The UMR Advantage

A unique solution for the self-funded market

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The value and advantage of UMR

We are the only TPA that:• Offers the significant network discounts and infrastructure investment

of a Fortune 50 company

• Offers fully integrated internal benefits solutions, such as care management,

pharmacy benefits administration and stop loss; or can plug and play with

your preferred vendors

• Can quickly respond to state and federal mandates, regulators and market

changes

• Most of all, we know how to put Customers First.

We call it the UMR advantage.We offer hospital-specific solutions based on:

• Sophisticated plan designs that promote domestic utilization, driving clinical

care and revenue to your providers and facilities

• Integrated products and services that incorporate your clinical resources and

organizational culture to deliver cost savings

• Market experts dedicated to serving the needs of hospital and health care

systems and specialized customer service teams trained on the intricacies of

hospital benefits administration and organizational culture

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What you should know about us

We’re big. But we’re also local and regional in scope with claim offices in each time

zone and account management staff in just about every state, close to our customers.

We have more than 3,000 people who can focus their expertise and experience on

your plan.

We serve more than 1,400 customers and their more than 2 million members every day – accurately, carefully and compassionately. Our customers range from mid-sized, self-funded companies to coalitions of employers to large state governments.

You should know, we treat each one with the same amount of care and expertise.

Most of our customers ask us to administer multiple, unique plan designs with various reimbursement methods …

It’s what we do best.

With more than 100 account management staff, it’s likely yours will be in driving distance of your office.

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Dedicated to serving hospitals

UMR administers self-funded benefit plans for hospitals and health care systems coast

to coast, serving more than 460,000 hospital plan members. Our health care clients

range from rural, stand-alone hospitals to multiple-facility integrated delivery systems

with complex organizational structures.

We have a team of product experts dedicated to serving the hospital market to ensure

we are doing everything we can to meet your needs. These market experts can provide

you with a variety of networking and educational opportunities to help you make

strategic decisions about your benefit plans.

In 2011, our book-of-business trend for hospitals was 2.8 percent per employee per

year on a paid basis.

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UMR hospital summit

As a UMR hospital client, you will be invited to our annual hospital summit, a two-day event that brings our hospital customers together to exchange ideas with peers from across the country. The UMR hospital summit offers an informal, yet educational, interactive setting that allows our hospital customers to learn from and network with colleagues who are encountering similar real-life benefit challenges.

The hospital summit consists primarily of peer presentations by other hospital plan sponsors, including presentations such as:

• Implementing a Domestic Provider Network & Reimbursement Strategy

• Is Your Health Plan’s Performance & Cost a Mystery to You?

• The Journey to Accountable Care Organizations

• Maximizing Your In-House Pharmacy Buying Power

• Let’s Play – Finding the Healthy, Active Child In Your Adult Employees

Those who participate in the summit tell us how appreciative they are to connect with peers and learn new ideas and strategies to take back with them. In fact, 97 percent of attendees over the past four years have rated the experience as “Excellent.”

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Plan designs to keep care in-house

As a hospital, one of your primary goals is to keep care within your hospital. A multi-tiered plan design is a common strategy for encouraging members to use your domestic providers. The most common is a 3-tier plan, with services from domestic facilities and providers paid at Tier 1, in-network providers at Tier 2 and out-of-network providers at Tier 3.

UMR can administer plans with any number of tiers. For instance, if your hospital is unable to provide a particular service, UMR can set up your plan to pay for such services at the Tier 1, domestic, level to ensure your employees and their dependents are not penalized.

Another option is to mandate that a specific service be provided at your hospital. For example, you can set up your plan to require that members receive MRIs at your facilities. Members still can receive an MRI at other facilities, but it would paid at the Tier 3, out-of-network, level.

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Taking control of plan costs

UMR has the flexibility to allow you to set your own domestic reimbursement, providing you more control over the bottom-line cost of your plan.

Doing so allows you to carve out your facilities and providers from the managed care network and determines what level of reimbursement UMR will pay toward their claims.

UMR can administer a variety of domestic reimbursement methods, with the most common being a percent of billed charges. Other available methods include:

• Diagnosis-related groups (DRGs)

• Per diems

• Resource-based relative value scale (RBRVS) fee schedules with a conversion

factor

Setting your own domestic reimbursement makes you less dependent on managed care networks, reducing the potential ramifications should your relationship with your network be severed.

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More money in your pocket

UMR is able to suppress checks for payment to your domestic providers and facilities while capturing these transactions in all claims data.

Because your hospital’s funds are not suspended during processing and delivery, you have more cash on hand. Increased cash on hand and improved cash flow can have a positive impact on your bond rating, making you better able to secure funding for large investments, such as facility expansion or new construction.

We can configure automatic payment suppression identified by hospital, domestic facilities or physicians (or a combination of these) at a tax identification number level.

However, we cannot configure check suppression to include individual hospitals, facilities or physicians, i.e., you cannot set up Dr. Smith with automatic payment suppression and Dr. Jones with paper check payment.

