Aih And Beacon Sales Presentation 010101[1]2007


Published on

Beacon Health Care Services

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Aih And Beacon Sales Presentation 010101[1]2007

  1. 1. The AIH and Beacon Approach Atlantic Integrated Health (“AIH”) was founded in 1994 by physicians to offer accessible, cost effective and high quality health care services to employers and other health care consumers in Eastern North Carolina. AIH is a regional network of credentialed physicians who are committed and accountable to improving the health status of their patients and the communities where they practice while reducing overall health care costs for employers and other health care consumers. In 1997, AIH formed The Beacon Company (“Beacon”) to be the integrator of care that links physicians, hospitals, and other health care providers into one regional health system. Beacon is a committed model of providers that offers employers and other health care consumers, single signature contracting authority for a full continuum of services throughout Eastern North Carolina.
  2. 2. The Objectives of AIH & Beacon <ul><li>Offer employers and other health care consumers an effective, selective, and regional managed care network of physicians, hospitals, and other health care providers at negotiated, affordable pricing; </li></ul><ul><li>Provide patients high quality, cost-effective health care managed by physicians and hospitals they know and trust; </li></ul><ul><li>Assure patients and physicians that decisions related to health care management and standards of care are made in Eastern North Carolina, not by insurance payers or other organizations located outside the region; </li></ul><ul><li>Respond to patient needs quickly and facilitate access to care without barriers to effective treatment; </li></ul><ul><li>Promote preventive services, early interventions, and the overall management of care; </li></ul>
  3. 3. Objectives of AIH & Beacon Continued <ul><li>Establish relationships between health care consumers and providers that result in the development of innovative health care management programs that meet and exceed the needs of patients; </li></ul><ul><li>Provide information requested by health care consumers and providers on a timely basis and in a format which is consistent with their needs; </li></ul><ul><li>Promote quality patient care through effective communication among all providers, including primary care physicians, specialty care physicians, and hospitals; and </li></ul><ul><li>Facilitate development of a truly integrated health system that offers a full continuum of health care services throughout Eastern North Carolina. </li></ul>
  4. 4. The Services of AIH and Beacon <ul><li>Beacon contracts directly with employers and other health care consumers as a credentialed network of physicians. Beacon offers employers and other buyers of health care services an integrated network of physicians, hospitals, and other health care providers that can be accessed through a single contract. AIH and Beacon continue to develop their regional provider network. For specific health care services that cannot be provided within Eastern North Carolina, AIH and Beacon are contracting with specialty physicians, hospitals, and other health care providers outside of the region </li></ul>
  5. 5. Services of AIH & Beacon Continued <ul><li>Provider network services </li></ul><ul><li>1. AIH regional physician network credentialed to guidelines established by the National Committee for Quality Assurance (“NCQA”); </li></ul><ul><li>2. Integrated health system and regional network of credentialed physicians, hospitals, home health and infusion services, pharmacies, and other health care providers offered by Beacon through a committed. </li></ul><ul><li>Medical management programs </li></ul><ul><li>1. Use of primary care physicians as patient care managers and advocates; </li></ul><ul><li>2. Provider credentialing; </li></ul><ul><li>3. Quality assurance; </li></ul><ul><li>4. Provider profiling and performance feedback; </li></ul><ul><li>5. Wellness and preventive health services. </li></ul><ul><li>Utilization management system </li></ul><ul><li>1. Medical director services; </li></ul><ul><li>2. Pre-cert. of facility admissions; </li></ul><ul><li>3. Concurrent on-site review of facility admissions and discharge planning; </li></ul>
  6. 6. Services of AIH & Beacon Continued : <ul><li>4. Pre-cert. of outpatient diagnostic and surgical procedures; </li></ul><ul><li>5. Case management; </li></ul><ul><li>6. Authorization of durable medical equipment, mental and behavioral health, and home health services. </li></ul><ul><li>Patient advocacy program </li></ul><ul><li>1. Assistance in resolving issues with physician offices and other health care providers; </li></ul><ul><li>2. Assistance in resolving billing issues and related concerns; </li></ul><ul><li>Health plan offerings </li></ul><ul><li> 1. Third Party Administrative services offered by experienced companies and placement of reinsurance or stop-loss coverage; </li></ul><ul><li>2. Reinsurance programs and coverage for self-insured groups. </li></ul><ul><li>3. Medicare Advantage through Arcadian Health Plans </li></ul><ul><li>Information reporting </li></ul><ul><li>1. Financial reports tailored to employer needs; </li></ul><ul><li>2. Utilization reports, including provider profiling. </li></ul>
