Deloitte Consulting www.deloitte.com
Harris/Nielsen Consulting www.nielsen.com/us/en.html HTMS Consulting www.htms.com
McKinsey & Company Consulting www.mckinsey.com
NTT Data Consulting www.nttdata.com Oliver Wyman Consulting www.oliverwyman.com
Pelorus Management Consultants Consulting www.pmcinfo.com
Primary Research Consulting www.primaryresearch.com Syntro LTD Consulting http://www.syntro.com Bella Gorman Consulting; Actuarial www.gormanactuarial.com
CTG Consulting; HR Recruiting www.ctg.com Change Healthcare Cost Look Up Cost/Quality Transparency Tools Fair Health Cost/Quality Transparency Tools www.fairhealth.org Healthcare University Cost/Quality Transparency Tools Ways To Save Cost/Quality Transparency Tools SunGard Customer/Member Service www.sungard.com
Kalido Data Warehouse www.kalido.com
McKesson Data Warehouse www.mckesson.com
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 15 of 20 Updated Spring 2014
Med Insight Data Warehouse http://www.medinsights.com Netezza Twin Fin Data Warehouse http://www.netezza-twinfin.com SAP Data Warehouse www.sap.com
Taradata Data Warehouse www.teradata.com
Oracle Data Warehouse; Customer/member service; Sales Tech/CRM www.oracle.com
Microsoft Data Warehouse; Sales Tech/CRM www.microsoft.com
Delta Dental Dental/Vision www.deltadental.com
Dental Benefits Providers Dental/Vision www.dbp.com Dental Care Organization Dental/Vision www.oregon.gov/OHA/healthplan
Dental Health Associates Dental/Vision Dental Souce Dental/Vision www.dentalsource.com DentaQuest Dental/Vision www.dentaquest.com
DenteMax Dental/Vision www.dentemax.com
Eyemed Dental/Vision portal.eyemedvisioncare.com/
Guardian Dental/Vision www.guardiananytime.com
MetLife Dental/Vision www.metlife.com
United Concordia Dental/Vision www.unitedconcordia.com/dental-insurance/ Vision Services Plan (VSP) Dental/Vision www.vsp.com
Blizzard Labs Digital Strategies www.blizzardlabs.com Ciber Digital Strategies www.ciber.com
Connecture Digital Strategies http://www.connecture.com Constant Contact Digital Strategies http://www.constantcontact.com Digitas Digital Strategies www.digitas.com
DRX Digital Strategies http://www.drx.com Gartner Digital Strategies www.gartner.com Gelia Digital Strategies www.gelia.com
HCB Health Digital Strategies www.hcbhealth.com
Healthnation Digital Strategies www.healthnation.net
SiteCore Digital Strategies http://www.sitecore.net Space150 Digital Strategies http://www.space150.com Bloom Group HR Recruiting
Career Builder HR Recruiting www.careerbuilder.com
Dice HR Recruiting www.dice.com Etech Hi HR Recruiting www.etechhi.com Executive Staffing Solutions HR Recruiting www.ess.jobs
Furst Group HR Recruiting www.furstgroup.com
GLC Healthcare HR Recruiting www.glchealthcare.com
ACHP Marketplace Systems Inventory
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Page 16 of 20 Updated Spring 2014
HEALTHeCAREERS HR Recruiting www.healthecareers.com LinkedIn HR Recruiting www.linkedin.com Monster HR Recruiting www.monster.com
Red Sky Consultants HR Recruiting www.redsky-consulting.com Reeder & Assoc. HR Recruiting www.reederassoc.com Robert Half International HR Recruiting www.rhi.com Sabio Systems HR Recruiting www.sabiosystems.com Slayton Search Partners HR Recruiting www.slaytonsearch.com
TEK Systems HR Recruiting www.teksystems.com Bancorp HSA/Banking www.usbank.com Employee Benefits Consultants Corps. HSA/Banking Evolution HSA/Banking
Fifth Third Bank HSA/Banking www.53.com
HealthEquity HSA/Banking www.healthequity.com
HSA Bank HSA/Banking www.hsabank.com
Lake Michigan Credit Union HSA/Banking www.lmcu.org
M&T Bank HSA/Banking www.mtb.com MBI HSA/Banking Mellon Bank HSA/Banking www.bnymellon.com
Metavante HSA/Banking www.metavante.com Sterling HSA HSA/Banking www.sterlinghsa.com
Wells Fargo HSA/Banking www.wellsfargo.com
Benefit Focus Internet/Web Hosting/e-Commerce www.benefitfocus.com
Connecture Internet/Web Hosting/e-Commerce www.connecture.com
Edocs Internet/Web Hosting/e-Commerce www.edocsusa.com
e-health Insurance Internet/Web Hosting/e-Commerce www.ehealthinsurance.com
Godaddy.com Internet/Web Hosting/e-Commerce www.godaddy.com Rackspace Internet/Web Hosting/e-Commerce www.rackspace.com
ThinkCreative Internet/Web Hosting/e-Commerce www.thinkcreative.com
Vitasio Internet/Web Hosting/e-Commerce www.vitasio.com
W3 Internet/Web Hosting/e-Commerce www.w3.com
Amazon EC2 Internet/Web Hosting/e-Commerce; Digital Strategies www.aws.amazon.com/ec2 Campbell Ewald Internet/Web Hosting/e-Commerce; Digital Strategies www.c-e.com
HealthTrio Internet/Web Hosting/e-Commerce; Digital Strategies www.healthtrio.com ViaWest Internet/Web Hosting/e-Commerce; Digital Strategies www.viawest.com CareCall Patient Communication www.carecallsafe.com
