Elite Health

Your healthcare costs are on the rise and you know the culprits – increasing premiums, medical claims costs, and prescription drug costs. The challenge is finding solutions that proactively address those increases.

Elite Health is a unique health plan that improves your healthcare cost by addressing your plan’s primary cost drivers. Our solution is the result of a collaborative effort by some of the nation’s most innovative, well-respected healthcare organizations and population health management programs. Together we have created an integrated approach that allows employers to control healthcare costs from every angle.

Our complete suite of programs allows us to address each of your employees’ specific health issues, regardless of where they are on the healthcare continuum.

Elite Health is a turnkey program, including claims administration, stop loss protection, case management and chronic disease management with nurse outreach and member contact. Best of all, Elite Health includes the lowest available healthcare cost within its primary network.

 

Product Overview

 

What is Elite Health? 

Elite Health was developed by local health care systems to provide the highest quality care at the lowest available cost. Its purpose is simple:  Collaborate to improve the health of the community by bringing a unique health solution to create better care for business. By collaborating with St. Elizabeth, TriHealth, Cincinnati Children’s, Kettering and the American Health Data Institute (AHDI), Elite Health is turning data into intelligence with a completely coordinated healthcare system treating people rather than patients while improving the overall health of the employer’s workforce. Elite Health’s population health management program combines data analytics and result-tested wellness initiatives to improve your employees’ health and reduce costs. Our complete suite of programs allows us to address each of your employees’ specific health issues, regardless of where they are on the healthcare continuum.

 

Is the network limited? 

No. Employees have access to tier one providers such as St. Elizabeth Healthcare, TriHealth, Cincinnati Children’s Hospital, Kettering Health Network, numerous local independent specialty practices, and a national wrap network, allowing plan participants to seek care at provider of choice. 

 

Who is the Pharmacy Benefit Manager (PBM)? 

Elite Health partners with several industry leading PBMs.

 

Who is the Third Party Administrator (TPA)? 

Key Benefit Administrators serves as the TPA.

 

What type of funding arrangements are available? 

Elite Health can be purchased as a partially self-funded/level funded (similar to fully-insured) or self-funded plan. 

  • Level funded plans start at two (2) enrolled employees.

 

Are plan designs flexible? 

Yes. Plan designs are predetermined, but employers have over 15 options including traditional PPO plans and HDHPs with HSAs. All of the available plan designs have tiered benefit structures with maximum out-of-pocket limits including out-of-network benefits.  

 

Is there a wellness component and/or requirement? 

No requirement is in place today. However, employers will be encouraged and have the opportunity to purchase additional services from pre-selected providers at discounted prices.

 

Why is it different?

Case Management (CM) and/or Chronic Disease Management (CDM)
The CM and CDM will be done by AHDI. As a result of the CDM protocols of AHDI any service rendered by a network provider pertaining to an included chronic disease will be covered at 100%.

The ability to actively manage health is directly correlated to controlling the cost of healthcare spend --- Elite Health will manage health by way of coordinated efforts between high quality providers and AHDI’s patented population health management program which combines data analytics and result-tested wellness initiatives to improve your employees’ health and reduce costs.

Access to Claims Information
All participating employers will have access to claims reporting and analytics including healthcare risk management reports.

 

Special Contract Provisions
For example, if you are admitted to a St. Elizabeth facility and are re-admitted for the same diagnosis within 30 days, any fee connected to the second admission will be waived.

 

Discounted Non-medical Benefits
Fully-insured dental and vision plans will be available with bundled discount pricing.

To learn more about Elite Health, please contact

Gene Kirchner gkirchner@nkychamber.com | 859-578-6395

 

Jack Graham
VP New Business Development
317-508-0313
jack.graham@keybenefit.com


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