Program Overview

CCM 1

Transforming Health Care Quality and Cost – Healthcare Systems Contracting Directly with Employers

 

THE CHALLENGE:

For years, local employers and their locally based health systems have sought a sound methodology that will allow them to engage with one another on a direct basis. Creating an arena in which the local health care community can coordinate the primary care of local employer groups, absent the restrictions and billing practices of a heavy handed carrier. With their interests aligned and a system in place to connect them, Employers and Health Systems can take concrete steps toward improving a broken and cyclical healthcare landscape. It is believed that a successful direct relationship of these parties will produce the long term goals of lowering both the employer’s health care costs and the provider’s unit cost, while increasing the wellness of the employer group.

THE SOLUTION:

The Covenant Services Group has developed a new integrated healthcare concept called COMMUNITY CARE MISSOURI (CCM), a comprehensive direct-to-employer commercial health plan and network solution designed to “CONNECT” employers with local “Host” health systems. All turn-key systems, network contracting, insurance and administration of COMMUNITY CARE MISSOURI (CCM) are coordinated through the TPA.

THE PRODUCT:

What makes COMMUNITY CARE MISSOURI (CCM) attractive is the ability to engineer healthcare plans that will eliminate out migration to other competing facilities and not only reach large employer groups but also small employer groups, which constitutes the largest business population.

COMMUNITY CARE MISSOURI (CCM) has created a specific partially self-funded program that provides small business owners the opportunity to control and manage their healthcare plan through an alternative funded arrangement, while maintaining the budget certainty of a fully funded product.

COMMUNITY CARE MISSOURI (CCM) also has a specific self-funded program for large employer groups that features a multiple year cost guarantee and a claim fund surplus, available to employers willing to truly manage their claim cost.

PLAN DESIGN:

COMMUNITY CARE MISSOURI (CCM) has been engineered to provide a low-cost alternative for Southeastern Missouri employers, offering a network of world class, high-quality providers. There are many advantages to CCM program:

  • Lower costs for employers and their employees
  • Easier access to primary & specialty care
  • Access to local clinics with zero cost to employees & their covered dependents
  • Local services that save time and money
  • Comprehensive programs that encourage consumerism, prevention, quality of care and wellness
  • World class care through a network of local physicians and local hospitals.
  • First dollar benefits for employees to encourage proper use of accessing healthcare