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Care management

UMR Care Management provides integrated, member-centric services that can be tailored to your overall strategy. We help employers develop multi-year strategies to adapt their health culture to value healthy lifestyles, emphasize personal accountability and, ultimately, mitigate their medical claim trend. We focus on educating and motivating members, moving them from incentives for participation to incentives based on achievement of empirical, clinical health markers, such as BMI, LDL, fasting glucose and blood pressure.

We equip your plan members with the knowledge and resources to take a more active role in their health care decisions and to think like consumers when choosing the right options for them. UMR recognizes that when it comes to member care, one size does not fit all – a service of utmost value to one plan member may be of little or no value to another. Incentives, such as reduced co-pays or premiums, reward members for appropriate use of high-value services or adopting a healthy lifestyle.

Government estimates show as much as 75 percent of health care costs can be attributed to a preventable disease, so offering 100 percent coverage for preventive care may be a sound investment. Preventive care, such as age- and gender-specific screenings, can detect these diseases early, when they are most treatable, and help at-risk members make healthy lifestyle changes to avoid developing a chronic and costly condition.

We can also offer value-based benefit solutions that combine the strength of our care management programs with the benefits of consumer-driven health plans. The result is a plan that uses incentives to steer plan members to the highest-value care at the most affordable rates.

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The value of our care management program

Our suite of care management products offer tightly integrated

internal solutions to medical management, but we also have the flexibility to “plug and play” with just about any vendor a client prefers.

We can give you access to the full spectrum of URAC-accredited programs – from utilization management and case management to disease management and health and wellness.

Each program is interconnected and linked to our sophisticated claims platform. Or you can pick and choose only those products that fit your unique needs.

To make the most of your medical plan and take full advantage of the discounts available to you through the UnitedHealthcare Options PPO Network, UMR requires you to use our utilization management and case management solutions to limit potentially costly claims.

When purchased in a combined package, our customers typically realize a 3:1 return on investment for our utilization management, case management and disease management programs.

There’s no silver bullet to our approach, but it is designed to connect with plan members and energize them to actively participate in their health care decisions and lifestyle choices.

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Flexible care management

UMR understands many of the care management services we provide are also available through your providers and facilities. We can customize our programs to maximize the use of your domestic facilities, clinicians, programs and initiatives, while interfacing with our care management services.

We offer two types of arrangements for coordinating our services with your internal resources:

• Coordinated care management

• Hybrid care management

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Coordinated and hybrid care management

Coordinated care management - In this arrangement, UMR offers services that you can provide in-house. Rather than duplicate efforts, we can coordinate those services with your facilities and providers.

Hybrid care management - Under this more common arrangement, UMR will wrap its care management services around your internal resources.

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Customized wellness programs

UMR can customize our health and wellness programs to your organizational culture, and work with you to incorporate your internal resources.

For instance, you can conduct your own clinical health risk assessment and biometric screenings and supply the data to UMR to identify members with current and future health risks. We then can help you develop incentive and reward programs that work best for the organization and your employees.

When working with hospitals and health care systems, one of the key concerns in developing health and wellness programs is confidentiality due to the extreme sensitivity of health-related information. We will work with you to integrate our internal resources and, when necessary, provide solutions that will alleviate confidentiality issues.

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The member experience

UMR Care Management works with members to:• Actively engage them in their health and health care decisions• Help them understand how to get more value for their health care dollars• Improve their daily behavior to enhance their quality of life

Members have an advocate who helps them navigate the health care system and their benefits options in a knowledgeable, friendly and caring manner. Our programs emphasize communication and education, participation, member satisfaction and clinical improvement. Members receive the tools they need to build stronger relationships with their health care providers, along with informative materials on important health topics and access to online resources.

Working hand-in-hand with clients and client advisors, we can drive participation through:

• Preventive care coverage• Plan inclusions and exclusions• Incentives tied to clinical health risk assessment (CHRA) or biometric screening

completion and health status, or incentives tied to participation with a health coach or case manager

We recognize that every member population is different, so we will work with you to customize an incentive plan that best meets your needs and those of your members. UMR care management provides a variety of member materials to help you introduce the programs and services available to your employees and encourage them to make healthy lifestyle choices. These include posters, flyers, tent cards, wallet cards, teleseminars, newsletter articles and lab screening handouts.

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Rewarding healthy behaviors

The right use of incentives will help you:• Engage and reward members• Encourage completion of CHRAs and biometric screenings• Drive enrollment in health coaching programs• Spur interest in wellness-related activities• Influence behaviors• Maintain momentum• Place a clear emphasis on what’s important to the culture of your organization

Incremental, phased, multi-year strategies have proven most effective. Consider rewards based upon:

• Activity/participation: Incentives for completing a CHRA or wellness coaching

• Diagnosis/risk: Co-pays waived on condition-specific medications, i.e., medicine for hypertension management or cholesterol reduction

• Compliance: Lower premiums for non-smokers, 100 percent coverage for preventive care or condition-specific care or medications

• Outcomes/health status: Incentives or benefits based upon biometric screening results or improved screening measurements, or for achieving specific health goals

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Identifying member risk

UMR Care Management uses diverse sets of data and advanced analyses to identify members with current chronic health conditions and future health risks.