  7. 7. Employer Health Plan Offerings <ul><li>AIH and Beacon can work directly with your insurance company, or if your company is self-insured, your third party administrator (“TPA”). AIH and Beacon offer: </li></ul><ul><ul><ul><li>A regional network of physicians, hospitals, and other health care providers; </li></ul></ul></ul><ul><ul><ul><li>Medical management services; and </li></ul></ul></ul><ul><ul><ul><li>Information reporting capability for health plan management. </li></ul></ul></ul><ul><li>Beacon can provide employers with additional health plan choices. Through a preferred relationship with several “A” rated Insurance Companies, Beacon can offer fully insured health plans, and administration services for self-insured employers. These products and services are the proprietary health plan programs marketed and managed by Beacon. Beacon only works with rated “A - Excellent” by the insurance rating agency, A.M. Best, and have a track record of superior performance as an insurance company and health plan administrator. </li></ul><ul><li>The distinguishing feature is that AIH and Beacon are accountable, and actually seek to be measured, as to the accessibility, cost-effectiveness, and quality of patient care offered directly to employers and other health care consumers. Participating AIH physicians have been selected by their peers, are credentialed, and agree to negotiated, competitive pricing. Our private label health plans provide employers with health plan options that are marketed and managed exclusively within the communities of Eastern North Carolina </li></ul>
  8. 8. Why Choose AIH & Beacon <ul><li>The answer is effective and demonstrated value with accountability. </li></ul><ul><li>1. AIH and Beacon are owned and operated by health care providers who live and work in Eastern North Carolina. </li></ul><ul><li>2. Participating providers have been carefully selected and credentialed and agree to negotiated, competitive pricing for their services. </li></ul><ul><li>3. Patients and employers have a local contact to resolve issues that arise, including those related to billing, quality of care, and appointment scheduling. </li></ul><ul><li>4. All medical decisions will be made by physicians who consider the quality of patient care to be the most important concern. </li></ul><ul><li>5. AIH and Beacon are in the process of developing local liaisons at each participating hospital who are discharge planning nurses, social workers, and case managers that will work with physicians to ensure that patient care is provided in the most appropriate, cost-effective manner through the entire continuum of care. </li></ul><ul><li>6. An interactive and informative web site to be used by Healthcare providers and employees alike, . </li></ul>
  9. 9. AIH and Beacon offer innovative health plan programs that reduce health care costs and result in effective patient care management. Effective patient care management means keeping patients healthy and productive within their communities……   ….. Regional employers are able to work directly with regional health care providers who are committed to excellence and patient advocacy. We feel provider commitment and accountability results in patient and employer satisfaction and the reduction of health care costs. AIH and Beacon
  10. 10. <ul><li>AIH Chairman…………………………… James Stackhouse, MD </li></ul><ul><li>AIH President & CEO…………………… Phil Mahaney, MD </li></ul><ul><li>AIH Chief Financial Officer .……………. Steve Nuckolls, CPA </li></ul><ul><li>AIH Credentialing Manager … …………. Alice Fiedler </li></ul><ul><li>BEACON Chairman & CEO ……………. Kerry Willis, MD </li></ul><ul><li>BEACON Vice President ……………….. Clark Gaither, MD </li></ul><ul><li>BEACON Provider Relation Manager …... Debbi Botelho </li></ul>Our Leadership
  11. 11. GROUP PURCHASING SERVICE <ul><li>Atlantic Integrated Health's group purchasing services program discounts on a wide variety of products and services, including medical and non-medical related supplies and equipment. From diagnostic imaging to digital copiers, from examination tables to desks, all participating business partners have been screened by an extensive set of criteria, ensuring the highest level of quality and service that your practice expects and deserves. </li></ul><ul><li>Atlantic Integrated Health's group purchasing services program offers your practice an opportunity to control and reduce supply purchase costs and related operating expenses. Competitive discounts have been negotiated with highly reputable and nationally recognized distributors. Program discounts are negotiated based on the combined purchasing power of the network, allowing you to take advantage of greater discounts, regardless of your practice size. </li></ul>
  12. 12. GROUP PURCHASING CONTRACTS <ul><li>LAB CORP </li></ul><ul><li>QUEST DIAGNOSTICS </li></ul><ul><li>Henry Schein </li></ul><ul><li>COPYPRO </li></ul><ul><li>CAVINS BUSINESS SOLUTIONS </li></ul><ul><li>TIME AND PAYROLL </li></ul>
  13. 13. AIH SAMPLE FEES CPT DISCRIPTION AIH ALLOWABLE 99211 Office/outpatient visit, est 26.00 99212 Office/outpatient visit, est 45.00 99213 Office/outpatient visit, est 62.00 99214 Office/outpatient visit, est 97.00 99215 Office/outpatient visit, est 144.00