As the country slowly recovers from the COVID-19 pandemic, employers face many challenges, including luring people back to work and recovering revenue lost during virus-driven shutdowns. But one familiar problem for employers endures: how to lower their health care costs while still providing their employees with high-quality care.
That’s the goal of UCHealth’s Employer Solutions program, which offers an integrated suite of clinical and administrative health care services to employers across the state of Colorado and beyond.
“Nationwide, health care coverage is the largest employee-related expense for employers. As an employer, it is important to partner with an integrated health system that can provide the highest quality of care through a vast network of providers and services,” said Lori Japp, vice president of Urgent Care & Employer Solutions for UCHealth.
Japp said UCHealth Employer Solutions focuses on working collaboratively with employers to deliver “accessible, affordable and comprehensive care” that meets the specific needs of their employees. The strategy to accomplish those goals rests on three main pillars supported by the UCHealth system: high-performing provider networks, occupational medicine, and third-party administration (TPA) services.
High-performing networks
High-performing networks provide a coordinated and integrated approach to health care delivery while simultaneously offering significant discounts. Both these strategies serve to reduce the total cost of care over the long term, said Jennifer Stone, senior project manager for Employer Solutions.
Employer Solutions offers a range of clinical services through UCHealth Coordinated Care Colorado (C3), a clinically integrated network of more than 600 primary care providers along the Front Range that includes 12 UCHealth hospitals. Stone added that UCHealth’s high-performing networks are developed in collaboration with payer partners and include the following network plans available to Colorado employers:
- Anthem Pathway
- Cigna LocalPlus
- UnitedHealthcare SelectColorado
UCHealth Coordinated Care Colorado helps employers manage their costs by providing data and tools to integrated primary care providers. This, in turn, assists providers in managing their patients’ care more efficiently, Stone said.
C3 Medical Director Dr. Amy Scanlan explained that this approach reduces duplication of services, unnecessary tests, inappropriate use of medications and other factors that add to the total cost of care. Additionally, an integrated network helps clinicians provide care in the “in-between spaces,” such as telephonic follow-up after emergency and hospital visits. This ensures that patients are connected back to their primary care physician for appropriate follow-up, Dr. Scanlan noted.
An integrated network also helps clinics to identify patients at the highest risk of poor clinical outcomes and take steps to protect them. The effort includes reaching out to patients to ensure they are getting the care they need to stay healthy, making sure they are taking their medications as prescribed, getting their screening tests on time, and helping them to problem solve when there are barriers to good care.
“Our integrated network is uniquely positioned to meet these objectives,” Stone said, noting that it is the only one in the state that joins an academic medical center – UCHealth University of Colorado Hospital – with community-focused hospitals and clinics.
“We do better because we have access to all cutting-edge services, including clinical trials, that we are bringing closer to home with community-based hospitals and virtual health care services,” Stone said.
Stone added that between 2018 and 2019, the network demonstrated success in both containing costs and improving value. For example, potentially avoidable ED visits, patient readmissions, total pharmacy costs and total medical costs all decreased.
“Our network takes a very patient-centric approach to care,” Dr. Scanlan concluded. “Our goal is to ensure that patients receive the right care, at the right place and the right time.”
Occupational medicine
Occupational medicine services are another key component of the Employer Solutions program. UCHealth provides these services in 14 Front Range clinics that served some 3,500 employers the past year, said Hannah Waltrip, practice administrator of Occupational Services for UCHealth.
The clinics operate both on-site or near-site and are staffed by Level 2 Certified Workers’ Compensation physicians specifically trained in skills like assigning impairment ratings to injured employees. The training ensures that employees receive treatment within the appropriate guidelines established by the state.
The clinics also have dedicated occupational medicine staff who handle key tasks to get employees on the job and keep them healthy, including:
- Injury management in both walk-in/urgent care clinics
- Diagnostic services
- Physical exams
- Preventive care
- Drug and alcohol screening
“We’re also an educational resource for employers,” Waltrip said, noting, for example that the UCHealth team helps ensure they are in compliance with Occupational Safety and Health Administration (OSHA) regulations.
Waltrip added that occupational medicine providers also help employers contain costs by identifying potential health issues like high blood pressure or cardiac problems. When it’s appropriate to do so, they can route patients who need more than primary care to the appropriate specialist.
Third-party administration
UCHealth Plan Administrators (UCHPA), launched in December 2013, works primarily to handle administrative functions for employers with self-funded health benefit plans. That means “doing everything an insurance carrier does,” but rather than collecting premiums for taking on risk, UCHPA procures stop/loss coverage for the employer. This coverage limits losses from catastrophic claims or heavier than expected utilization.
As a third-party administrator (TPA), UCHPA assists employers by:
- Processing claims
- Handling member and provider calls
- Issuing health plan ID cards
- Providing EOB (explanation of benefits) statements
- Working with brokers
- Administering pharmacy benefits
- Developing sales and marketing materials
“We deploy a single integrated product to the marketplace,” said Kathy Major, executive director and vice president of UCHPA. She added that UCHPA’s work goes beyond these traditional TPA services. For example, UCHPA connects its members to the services provided by the hospitals, clinics and thousands of providers in the UCHealth network.
“We work together to identify the unique needs of each employer and connect them to appropriate resources within the Employer Solutions division,” Major said.
Additional opportunities
There are many factors apart from hospital and provider charges that affect health care costs. Stone noted, for example, that prescription drugs, particularly new biologics, are “huge drivers” of the cost of care. Still, UCHealth and Employer Solutions continue to forge forward with measures to help employers contain costs.
For example, UCHealth continues to build its telehealth capacity, which allows employees to receive care remotely.
“Over the past 24 months we have expanded access to virtual primary care, occupational medicine and specialty care in addition to 24/7 access to virtual urgent care,” Japp said. “We are currently working on innovative solutions to further support employers and their employees through even greater access to virtual care.”
Other cost-containment measures UCHealth continues to take:
- Adding primary care clinics. UCHealth opened 20 new locations between 2019 and today.
- Providing ambulatory surgery centers, which perform surgeries at a lower cost than hospitals.
- Expanding access to urgent care and primary care locations. In 2019, UCHealth converted three freestanding emergency departments to hybrid urgent care/primary care clinics and converted one to urgent care.
- Educating patients on how to avoid unnecessary trips to emergency rooms and use primary and urgent care for non-emergency needs.