After collecting the data, we examine the stratified results, using algorithms based on standards outlined by nationally recognized health organizations.

When we’ve identified at-risk members — catastrophic, chronic or at-risk (non-chronic) — it is important to engage them in the right program through plan design and targeted member communications.

Members in the following categories are targeted to participate in one-on-one sessions with a health coach or nurse:

• One of seven disease states: asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (heart disease), depression, diabetes and hypertension

• Pregnancy

• High-risk for developing heart disease

• High-risk for developing diabetes (pre-diabetes)

• Multiple lifestyle risks (nutrition, activity, blood pressure and/or weight/obesity)

• Tobacco use

• Body mass index of 35 or more (morbid obesity)

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NurseLine® and maternity management

NurseLine connects members with highly trained registered nurses any time of day, seven days a week. Nurses help callers make more informed choices about when and where to seek the appropriate care, providing information on specific conditions and treatment options. This can result in fewer emergency room visits and hospital stays, leading to lower overall health expenses.

Through NurseLine, members also can access an audio health information library, with more than 1,100 recorded topics, such as aging, common illnesses, fitness and surgical procedures.

Our maternity management program offers assessments and information for women considering having a baby and prenatal education and guidance to those expecting. The result is an increased number of healthy, full-term deliveries and a decrease in costly, extended hospital stays.

We identify participants using claim edits, triggers and utilization review. Our nurse coaches then provide education, follow-up calls and support based on the woman’s individual risks. Those identified as high-risk are placed into our case management program, to monitor their conditions and keep customers informed of high-cost situations.

All members who join the maternity management program during the first or second trimester receive an incentive gift. Once enrolled in the program, expectant mothers are contacted by nurse case managers who have extensive clinical backgrounds in obstetrics/gynecology. Members also can choose from a selection of high-quality books and other materials containing helpful information about pregnancy, pre-term labor, childbirth, breast feeding and infant care.

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Health and wellness

UMR’s health and wellness program provides a proactive approach to improving the health of employees. We identify members’ current and future health risks and then help them understand those risks and how they are linked to conditions such as diabetes and heart disease. We give them the tools and support to make healthier lifestyle choices that reduce their likelihood of developing a chronic disease.

Completing a clinical health risk assessment (CHRA) is the first step for members. Our CHRA asks questions about members’ medical history and lifestyle habits such as food choices, physical activity level, tobacco use and readiness to change.

We combine the CHRA reports with biometric screening results for blood pressure, glucose levels and cholesterol to gain a more complete picture of the overall health of a group. Members identified as high risk for future health problems are invited to work with a personal health coach in a series of one-on-one phone conversations. Our coaches are trained in behavior-change techniques and provide information and encouragement to help participants set goals and follow through with their plan to live healthier.

UMR can assist you in establishing a workplace culture that supports healthy behaviors to improve the well-being of your employees. We provide strategies and support in crafting customized wellness plans, along with employee challenges that encourage participation in physical activity, weight loss or healthy eating programs.

We encourage customers to attach incentives to their wellness programs. Incentives increase participation and have a direct impact on your program’s success. Because every employer population is different, successful incentive programs are structured with the particular motivations of the members in mind.

The program includes:Clinical health risk assessments

Onsite biometric health screenings

Personal health coaching

Quarterly newsletters

Educational information

Worksite wellness strategies and support

Incentive administration

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Disease management

UMR has found that these seven health conditions drive medical claims costs for employers:

• Asthma• Chronic obstructive pulmonary disease (COPD)• Congestive heart failure• Coronary artery disease• Depression (co-morbid condition)• Diabetes• Hypertension (high blood pressure)

Identifying plan members and helping them manage their conditions provides the maximum value to you, while helping participants improve their well-being. The program also can mitigate indirect costs to you, such as absenteeism and reduced productivity.

Our program uses the leading behavior change model to determine an individual’s current stage of readiness to change and how we can best guide the participant toward improved health. To maximize your short-term return on investment, we focus on those who are currently most ready to make a healthy change. Members with a chronic condition are automatically enrolled in the program, and those identified for one-on-one coaching are invited to participate through a combination of letters and phone calls.

To help drive participation in the program, UMR offers customers new to disease management a $100 gift card incentive. It is given to eligible members who enroll in one-on-one coaching during an introductory time period.

Lower-risk participants receive a free subscription to our quarterly newsletter and periodic communications about their condition and making healthy changes.

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Case management

UMR case management targets complicated cases to achieve better medical outcomes for plan members and greater cost savings to you. The key to our success is the case manager’s ability to identify, coordinate and negotiate alternative treatment plans and related costs.

