Paradigm Health Plans Presentation

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The Paradigm Health Plans Solution Presented to: (ABC Company)

[email protected] www.paradigmhealthplans.org

http://www.paradigmhealthplans.org/



The Paradigm Position• Formed in 2007, Paradigm Health Plans, LLC® is a wholly-

owned subsidiary of Paradigm Health Holdings, an industry leader in self-funded plans, partnering with businesses to empower employees to actively manage their healthcare costs through our Member Advantage ProgramSM

• Since 2013, Paradigm has seen an increase in new group self-funded sales and members of more than 180% over a two-year period

• Paradigm has offices in New Hampshire and Long Island, New York, and is expanding in four strategic U.S. cities in third-quarter 2016

• Paradigm’s Member Advantage ProgramSM allows for the Employer and their Employees to reduce or eliminate their out-of-pocket expenses

• Our Lifestyle-for-Life® Health Management Program includes Biometric Screenings of up to 38-panels provided on-site


The Paradigm PositionThe healthcare market has been evolving and changing for several years, and it will continue to become more complex

Option 1:Business as Usual• Brokers continue to be subject to

whatever regulatory changes occur

• Inherit increased costs due to regulatory changes

• Lack of control and unpredictable costs for brokers and their clients

Option 2:Partner with Paradigm• Brokers and Clients can become

pro-active and regain control of the quality, access and cost of their healthcare plan

• Explore Paradigm Health Plans’ Self-Funding Solutions and find out how our Member Advantage Program℠ (MAP) saves Clients and their Employees time and money!

• Start giving your Clients accurate Rate Renewal Pricing

OR


The Paradigm Service Model

Reinsurer/Stop-Loss Carriers:

AIGFSL

Munich REFairmont Specialty

(Crumb and Forrester)Standard Security

Lifestyle-for-Life®

And Health Management

TPAFor Processing

& Billing

Leased NetworkCIGNA PPO

AETNA PPO & OAAnthem BCBS

PPO


Plan Designs that Work

• Comprehensive EPO and PPO Health Plans

• 30 FTE and Above

• Wage Parity/Living Wage Plans

• Supplemental for Living Wage

• Minimum Value (MV)

• Minimum Essential Coverage (MEC)


Workforce/Ancillary Coverage

• Dental

• Vision

• Short- and Long- Term Disability

• Critical Illness/AD and D/Group Life

• Pharmacy Benefit Management

• Telehealth, Video, Skype Conferencing using 1-800MD


The Member Advantage ProgramMap the Gap: Closing the GAP in your Healthcare Plan


MAP The GAP: Resetting Member Expectations


MAP The GAP: Resetting Member Expectations


How MAP Works


MAP The GAP: Services

• Research and Present the Qualifications of providers to Members

• Review Benefits Prior to Plan Year Commencement

• Reduce or Eliminate Member OOP Expenses

• Locate in-network providers

• Schedule doctor visits for the family each year

• Provide quality and cost information on providers and proceduressuch as labs & diagnostics and surgeries

• Order RX/medications for members - no paperwork!

• Resolve tough billing issues

• Explain the summary of benefits

Each Enrolled Member Is Assigned A Dedicated MAP Who Will:


MAP The GAP: Program Results

Access to the highest-quality medical services that reduce or eliminate the co-pay, co-insurance or deductible costs for the members

Reduce RX costs by 18% to 22%

Reduce Complex Imaging costs by 61%

Reduce Lab & Diagnostics costs by 76%

Remove Facility charges and outpatient hospital excess claims cost.


Non-MAP Users vs.

Paradigm MAP Users

Physician Visit

Urgent Care

Retail Clinic

Emergency Room

$0 $100 $200 $300 $400 $500 $600

National Average Member OOP Expense

USING THE

MAP PROGRAM,

THESE EXPENSES CAN BE

REDUCED OR ELIMINATED

ENTIRELY


Self-Funded Plan Advantages• Level-Funding: Make 12 payments and you owe nothing else

• 115% corridor funded

• 125% corridor funded

• Self-Funded Options

• 100% of unspent claims surplus is returned to Client!

• Access to Tier 1 PPO networks, such as CIGNA, Anthem and Aetna

• Guaranteed Max Rate Cap Increase for 3 renewal cycles (Paradigm Exclusive!)

• Easy Fund: Our New Aggregate Management Program

• Savings Partners Program: Less up-front costs

Determine your maximum annual costs upfront!


