by gilsbar, inc.

Evolent Health Presentation by gilsbar, inc.

Derrek Barfield, Senior Sales Executive

Doug Layman, EVP, CSMO

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Our Vision.Our personal healthcare experts engage members and guide them through the complex healthcare system, creating savings in both time and money.

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Evolent HealthThe words evolve and transcendent define our ambition and inspire our name. We aim to help our partners evolve their approaches to care delivery and reimbursement beyond the current model, and in so doing, achieve transcendent outcomes for their organization and the populations they serve.

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Care Advocates

Evolent Health

Strategic & Cultural Alignment

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Gilsbar differentiators• A health and benefits organization for over 50 years• Skilled in healthcare, vision, dental, life and disability plan management and customer service as a third party administrator• Own our medical management company that has provided patient care management for over 20 years• Registered nurses and benefits professionals triage incoming calls and service• Consistently ranked among the “best of the best” in customer and employee satisfaction• Healthcare clients represent a significant percentage of Gilsbar clientele

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Patients are relatively inconsequential in healthcare today.

How can we put them at the forefront and

give them the resources they need?

 

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The need for advocacy.

INSURANCE IS CONFUSING.

• Filled with jargon and acronyms that only those in healthcare or benefits understand

• Loop holes in the system make it hard to navigate

• Access to care is becoming more complex and restrictive

 

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The need for advocacy.

HEALTHCARE REFORM

• FSA caps and more out of pocket for employees• Exchanges may force employees out of employer health plans• More patients in the healthcare system leads to shortages in providers• Rampant confusion in the marketplace

 

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The need for advocacy.

AGING POPULATION

• One in four American adults provides care for an aging parent1

• Complexities in Medicare, parts A, B, C, D, supplements and Rx•Long term care needs prompt

many questions in coverage, facility options, in-home care

1Atlanta Journal-Constitution writes in Caring for Parents Increasingly Costly that “One in four American adults provides care for an aging parent, a threefold increase since 1994.

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The need for advocacy.

HEALTH EDUCATION & RESOURCES

• Endless information available on the

web ~ causes confusion and stress.• Who do employees turn to for education on a new diagnosis or condition?• Where will they find the highest quality providers and facilities?• Who can they trust to help them navigate the system, understand the

costs, and make the best choices?

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The need for advocacy.

PRESENTEEISM & PRODUCTIVITY

• Costs of presenteeism are estimated at $2,000 per employee per year• Employees are working through difficult personal healthcare issues for themselves, and their family members, on work time, contributing to lost productivity. • The stress and distraction involved is a direct cause of presenteeism during working hours.

 

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HR/Benefits Broker

Healthcare Reform

Insurance Confusion

Aging PopulationHealth Education

Presenteeism & Productivity

Who’s responsibility is it to help employees?

• The epicenter is typically HR or the broker.• Insurance call centers can help, but don’t help with the whole maze.• Who is the best resources to help with

PHI and referrals?• Who has the time to really devote to employees’ personal needs and those

of their family?

 

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HR/Benefits Broker

Healthcare Reform

Insurance Confusion

Aging PopulationHealth Education

Presenteeism & Productivity

Care Advocates takes on the responsibility.

 

Care Advocates

Healthcare Reform

Insurance Confusion

Aging PopulationHealth Education

Presenteeism & Productivity

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Comprehensive Service Bundle

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Assists members with understanding benefits and what they cover.

• Explanations of EOBs, co-payments, deductibles and out-of-pocket expenses• Explanations of coverage including dental, vision, life, disability and more • In-network vs. Out-of-network providers and how to best use benefits• Assistance locating in-network providers• Coordination of benefits between multiple carriers• Pros and Cons of FSAs, HRAs and HSAs & help making the right choices

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Provides expert assistance with claims, EOB’s and billing.  • Answering questions about paid or denied claims• Explaining the details of the medical claims payment process• Explaining EOBs and what out-of-pocket responsibilities specific claims may represent • Resolving claim and billing issues• Assisting with pre-authorizations• Assisting with claims appeals• Facilitating coordination of benefit filing• Facilitating discussions with non-network providers on reasonable and customary charges

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Offers assistance with coordination of care.  • Assistance finding a doctor, hospital or community resource • Help scheduling appointments with primary care physicians and specialists• Assistance with referrals, pre-authorization and second opinions• Assistance transferring medical records, including x-rays and test results transfers between hospitals or other medical service providers• Explanations of test results after a doctor visit or after an employer’s wellness health fair • Clarifications regarding recent diagnoses—what they mean and what treatment options are available.• Clarifications regarding recommended treatments, explained in simple and straightforward terms • Coordination of home health care visits and equipment• Explanations of what to expect before and after a surgery, procedure or diagnosis• Coaching on lifestyle changes to improve health

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Provides care coordination for aging parents.  • Making arrangements for visiting nurses or personal care providers, hospice, home health or equipment• Assistance finding a doctor, hospital or community resource • Help scheduling appointments with primary care physicians and specialists• Assistance with referrals and pre-authorization• Assistance transferring medical records, including x-rays and test results• Explanations of test results after a doctor visit or after an employer’s wellness health fair • Clarifications regarding recent diagnoses—what they mean and what treatment options are available• Clarifications regarding recommended treatments, explained in simple and straightforward terms • Help obtaining a second opinion if requested• Coordination of transfers between hospitals or other medical service providers

This service is provided to the elderly parent and coordinated through their named dependent.

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Standalone Products

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Provides assistance during annual open enrollment to improve employee engagement: • Provides dedicated telephone support during the annual enrollment period• Help members understand all the benefit options available• Help members model their choices from a financial and coverage perspective• Explain consumer directed healthcare options and provide tools to help members understand choices available to them

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Provides expert assistance to help members save time and money in the following areas: 

Negotiation of Uncovered or Out-of-Pocket Medical Bills – Our billing specialists can help negotiate down the cost of out-of-pocket medical bills, thereby gaining a discount for services rendered. Out-of-pocket claim expenses are negotiated at a reduced rate to help members manage overall costs.

 Medical Billing Audits/Reviews – Our advocates will review and audit medical bills for errors, including overcharges, unbundling, duplicate charges, incorrect diagnoses, “billed-but-undocumented” and other areas related to generating a correction.

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What are the benefits?

Employees

• Less stress• Reduced expenses• Higher benefit satisfaction• Consolidated resource for all benefits, even non-employer sponsored• Consolidated resource for entire family, even if not covered on employer’s plan

+ =HR /Employer

• Less burden on HR• More time to focus on strategic initiatives• No PHI/HIPAA concerns• Increased productivity• Decreased presenteeism

Healthier Business

Broker / Consultant

• Solidifies your relationship with client• Drives your value- added suite of services• Provides a unique, unanticipated solution

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Member communicationsthat are engaging, attractive and compelling drive awareness of this valuable new benefit.

• Wallet cards•Welcome brochures•Quarterly E-newsletters•Posters•Table tents with tear off cards•Key fobs•Magnets

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How do I get started?

EASY

Step 1: Sign Contract

Step 2: Send eligibility file

Step 3: Provide group benefit

documents

Step 4: We start taking calls!

We also offer:• A dedicated account

management team• Quarterly reporting on number

and nature of calls, engagement and touch points

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Thank you!We look forward to hearing from you!

Care Advocates by Gilsbar, Inc.2100 Covington CentreCovington, LA 704331-800-445-7227 Extension 830

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