• Our case management team is made up of licensed, registered nurses• 95 percent of our nurses have certified case manager (CCM) credentials• All must have three years of acute care clinical experience and expertise in at

least one specialized field

Our system identifies case management opportunities using an automated trigger list that can be customized at your request. The list is based on ICD, CPT and dollar threshold criteria or when a member’s inpatient length of stay reaches five days. Each case is unique and handled according to the specific needs of the member. On average, cases remain open for four months.

UMR measures the success of its case management program by the following criteria:

• Improved clinical efficacy• Reasonable medical action plan• Coordination with providers and family• Clinically eligible for coverage• Customer satisfaction correspondence• Coordination with stop loss vendors• Return on investment

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Tangible results

UMR Care Management can provide data to support cost savings based on risk reduction through comparison of behavior change and clinical outcomes.

Our programs put an emphasis on communication and education, participation, member satisfaction and clinical improvement. As a result, customers achieve a measurable return on their investment, including participation, clinical, utilization and financial results.

When purchased in a combined package, our customers typically realize a 3 to 1 return on investment for our utilization management, case management and disease management programs.

In 2010, UMR’s book of business showed that for members who completed health coaching:

• 39 percent improved their physical activity frequency• 25 percent state they have less life stress after coaching• 32 percent stopped tobacco use during coaching• 34 percent showed improvement in blood pressure• 44 percent stated they eat high-fat foods less frequently• 44 percent stated they eat high-fiber foods more frequently

By working with UMR’s health coaches, disease management participants overall are able to improve or maintain their health status for nearly 75 percent of the clinical risk factors measured.

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Pharmacy

Whether you choose to maintain a retail pharmacy within your hospital, you have unique opportunities as both a purchaser and dispenser of prescription medications.

UMR’s preferred pharmacy benefits manager, OptumRx, has worked with customers to transform their inpatient pharmacies into retail outlets for employees and their dependents. This arrangement can open the door to new revenue and give employees a convenient option for filling prescriptions onsite.

You can choose from a variety of plan designs and pricing strategies to control costs and encourage employees to use the domestic pharmacy, keeping revenue within your organization. These strategies can help you take advantage of discounts available on prescription drugs and allow you offer a national wrap network that best meets the pharmacy needs of your plan members.

You also have an experienced PBM to oversee prescription drug utilization for your plan.

Make the most of your pharmacy.

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Our preferred PBM partner

In this kind of environment, you need a pharmacy benefits manager that knows the business, has the financial backing and access to state-of-the-art technology only a Fortune 50 company can provide and has the mindset of building infrastructure around the client and consumer.

UMR found this expertise right in the family — OptumRx. As the largest health-plan-owned PBM, OptumRx (like UMR) can bring much more to the table than a typical stand-alone PBM. In addition to strength and depth of skill, OptumRx offers accountability for not only pharmacy outcomes but also the effect those decisions have on your medical benefit.

Both UMR and OptumRx are proud to be part of UnitedHealth Group. Our businesses are organized into two arms — UnitedHealthcare, which contains the core medical businesses, including UMR; and Optum Health Services, which is composed of the health services businesses, including OptumRx.

This close association makes it easy to understand why OptumRx is our preferred pharmacy benefit manager. We are tightly integrated, have access to the same committed investments of UnitedHealth Group and present a unified approach to serving the full spectrum of our clients’ needs.

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A full spectrum of PBM services

OptumRx is an innovative, full-service pharmacy benefit management company, managing the prescription drug benefit of commercial, Medicare and other governmental health plans, as well as those of employers and unions.

From claims processing to clinical services, rebate management to network management, OptumRx takes pride in bringing excellence throughout every service we provide.

OptumRx now serves more than 13 million members, translating to approximately 21 million members due to the size of our Medicare Part D segment. Those members typically take 2.5 times more medications than a commercial member. Last year, OptumRx processed more than 350 million adjusted scripts, which makes us the fourth-largest PBM in the nation.

Our business-wide generic penetration was at 74.6 percent in first quarter 2011, and mail order generic penetration at 74.4 percent in first quarter 2011 – positioning us as one of the industry leaders in generic utilization rates.

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By the numbers

One important key metric is our Net Promoter Score (NPS), which we calculate internally every month. NPS is critical because it measures a member’s word-of-mouth recommendation of a service. NPS is defined as the percent of promoters minus the percent of detractors while ignoring the passives.

We use a 5-point scale from Completely Satisfied to Completely Dissatisfied for the question “Would you recommend OptumRx to a friend or family?” Our current Net Promoter Score is 64.6 percent.

To level set, net promoter scores for most companies are between 5 percent and 15 percent; high-performing companies such as American Express are usually around 40 percent to 45 percent.

In 2009, JD Power did an NPS analysis and based on adjusted data. We were at 66.2 percent at the time, and our Big 3 competitors were at 36 percent (ESI), 31.1 percent (Medco) and 29.4 percent (Caremark).

According to a 2010 Satmetrix NPS analysis, comparable scores to ours list eBay at 65 percent, Facebook at 65 percent and Google at 63 percent. Apple leads the NPS space at 78 percent.