Self-Funded Opportunity GrowsThe Affordable Care Act

Increases Interest in Self-Funded Plans:

Health Plans once offered only to Management and salaried employees must be offered to the balance of the workforce, scaling up the employers count of employees

As a result, small groups become large groups, and become excellent candidates for self-funded plans

82% of Health Executives expressed a growing interest in self-funding their group health insurance plans

70% of health organizations expected to grow their self-funding portfolios in 2015


Drivers for Self-Funded Increases

Health Insurance Premiums are Increasing at an unsustainable rate:

• Employees pay 89% more for family healthcare premiums then they did a decade ago.

• In 2013, premiums rose 4%, but that was still twice the rate of wages.

• According to a 2011 Department of Labor report, fully-insured premiums increased by $808 and self-funded premiums increased by $248.

Paradigm Health Plans’ average premium renewal

increase for clients is less than 3.5%


Drivers for Self-Funding: Health Industry Consolidation

• Health Industry consolidation has increased more than 50% since 2009 - with more consolidation in 2014

• Higher prices are sure to follow in some markets

• Hospital Mergers can lead to price increases of up to 20%

• These prices are especially acute in markets with one dominant health system

• Over half of hospitals plan to acquire physician practices in 2014 compared to 44% in 2012


Paradigm Health Plans Clients vs.

National Average Medical Cost Trends

Average Medical Cost Trend Nationally

Paradigm Client Average Renewal Increase

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00%

Compare the Difference with Paradigm Health Plans!


Self-Funded Employers: Deeper Discounts using Paradigm Health Plans

• Self-funded plans still meet ACA Guidelines and provide comprehensive benefits

• Employers gain control over their Network selections without limitations in provider choices (No Narrow Networks or Large Disruption!)

• Paradigm’s Lifestyle-for-Life® Program allows for cost containment with incorporated biometric screenings, health assessments, disease and care management resulting in a 6-9% savings on claims costs!

• Paradigm’s Member Advantage Program (MAP) embedded in most Paradigm Health Plans allows for Employers to contain costs when they encourage Members to utilize the programs

• Members who utilize the MAP Program significantly reduce their out-of-pocket expenses and can spend money on what they love – not on the healthcare they need!


Self-Funded vs. Fully-Insured

1. What if claims exceed your monthly payment?• For Fully-Insured Groups, the Insurance Company pays the claims

• For Self-Funded Groups, the Stop-Loss carrier pays the claims

2. What if claims are less than your monthly payment?• For Fully-Insured Groups, the carrier keeps the difference

• For Self-Funded Groups, the Employer keeps 100% of the savings!


Controlling Costs without Disruption

LEVEL ONEMajor PPO Providers | Highest Quality Of Doctors & Hospitals Reduces Medical Claim Costs |

Aetna And CignaLEVEL TWO

Paradigm Premier Provider Network | Highest Quality

Providers For Lab & Diagnostics, Prescription Drug/RX And

Complex/Advanced Imaging | Reduces Claim Costs

LEVEL THREEPPO Wrap Network | Plan

Design Rewarding Members For Proper Plan Utilization | Member Advantage Professional Service

For Member Education And Convenience | Negotiate All

Claims Above 5k | Use Our Out-of-network Shared

Savings Programs | Fraud Management System |

Subrogation Of Non-plan Responsible Claims


Members Will Have Access to the Best PPO Networks Available

More than 200 Networks are available to Paradigm Health Plan Clients!


To contain costs, you must know where they come from

74% of healthcare costs are due to lifestyle-related conditions, and are therefore preventable

52-61% of all claims come from these standardized services: Rx, Complex Imaging, Urgent Care, Preventative, Labs & Diagnostics

32-37% of all claims are for Inpatient or Surgical procedures at hospitals that charge more, simply because they can

Reduce costs by auditing all claims above $5k

On average in 2012-2014, Paradigm Health Plans Clients saved more than $14K annually


Lifestyle-for-Life® Health Management Program

• Provides a dedicated Program Manager: We do the work for you!

• Biometric screening of up to 38 panels: identify hard-to-treat diseases before they progress!

• Health Assessment

• Health Evaluation

• Healthy Activities

• Workplace Wellness Champion

• 20.7% lower medical spending compared to companies not using the Lifestyle-For-Life® program

Results in a 6-9% Annual savings on Claims Cost


Questions?

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Paradigm Health Plans Presentation