Eliza Patient Communication www.elizacorporation.com
IMN Patient Communication www.imninc.com
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
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Silverlink Patient Communication www.silverlink.com
Text4Baby Patient Communication www.text4baby.org Wilde Patient Communication
Argus PBM www.argushealth.com
Catamaran PBM www.catamaranrx.com
CVS/Caremark PBM www.caremark.com
Health Trans PBM www.healthtrans.com
MedImpact PBM www.medimpact.com
Pharmacy Benefit Dimensions PBM www.independenthealth.com
Prescription Solutions PBM www.prescriptionsolutions.com
Prime Therapeutics PBM https://www.primetherapeutics.com/index.html SXC PBM www.sxc.com
Walgreens PBM www.walgreens.com
ABF Printing/ID Cards www.abfprint.com
ABS Printing/ID Cards http://www.absprinting.com Clarity Printing/ID Cards www.clarityinc.com
Emdeon Printing/ID Cards www.emdeon.com
FSI Printing/ID Cards http://www.fsiprintingandgraphics.com Garvey Group Printing/ID Cards www.thegarveygroup.com
Harrington Health Printing/ID Cards www.harringtonhealth.com
Healthlogix Printing/ID Cards www.hlxusa.com
Incepture Printing/ID Cards www.incepture.com
Legend Data Systems Printing/ID Cards www.legendid.com
Metavante Printing/ID Cards www.metavante.com
NEPS Printing/ID Cards www.neps.com
Newkirk Printing/ID Cards www.newkirk.com
Red Card Printing/ID Cards www.redcardstudios.com
CIGNA Rental Network www.cigna.com
First Choice Health Rental Network www.fchn.com
First Health Network Rental Network www.firsthealth.coventryhealthcare.com
MagnaCare Rental Network www.magnacare.com
MultiPlan Private Healthcare Systems Rental Network www.phcs.com
Care Isack Risk Adjustment Censeo Risk Adjustment www.censeohealth.com
Cognisight Risk Adjustment www.cognisight.com
DxID Risk Adjustment www.dx-id.com Innovation Risk Adjustment The Coding Source Risk Adjustment www.thecodingsource.com
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 18 of 20 Updated Spring 2014
Treo Risk Adjustment www.treosolutions.com Verisk Health Risk Adjustment www.verisk.com
Avenue Sales Tech/CRM www.avecrm.com/en_default.asp
Cisco Sales Tech/CRM www.cisco.com
Colibrium Partners Sales Tech/CRM www.colibriumpartners.com
Consona-Onyx Sales Tech/CRM crm.consona.com
IBM Sales Tech/CRM www.ibm.com
ikaSystems Sales Tech/CRM www.ikasystems.com
Maximizer Sales Tech/CRM www.maximizer.com
Pega Systems Sales Tech/CRM www.pega.com
Salesforce.com Sales Tech/CRM www.salesforce.com
Companion Life Stop-loss www.companionlife.com/ Dubraski and Associates Stop-loss www.dubraski.com HCC Life Insurance Company Stop-loss www.hcclife.com
Highmark Stop-loss www.highmark.com/ IISI Stop-loss www.iisinet.com RBS Re Stop-loss www.rbsre.com Summit RE Stop-loss www.summit-re.com Symetra Stop-loss www.symetra.com Towers Watson Consortium Stop-loss www.towerswatson.com
Discovery Health Partners Subrogation www.discoveryhealthpartners.com Lawrence & Russel Subrogation www.lawrencerussell.com
LRCMS Subrogation MedRecovery Subrogation www.medrecovery.com Rawlings Subrogation www.rawlingsgroup.com
Socrates, Inc. Subrogation www.socrates.net
Subrogation Services, Inc. Subrogation www.subroservices.com Ultrabenefits TPA/ASO Partner www.ultrabenefits.com/
Limeade VBID www.limeade.com
Accordant Wellness https://www.accordant.com Alere Wellness www.alere.com
American Specialty Hospital Healthyroad Wellness www.ashcompanies.com
Cardiocom Wellness www.cardiocom.com
Cemer Wellness Constant Contact Wellness http://www.constantcontact.com
EBSCO Wellness www.ebscohost.com Forever Fit Wellness www.stayforeverfit.com
Hallmark Insights Wellness www.hallmarkbusinessconnections.com
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 19 of 20 Updated Spring 2014
Health Dialog Wellness www.healthdialog.com
Health Enhancement Systems Wellness http://www.hesonline.com HealthMedia Wellness www.healthmedia.com
HealthWise Wellness www.healthwise.org
Hooper Holmes Wellness www.hooperholmes.com
Krames/Staywell Wellness http://kramesstaywell.com MapMyFitness Wellness www.mapmyfitness.com PureWellness Wellness www.purewellness.com
Redbrick Health Wellness home.redbrickhealth.com WellTok Wellness www.welltok.com WebMD Wellness; Cost/Quality Transparency www.webmd.com
Healthways-Silver Sneakers Wellness; Patient Communication www.silversneakers.com
**Note: This listing of vendors reflects information provided by plans. It is not a comprehensive list of all vendors used by ACHP plans nor does it list all services provided. For more information please contact the vendor directly or the ACHP plan with an existing relationship.