The folks promoting us are dispersed throughout very different market segments as we serve employers, labor unions, TPAs, PBMs and MCOs.

When clients work with both UMR and OptumRx, we receive consistently higher customer satisfaction rates than groups without OptumRx as their PBM.

Our surveys show that when a plan has integrated benefits, we see a four-point increase in overall satisfaction. Better accuracy, faster turnaround, members who are treated with respect and coordinated warm call transfers drive this satisfaction.

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An integrated team

Clearly the relationship between OptumRx and UMR is strong and connected, offering clients that integrated support as part of the UMR team.

For instance, your OptumRx client relations manager will take care of your day-to-day operational needs, while your OptumRx strategic account executive will ensure you are satisfied and that we are meeting your overall strategic goals and needs.

We are grounded by strong business development and sales executive support. Because if we are strong — you are, too.

And finally, the UMR client service coordinator and SAE are there to enrich the customer experience even more — ensuring the health/medical plan branches are far-reaching and intertwined with the pharmacy benefits.

In a true client partnership model, we need to define a balance between all the moving factors to create an appropriate benefit plan for our customers. It’s a balance between cost savings and member disruption; how can we maximize your savings with the least amount of disruption to your membership? OptumRx has the flexibility to build a customized pharmacy benefit plan to hit the right balance for you.

Together, we will determine which programs to implement that will address consumer needs and maximize satisfaction, while driving value to the overall benefit strategy.

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Pricing flexibility

You have three choices of pricing:

1. Fixed fee:

• OptumRx passes through the ingredient cost and dispensing fee charged by the pharmacy, without mark-up

• The plan knows what they pay their PBM – a fixed, per-paid claim fee

• The plan does not need to negotiate with OptumRx to receive improved terms; the plan receives them as soon as the renegotiated pharmacy contract takes effect

One point to consider, the pricing arrangement looks different and can be difficult to explain and contrast with the traditional model, so it may not be the best strategy or fit for all plans.

2. Traditional:

• The plan receives guaranteed and predictable discounts and rebates

• Traditional is the most widely used pricing model in the PBM industry

• Easy to explain to clients and generally viewed as a low-risk option

• The plan trades predictability of fixed discounts for disclosure of PBM revenue and transparency

3. Rebate Fee Credit:

• Reduction to UMR’s TPA administration charge, instead of rebate payments

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The advantage of OptumRx + UMR

The long standing history between UMR and Optum Rx strengthens us with several key differentiators, including:

• A single financial process – The human resources manager receives one combined feed for reporting, data and eligibility.

• Nightly HDHP/HSA FSA auto-reimbursement feed – Information is updated in real time, so members receive FSA information sooner.

• Stop loss (aggregate and individual) pharmacy data integration feeds sent several times per year – Reimbursement is sent to the customer in June or July, versus the end of the year.

• DM/CM/wellness data integration – Customer service can view real-time pharmacy information with members enrolled in these programs.

• Coordinated call center – Our integrated call centers and warm transfer technology allows for an holistic approach to member services; the member can make one call and manage all their medical and prescription benefit inquiries.

• One ID card – Members have the convenience of one ID card to hold all their important Plan ID numbers and service center information.

• Member portal – Members need to access only one Web site to see all important medical and pharmacy benefit information.

• Flexible benefit design – We match the needs of the plan with a customized benefit design.

• Client service model – Our dedicated service team partners with the UMR service team.

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What people are saying about OptumRx

Our own industry validates our value, consistently awarding us for our investments and service philosophy.

• 2010 URAC Best Practices Award in Health Care Consumer Empowerment and Protection for its Multiple Sclerosis Disease Therapy Management Program – One of only two platinum awards (and the only one given to a PBM) for our innovative member outreach program that improves outcomes and reduces costs. Additionally, we are the first PBM to earn all four URAC Pharmacy Quality ManagementSM accreditations.

• 2011 LearningElite Award – This is similar to the ASTD BEST award. We won a 2009 ASTD BEST Award from the American Society for Training and Development (ASTD) for our Customer Advocacy initiative, becoming the first PBM to be so honored. The initiative features innovative, interactive curriculum with hands-on activities, role playing and simulations.

• Top 1 percent of companies nationally and highest among peers in 2010 JD Power Customer Call Center satisfaction survey – We showed best-in-class among all 12 mail pharmacy call centers with an overall score of 870. OptumRx received the highest rankings for customer service and cost competitiveness factors among mail order pharmacies in the J.D. Power and Associates 2009 National Pharmacy Study. We ranked second overall among mail order pharmacies, and were one of only two mail order pharmacies to receive all five Power Circles, which equates to “among the best” for the overall experience.

• Third consecutive TIPPSSM Re-Certification for Pharmacy Benefits Transparency Standards – We received re-certification for Transparency in Pharmaceutical Purchasing Solutions (TIPPS) from the HR Policy Association Pharmaceutical Coalition, earning the coalition’s highest level of transparency by providing actual average inventory cost for mail order drugs. Certification is bestowed only upon PBMs that are willing to meet the Coalition’s rigorous transparency standards and agree to provide Coalition members with audit rights to validate compliance.

