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© 2015 by Accountable Care Solutions Group, LLC

Services

Integrated, Patented + Proven Population Health Management

Program Administration

 

 

KBA is "high touch" as well as "high tech."  It has always been our philosophy to work personally with every client.  We consult and manage benefits to favorably impact the total cost and effectiveness of the health care package.  When doing so, we employ the creativity and innovation we've accrued since our founding in 1979 to properly analyze  data and manage plan design...all with the ultimate goal of promoting wellness, quality coverage, and affordability. 

But we don't do this alone.  KBA is part of the Key Family of Companies, each of which offers ancillary products and services that allow KBA to provide a varied and flexible portfolio of products. 

Link to Key Family Web Site:

Program Implementation

 

 

Accountable Care Solutions Group (ACSG/Key Family) has developed a “turn-key” and customizable infrastructure that medical providers can deploy within their communities to access self-funded employer purchasers on a direct basis with a value proposition of quality and cost savings that no other system can attest.  With more than 30 years of health plan management experience and over 3,300 corporate clients covering over 1 million members, ACSG/Key Family has developed a system that medical providers can “private label” to attract small, medium, and large employers into their medical provider delivery system.  The infrastructure supports all of the components for managing and administering self-funded plans with preferential stop loss and pricing advantages.  

 

Program implementation includes, but is not limited, to the following key tasks conducted by ACSG:

 

  • Facilitate Gain Sharing Arrangement

  • Plan Design Development (EPO and Tiered plans)

  • Network Development and Wrap Networks

  • Administrative Systems – Claims, Customer Service, Fulfillment, Compliance, Data Reporting

  • Employer Group Education

  • Actuarial Pricing and Stop-Loss Carrier Selection

  • Integration of Claims Data and Certain Medical Records

    • Population Health Management, Wellness Programs, Nurse Coaching

  • Educate and Communicate with Medical Providers

  • Referral Management and Authorization Processes

  • Sales Strategy, Marketing/Branding, and Distribution

  • Financial Distribution of Gain Share Disbursements & Reporting

Download Direct to Employer Program Description:

Population Health Management

 

 

The American Health Data Institute (AHDI) assists medical providers who work with employers to manage the cost and risk of their health plan in a way that optimizes benefits to the members, produces a favorable variance to the employer's health care budget, and optimizes gain sharing opportunities to medical providers. AHDI has created a unique and proprietary reporting system (Copyright 2004) that transforms claims and other data into actionable intelligence. The basic platform of the system is through Optum Insight/Symmetry. In addition, AHDI has substantially enhanced the data analytic capabilities thereby producing a unique combination of data and reports that effectively evaluate the cost drivers of a health plan. In fact this system is so unique the United States Patent and Trademark Office granted patent title rights to the entire AHDI process. AHDI is able through this unique process to provide a comprehensive Population Health Study that identifies and analyzes the overall health of the members and the cost drivers of the health plan. This analysis includes drilldowns into specific segments of the population identified as high risk.

 

The American Health Data Institute receives health related data from claims, biometric, Rx, health risk assessment data and builds a data warehouse.  The unique combination of information produced by AHDI includes the following:

  • Assessment of 27 chronic conditions

  • Predictive modeling that identifies large claimants twelve months in advance

  • Trend reports that analyze key health indicators

  • Analysis of health information by Health Economic Zones (HEZ)

  • Use of Episode Risk Groups (ETGs) and Episode Treatment Groups (ETGs) that aggregate health data into a Healthcare Index

  • Individual physician profiling that analyzes the cost and quality of care provided

Guide to AHDI White Paper:

Branding, Sales, and Marketing

 

 

The program will be marketed through local insurance agents.  This will require dedication and a focused effort.  A direct program sales person - supported by a new business and program support team - will be deployed into the community for the express purpose of motivating, focusing, and driving sales for this program through the agents in each community.  The direct sales team will be responsible for developing and implementing the local marketing and sales campaign in partnership with the sponsoring medical providers, overseeing the development and training of the local insurance agents, and representing the program to the community.  The local insurance agent will need to be motivated and energized to sell this program to local employers in the community. This will be accomplished by bringing the local agents new ways to sell value by emphasizing local medical provider integration, evidence-based medicine, data analytics, focused intervention for the chronically ill, and outcomes management.