Strategic Partners

Fox/Everett  has formed strategic partnerships with professional organizations that have exhibited their ability to bring added value to our clients in the management of cost control for their self-funded or partially self-funded plans.

Healthcare Strategies
Pharmacy Benefit Managers (PBM)
United Resource Network (URN) 
Network Coverage and Quality
National Health Benefit Corporation (NHBC)

Contact us for more information.

 

Healthcare Strategies

Care
  • 24 hour, 7 day a week professional (RN) accessibility    
  • Hospital pre-admission and concurrent review of all admission   
  • Integration with case management process   

Technology

  • Administration access to information   
  • HIPAA compliant system   
  • Electronic interface with payors   
  • Real-time and summary reports provided via web server results   
  • Administrative notice of potential large claims at the earliest possible interval   
  • Early referral and initiation of case management   
  • Increased use of cost-effective alternatives to hospitalizations    
  • Hospital admissions and days comparable to HMO without restricting access patient-centered services, balancing advocacy and financial considerations   

HealthReach Predictive Care Management

   
Eighty-two companies lowered their aggregate medical expenditures an average of 6.6% in 2004 while improving the overall health of their members with this program.    

MaterniCare Program

  • Lowered incidence of premature births     
  • Dedicated team of RN's specializing in the management of high-risk pregnancies    
  • Periodic risk-assessment and individualized interventions to promote positive outcomes     
  • Round-the-clock RN support    
  • Personal attention. Providing reassurance, awareness and encouragement to expectant mothers     
  • Educational and emotional assistance 
  • Interactive online educational resources for members to augment telephonic services and printed materials

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Pharmacy Benefit Managers (PBM)

Fox/Everett has strategic partnerships with multiple pharmacy benefit managers. Each partner has unique pharmacy management programs. Fox/Everett consults with our clients and the pharmacy managers to implement the pharmacy benefit management program that best suits the client's needs. Our PBM partners offer:      

  • Traditional pricing models versus transparent pricing models     
  • Generic models utilizing high performance formularies      
  • Closely managed plans that excel in man-aging utilization with heavy focus on patient safety     
  • Programs that allow patients to fill maintenance medications for 90 days at retail with discounts comparable to mail order

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United Resource Network (URN)

Fox/Everett has partnered with URN to provide fully-insured transplant coverage for our clients with self-funded or partially self-funded medical plans. URN provides expertise in:      

  • Transplant risk underwriting      
  • Case management      
  • Eligibility auditing      
  • Claim review and payment      
  • Early detection of transplants based on diagnosis codes and high dollar claims      
  • Patient education      
  • Plan design      
  • Reviewing each potential Center of Excellence based on these key factors:            
    • Volume of transplants performed by organ type 
    • Patient survival statistics by organ type           
    • Organ graft survival statistics by organ type

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Network Coverage and Quality

A critical component of any health benefit program is the accessibility of contracted providers to the participants. This includes offering adequate numbers of providers and geographic coverage that ensures that the distance a participant must travel is minimized. Additionally, providers must meet strict criteria for participation (credentialing) and be managed on an ongoing basis.

Fox/Everett has direct contracts with approximately forty regional and national preferred provider organizations (PPO's). We strongly believe in providing direct network access to all members whenever possible. We work very closely with our clients' employees to ensure the very best network access is obtained.

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National Health Benefit Corporation (NHBC)

Fox/Everett has partnered with NHBC to provide a national provider network for our clients. This national access program brings an added value to our client's plans by obtaining savings through network contracts and negotiations on 89% of all non-network claims.

Employees and their families can access contracted providers nationally and benefit from reduced charges. We offer the flexibility of paying benefits for these individuals as in-network or out-of-network. This national coverage has been very well received by those traveling and by dependent students residing in other areas of the country.

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