We received the prestigious Verified Internet Pharmacy Practice Sites™ (VIPPS®) reaccreditation by the National Association of Boards of Pharmacy® (NABP®) for web- based pharmacies in Carlsbad and OPS. We won Gold for Best eBusiness Site from the eHealthcare Leadership Awards in 2010 and a 2009 Gold MarComm award for writing/Web copy. Plus the WilsonRx Survey placed us as the top mail service pharmacy two years running, rating us No. 1 nationally in overall member satisfaction for two years in a row.

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Stop loss

UMR has strong relationships with the nation’s leading stop loss carriers. Our preferred status earns customers premium discounts. Just as importantly, customers experience fewer handoffs and encounter fewer of the complications that can occur when you use more than one vendor.

By using our arrangements, customers can work with financially stable carriers who are committed to the stop loss market. Our customers receive preferred pricing because of UMR’s ability to provide access to the UnitedHealthcare networks and our proven cost containment programs. Customers have access to plan mirroring provisions, avoiding coverage gaps between their medical plan documents and stop loss policies.

Our claim turn-around guarantees are the best in the industry. Our customers are able to have carriers lock in rates sooner than the industry average, which allows them access to unique programs, such as three-year contracts, Raising the Bar and Contract Advantage Plan (CAP).

CAP is a policy endorsement offered by HCC Life. It guarantees that if the customer renews, the renewal policy will not contain any additional covered persons with a separate individual-specific deductible (i.e. laser). Specific monthly premium rates on the renewal are guaranteed not to increase by more than 12 percent over the current rates. The group must purchase CAP upfront; it is available for additional premium.

The UMR advantage gives customers integrated and immediate claim notification, so you can get a jumpstart on managing high-cost claims.

Our support features include weekly claim filing of new and subsequent claims, electronic claim filing and select carrier system integration and low document filing requirements. Our support also includes an industry-leading Stop Loss Activity Monitoring (SLAM) notification and trigger reporting that includes online and drill-down with daily updates.

UMR gives direct carrier access to in-house care management resources for prognosis updating. We send final plan documents and amendments to carriers for you.

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MyStopLossCenter.com

To stay on top of your stop loss activity, just click on the myStopLossCenter tab at www.umr.com. You’ll gain immediate access to current and prior year stop loss activity, as well as aggregate and specific stop loss reports.

myStopLossCenter allows you to view specific stop loss claims. With stop loss claim inquiry you can see:

• Employee and claimant name• Policy number• Claim type• Carrier• Contract type• Requested, denied and received amounts• Dates requested and received• Stop loss deductible

And, UMR’s automated e-mail notification will keep you informed of any activity for your account.

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Client and member service

At UMR we don’t just aim at service excellence. We deliver it.

Our Customer First business model ensures accountability is embedded across your service team. I’ll get into the detail of our implementation model but let me assure you—the detailed approach means we get it right the first time.

We take our time training the customer first representatives (CFRs),starting with six weeks in the classroom followed by a full month on the job with limited authority, concentrated audits and close mentoring.

And as we administer your plan, we conduct individual audits in claim and call. Each CFR has five calls recorded every week to review service accuracy and quality. We conduct a corporate audit of each service office to make sure our company standards are met for processing accuracy.

UMR provides monthly and sometimes even daily or weekly reports for claim transactions, check registers, and even care management and (if you opt for Optum Rx) prescription usage online. We supply quarterly standard reports as desired using Advantage Suite by Thomson Reuters and an annual Plan Performance Analytic Review which merges clinical findings with claim costs and trends against normative data for application in strategic planning or benefit modifications.

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Delivering service excellence

UMR has developed a specialized training program to help our customer service teams understand the complexity of hospital benefit plans so they can provide superior service to you and your members.

The program includes training on:

• Multi-tier plan designs • Custom provider networks • Direct contracting • Hospital self-pay • Referrals • Telephone and e-mail etiquette • Organizational mission and culture

We have designated three service locations as Hospital Centers of Excellence, where we administer benefits for more than 90 percent of our hospital customers. Our approach drives accountability and results in timely and accurate claims processing and attentive service.

We invite you to participate in the installation process for your benefit plan. Take the opportunity to meet your claims team to set expectations and educate our CFRs on your hospital’s capabilities and organizational structure.

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Member support

Our operations model is built around the plan members and customers to meet their needs in the most efficient manner. Taking care of plan members is critical to plan sponsor satisfaction, so we concentrate on providing accurate, fast and compassionate service. Each client is assigned a dedicated team that’s focused on accuracy and turnaround. They get to know each plan in detail and often get to know members by name.

CFRs answer the phones and pay claims so they have all the information they need to respond quickly to a call. We find this approach results in more than 90 percent of inquiries resolved on the first call. On average, each CFR has more than six years of experience and takes ownership for their customers.

