Proactive Health Management Plan (PHMP)
Purpose
PHMP can be a key driver for your comprehensive growth plan. But more than just a strategy, PHMP has the potential to be a brand new business entity for a large health system or medical group. This is a new private-labeled (or co-branded) health promotion plan that will not only link you more closely with your own employees, but also provide you with a direct connection to the employers in the market areas that you serve. This direct connection will become a very important asset for retaining and growing market share of commercially insured patients. It can be offered as a standalone solution or as an enhancement to the DTE program.
The program complements your existing major medical plan and does not require any changes or replacement of current benefit programs. PHMP is a fully-insured hospital indemnity plan with population health management riders that allow for payment of a fully insured indemnity claim. This claim is payable upon completion of a suite of concierge health benefits rooted in four statistically valid patents on population health improvement, chronic disease management and data analytics. The PHMP program is designed to deliver the following prevention and wellness benefits to employers and their employees:
- Improve the underlying health of the participants and create savings in your health plan – both for the employee and employer
- Increases after-tax spendable income by 3% to 5% for the majority of your employees
- Provides a guaranteed return to the employer of almost $324 per year per employee enrolled in the program
The effectiveness of the PHMP program is based upon the same patented processes used by the American Health Data Institute (AHDI) on over 2.5 million people for more than 16 years. Intelligent engagement with appropriate, professional coaching and strong economic incentives exist as the main ingredients to the AHDI success formula. PHMP incorporates all of these patented, proven and creative techniques.
Net Cost (Benefit)
Through a Section 125 benefit in the Federal Income Tax Code, significant reductions in payroll tax result for BOTH the employer and employees who actively participate in this program. So while an employee payroll deduction of $755 per month funds the cost of this program, the reductions in payroll taxes exceed the payroll deductions resulting in the net pay increases each payroll period referred to in the bullet points above.
The indemnity benefit reimbursement of $625 per month is paid to the employee for completing the monthly required activities, all of which fall under section 213(d) medical expenses. This includes health risk assessments, online health coaching, concierge health and lifestyle telephonic coaching, health and fitness DNA screening, biometric screening and telemedicine. So there is a significant financial incentive for staying active in this prevention and wellness program. See the details of how the benefits and costs net against each other by clicking this program brochure link.
Implementation
The implementation of the PHMP Program is accomplished with the coordinated resources of CSuite Solutions and KBA (Key Benefit Administrators) one of the largest independent third party administrators in the US. The program itself is fulfilled by KBA and Companion Life Insurance Company, an A+ Superior rated insurance carrier.
CSuite Solutions roles, responsibilities and expertise include:
- 1. “Go-to-market” strategy and implementation
- 2. Readiness and market assessments
- 3. Network development
- 4. Clinical integration
- 5. Change management
- 6. Cultural acceptance
- 7. Comprehensive business plan
- 8. Agile project management with timeline
- 9. Program launch
- 10. Account management and oversight
There are major synergies of doing the PHMP program along with DTE because they are both administered by KBA and share many of the same support services. The benefit infrastructure and technology work together to lower the health costs of the employees and their employers. While DTE provides a strong foundation for controlling and reducing healthcare costs, PHMP adds important incentives to employees for taking an active role in improving their health.
Key Benefit Administrators roles and responsibilities include:
- 1. Communicate the program benefits to providers and employers
- 2. Help implement and manage enrollment into the program
- 3. Deliver benefits to employees and reimburse providers for services provided to program participants
- 4. Identify those employees who are in 27 chronic disease categories
- 5. Provide counseling and support those employees identified to have chronic diseases
- 6. Help significantly reduce healthcare costs based on past performance
- 7. Increase economies of scale for employee health prevention and wellness results by adding thousands of lives that are currently covered and also not covered by any health plan.