|
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)
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
Top
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
Top
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 diag-
nosis 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
Top
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.
Top
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.
Top
|