The CFRs are joined by customer specialists who solve day-to-day claim issues and work with experts throughout UMR to maintain quality in our daily operations. We maintain a ratio of 2,300 plan members to one CFR. The team also includes a claim supervisor.

Care management nurses, as well as disease management and wellness coaches, provide members with ongoing support to live as healthy a life as possible. Our care management is integrated with claim operations, so UMR provides seamless member interaction that increases first-call resolution.

If a client chooses consumer-driven (CDH) plans or value-based benefit designs, UMR offers a trained Consumer Concierge to act as their advocate and provide cross-functional customer service (medical, CDH and dental), beginning at pre-enrollment and continuing throughout the life of the plan.

Our pharmacy services partner, OptumRx, has dedicated UMR resources and user-friendly Web and mobile tools to boost member compliance. UMR also has strong online tools to help members keep track and understand their benefits and monitor not only their claims but their own health.

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Customer support

On the plan sponsor side, each customer has a dedicated strategic account executive (SAE) who becomes an expert on that client’s culture, objectives, benefit strategy and expectations. SAEs hold an authoritative role within the UMR structure. They are able to influence decisions and provide superior, proactive service in managing accounts. Bilingual SAEs are available.

SAEs are accountable for their client’s overall satisfaction and:

• Partner with clients and their advisors in enhancing their plans and savings through ongoing analysis and regular results meetings

• Are a single point of contact for escalated issues and liaison between clients and UMR

• Have self-funding knowledge

• Hold a strong partnership with account executives

SAEs are supported by customer specialists who:

• Solve day-to-day claims issues and escalated, complex customer service challenges

• Work with experts throughout the organization to maintain quality of daily operations

• Provide technical expertise to the team

Client service consultants support the SAE and, of course, the client in service delivery. They:

• Support clients and their SAEs in day-to-day questions or issues

• Partner with the SAEs in service delivery and tasks for the account

• Are key facilitators for tracking, fact gathering, and information delivery such as reports, contracts, plan summaries and ID cards

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Specialized support

Customer First teams have access to specialized teams who designate contacts by customer to increase accountability and familiarity.

• Reporting and analysis – provides access to online reports supporting financial reconciliation and facilitating strategic decision making

• Care management – integrated with claims operations, which creates seamless member interaction and increases first-call resolution

• Ancillary services – provides access to best-in-class ancillary services, including vision, hearing and telemedicine products

• Stop loss – focuses on delivering the best carrier and contract type with quick claims filing and reimbursement

• Consumer-driven solutions – a comprehensive approach that increases consumer engagement while reducing overall medical trend

• Claims – dedicated team that’s focused on accuracy and turnaround while working to maximize your savings on today’s claims costs

• Network administration – focused on maximizing the access and savings associated with local, regional and national networks

• Pharmacy benefits -- a preferred relationship with our sister company OptumRx offers the best integration, flexibility and lower prescription costs.

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Customer First delivers results

Customer First teams drive accountability, resulting in timely, accurate claims processing as shown by the results below. We also externally validate our results through annual SAS70 audits. We audit 3.5 percent of our claims.

Additionally, we conduct regular customer satisfaction and account management surveys, provide performance guarantees and use consistent feedback metrics.

UMR’s auto-adjudication rate is greater than 75 percent, and more than 70 percent of our claims are submitted electronically, which further improves accuracy.

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A reputation for smooth implementations

Transitioning to a new TPA can sometimes be a barrier to making a change. At UMR, we understand how important a smooth implementation is, and we pride ourselves on a successful and — if we say so ourselves — impressive track record.

We assign experienced transition leaders who oversee a full team that includes:

• The strategic account executive• Claim management• Supervisors• Technical experts from each of our business units

All our teams, and especially our transition leaders, are experts at dealing with unexpected issues without jeopardizing their deliverables.

We keep detailed implementation logs, assigning each and every deliverable and task a target date and an owner who is held accountable. Management also plays an active role.

As the implementation moves along, this team evolves into an ongoing service team — so they understand the issues and the complexities of your plan better than anyone else.

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Reporting

UMR offers more than the UnitedHealthcare network advantage. With capital investment, we are also able offer state-of-the-art reporting capabilities so you can measure just how effective your plan is and where your money is going. With UMR’s customized, on-demand reporting, you can leverage industry and national benchmarks to measure your plan’s trend.

UMR will provide you with in-depth plan analysis and recommendations to support continuous improvement and strategic decisions. We offer predictive technologies to support targeted, proactive health and wellness programs. And, our online resources are available 24/7, so you can access reports at your convenience.

UMR offers integrated and detailed reporting through several tools.

Our online reporting tool—InfoPort—provides daily, weekly, monthly or quarterly reports, according to your preference.

Thomson Reuters Advantage Suite© (formerly known as MedStat) is a Web-based analysis tool for medical, pharmacy (if available) and enrollment data. You have access to extended data analytics with slicer/drill capabilities and extended benchmark information. This tool offers 32 reports with exploring capabilities and is easy to export. It offers condition and Major Diagnostic Category information and provides rolling 24-month data, paid and/or limited incurred. Benchmark data (called MarketScan®) is based on 31.5 million lives.