ACHP Marketplace Systems Inventory
1825 Eye Street, NW, Suite 401 | Washington, DC 20006 | p: 202.785.2247 | f: 202.785.4060 | www.achp.org
Page 20 of 20 Updated Spring 2014
Appendix B: ACHP Marketplace Systems Inventory Survey
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ACHP Marketplace Systems InventoryACHP Marketplace Systems InventoryACHP Marketplace Systems InventoryACHP Marketplace Systems Inventory
The Alliance of Community Health Plans (ACHP) is fielding a survey among its members relating to their systems, capabilities and vendor relationships. This survey invitation has been sent to the marketplace leaders at each member plan, we would like one response per organization. The survey results will be compiled and sent out to members to enable networking and sharing of experiences. The time for completing the survey is approximately 25 30 minutes. It may be helpful to print a hard copy of the survey first and gather the information before completing it online. Once starting a survey online, you can exit and save a partially completed survey as long as you hit "Next" at the bottom of the web page ("Next" acts like a save button) and use the same computer when you return to the survey. Before you begin, please fill in the name of your organization and point of contact for any questions we may have regarding your response. If you have any questions or problems completing the survey please contact Stephen Cox at [email protected] or (202) 7852247.
Contact Information
Name:
Organization:
Title:
Email Address:
Phone Number:
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This set of questions relates to the systems at place in your organization (note homegrown if appropriate.) For the satisfaction fields, please just highlight anything of particular importance regarding your experience with the system.
What claims system and version does your organization use?
What customer/member service system and version does your organization use?
What data warehouse system and version does your organization use?
What sales technology/customer relationship management system and version does your organization use?
Please comment on any system changes that you are currently undergoing or considering.
Systems and Versions
System
Version (if applicable)
Satisfaction (optional)
System
Version (if applicable)
Satisfaction (optional)
System
Version (if applicable)
Satisfaction (optional)
System
Version (if applicable)
Satisfaction (optional)
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This set of questions relates to the vendor relationships at place in your organization (note none if appropriate.) For each question, provide the name of any companies that you work with and the nature/extent of the services that they provide. Please also highlight anything of particular importance regarding your experience with the relationships.
What pharmacy benefit manager vendor relationships does your organization have?
What behavioral health relationships does your organization have?
What rental network vendor relationships does your organization have?
What dental/vision vendor relationships does your organization have?
What wellness vendor relationships does your organization have?
What health savings account/banking vendor relationships does your organization have?
What internet/web hosting/ecommerce vendor relationships does your organization have?
What printing/ID card vendor relationships does your organization have?
Vendor Relationships
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ACHP Marketplace Systems InventoryACHP Marketplace Systems InventoryACHP Marketplace Systems InventoryACHP Marketplace Systems InventoryWhat digital strategies vendor relationships does your organization have?
What consumer cost and quality transparency tool vendor relationships does your organization have?
What actuarial vendor relationships does your organization have (e.g. Milliman)?
What patient communication services vendor relationships does your organization have?
What risk adjustment vendor relationships does your organization have?
What subrogation vendor relationships does your organization have?
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This set of questions relates to the capabilities and partnerships at place in your organization.
Does your plan offer Third Party Administrator/Administrative Service Organization services?
Does your plan offer valuebased insurance design products?
Does your plan offer a narrow network product?
Does your plan offer a multiple year premium contract (e.g. maximum rate increase cap in second or third year)?
Does your plan offer stoploss insurance?
Plan Capabilities and Partners
Yes
nmlkj No
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If so, do you partner with other organizations to do this? What is the smallest group you will selffund?
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Yes
nmlkj No
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If so, do you partner with other organizations to do this?
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Yes
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If so, about what percent of your total network is in your narrow network?
Yes
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If so, do you partner with other organizations to do this?
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Does your organization have ongoing relationships with any major national consultants (e.g. Oliver Wyman)?
Does your organization use any national services for human resources recruiting?
Other Questions
Yes
nmlkj No
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If so, with whom and for what?
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nmlkj No
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If so, who?