Health Plan Administration for Health Care Providers

Enabling Flexible Models

National Alliance has been developing and administering custom arrangements for hospitals, provider organizations and complex health systems since 2003. This specialized experience allows us to better understand our clients’ priorities and concerns. No matter what, keeping people healthy is the top priority. National Alliance is here to help by minimizing administrative burden, achieving more with internal resources, navigating the complexities of being both a system and provider and staying on the leading edge of innovative technology.

Hospitals are a common symbol of the health care industry and are often the most well-equipped to meet the health care needs of the communities they serve. Yet, their dedicated hospital staff will eventually need care, too. When a hospital employee needs care, do they utilize the hospital’s resources or go elsewhere? And what happens if the hospital doesn’t have a specific service for the employee’s need?

At National Alliance, we understand that hospitals can better control health plan quality and cost when their employees use internal resources instead of going outside of the hospital’s network for a provider or service. To steer employees to internal providers and resources, National Alliance works with clients to map out domestic and non-domestic tiers. We integrate a client’s built-in care programs and third-party vendors, and help clients proactively manage cash flow to ensure the highest efficiency while avoiding duplication of services. These solutions help our clients deliver seamless care for employees and reduce the administrative burden for benefits teams.

Plug and Play Integration and Flexible Benefit Tiering

We provide a national platform that offers a plug and play approach, allowing our clients to custom-build a plan that expertly blends their capabilities and ours. We engage third-party vendors early, setting up integration and data feeds during implementation and educating our service teams on all resources available to plan members We work with clients on strategies to help steer members and drive domestic utilization of health system resources. Our highly flexible platform allows us to build and administer up to six tiers of benefits. For example, we’ve created additional tiers to manage benefits for an affiliated children’s hospital or for employees living more than 50 miles from the hospital. Data-sharing and co-management of members reduces duplication of efforts so that clients benefit from added cost savings balanced with high quality care.

Customizing and simplifying the money side of the equation

We take a similar, customized approach when it comes to the financial aspects of hospital and health system plan administration. Hospitals are in a unique position because insurance carriers pay them for their services to patients. When providing services to employees, the hospital may choose to offset their costs in other ways instead of paying themselves for the services rendered. This can get complicated quickly. National Alliance works with clients to establish a balance in how the hospital wants to pay themselves versus how much they’re willing to increase or decrease the medical plan spend.

We also offer hospitals the option to set custom pricing for how much they want to pay themselves for the services they render to their own members. For example, we work with hospital groups to customize percentage off billed, percentage of Medicare, contractual pricing and pre-defined fees.

Cashless processing is another solution to simplify financial management of the hospital’s plan. Hospitals can choose not to exchange money with themselves to pay for their own services at their own facilities. Billing and claims processing remain the same, but payments are suppressed for a Tier 1 provider or service. Full reporting is maintained and, of course, there's no member impact as the member still gets an explanation of benefits.

Delivering creative solutions while steering utilization

Even if health systems set up integrations and custom financial solutions, there’s a chance that their employees will still seek care elsewhere. To reduce leakage and overall medical spend for our clients, we recommend additional creative strategies to help drive domestic utilization, such as domestic exclusivity, configurable exceptions and specialty pharmacy steerage.

National Alliance works hand in hand with hospitals, health systems and provider groups to help create the best possible outcomes—for them and their employees. We leverage internal assets and third-party vendor relationships, custom-build tiers to steer members to domestic providers and services and provide continuous strategic support at every level.

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