Finally, our data services provide claim extract setup or FTP-Internet file transfers. We support one-time ad hoc reports, data requests and production reporting.

Additional UMR custom support is available for:

• ASA-certified reserve/IBNR estimates

• Customized benchmarking

• Ad hoc reporting

• Stewardship analysis reports

• Predictive modeling

• Episode cost/quality profiling

• Care management reporting (if using UMR’s internal solution)

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InfoPortSM – online reporting tool

InfoPort allows you to not only monitor plan performance but identify trends and outliers through analyses of three or more years of UMR data.

You can access information on claims, benefit utilization, financial activities, network performance and enrollment. Transactional data is updated daily, with only a two-business-day lag.

InfoPort allows you to drill down by group, benefit level, benefit plan, class, coverage tier, location, member ID, patient relationship and more. We have report designs with multiple report layouts, and you can customize report criteria, allowing you a myriad of reporting options. Even better, you can save your own customized templates.

You can run reports on incurred and paid timeframes. And, you can create, run and view your reports on demand. You can also schedule recurring reports with dynamic dates. Report data is available in PHI and non-PHI versions. Also, you can easily export your reports to multiple formats, such as Excel, PDF, and Word.

Available reports include:• Census: enrollment; summary

• Extracts: claim level, claim service level, enrollment census

• Claim: detail, lag, summary, summary by member/network/provider, summary service level

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Advantage Suite® – online reporting tool

For an analytical overview of claims, UMR offers Advantage Suite®, an online reporting tool created and maintained by Thomson Reuters.

While not a financial tool for reconciliation, Advantage Suite (formerly called Medstat) can help you analyze health care costs, utilization, quality and performance trends and measures. You can drill down to product line/plan, region, metropolitan statistical area, employee status, relationship, location and coverage tier. You can compare your costs and utilization to robust geographical and industry benchmarks.

Advantage Suite, which is updated monthly, shows gross claims. It does not include stop loss information or administration fees. Reports are run based on paid dates or incurred dates, and standard reports can be modified to conduct ad hoc analyses.

You can see trends in medical and Rx data, compare against benchmarks, track preventive and chronic conditions and identify cost drivers.

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Hospital-specific plan analysis

UMR offers a specialized reporting package designed to meet your unique information needs as a hospital. The quarterly report is an extension of the Thomson Reuters Advantage Suite© and provides detailed plan data related to demographics, financial performance and utilization.

The hospital reporting package also provides valuable benchmarking data against UMR’s hospital book of business and the health care industry pulled from Thompson Reuters’ MarketScan® Commercial Claims and Encounters database.

Detailed plan analysis gives you the tools you need to make informed strategic decisions to ensure your health plan meets its goals. Available reports provide extensive data delineating domestic, in-network and out-of-network cost and utilization.

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Online services

UMR’s Web portal gives you one online source for all your benefits needs. There’s no need to remember multiple user names and passwords, because you don’t need multiple accounts.

Such easy access to all UMR products encourages members to actively participate in all aspects of their health plans.

Members can look up:

• Medical claims and benefits• Dental claims and benefits• Flexible spending account

information• Pharmacy claims through

single sign-onaccess to OptumRx

• Care management information

Employers and brokers can find information on:

• Medical claims and benefits• Dental claims and benefits• Flexible spending accounts

They can also access:

• OptumRx reports• Stop loss claims and reports• Subrogation reports• Enrollment

UMR is not reliant on third-party development or canned solutions for our Web capabilities. We develop our solutions in house, so we can be as flexible as you need us to be and respond faster to your needs.

To find information about our products and how we do business, visit www.umr.com. That’s where members, employers, providers, client advisors and partners go to access a wealth of services. Information is kept confidential and secure. Users must register and log into the portals, allowing us to verify their identities.

We also want you and your plan members to easily navigate the site. Any problems or lag time can be resolved through a toll-free phone call.

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Features for employers

These features are all just a click away:

For a demo of the Employer Information Center:

• Logon to www.umr.com

• Select “employers”

• Enter group number: 76888888

• When prompted for username and password, use:

Username: demoemployerPassword: secret1

• To search for employee information, use Member ID: 088000001

• For Check Register, use dates 10/01/2002 – current date

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Features for members

For a demo of the Member Information Center:

• Logon to www.umr.com

• Select “members”

• Enter member ID: 088000001

• When prompted for username and password, use:

Username: demoemployeePassword: secret1

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Our value to you

In summary and to repeat, UMR offers hospitals an advantage no one else in the industry can offer.

UMR helps hospitals:

• Provide quality health care to employees and dependents while effectively managing plan costs and employee productivity

• Maximize their return on existing hospital resources

• Reduce the administrative burden of the employee health plan

• Recruit and retain talented health care professionals

• Identify new services to better meet demand and increase competitiveness

• Develop stronger relationships with their physicians