About Cypress Benefit Administrators


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Cypress Benefit Administrators is a full service Third Party Administration (TPA) company. We specialize in helping companies outsource Flexible Spending Accounts (Section 125), HRA, HSA, and COBRA. Additionally, we provide expertise in self-funded medical plan administration.

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About Cypress Benefit Administrators

  1. 1. The Cypress Solution
  2. 2. The Problem: Annual Employee Health Care Costs
  3. 3. Soaring Annual Health Care Costs U.S. Costs, in $ Trillions Source: USA Today <ul><li>$3.6 TRILLION by 2014 </li></ul><ul><li>$11,000 per capita expenditure by 2014 </li></ul>
  4. 4. Health Insurance Premiums vs. Other Major Indicators 12.0% 18.0% 8.5% 0.8% 8.2% 13.9% 9.2% 13.7%
  5. 5. Health Care Costs Affect Corporate Profits <ul><li>General Motors ® </li></ul><ul><ul><li>$1,525/car for health care </li></ul></ul><ul><ul><ul><li>$700 more than car’s steel </li></ul></ul></ul><ul><li>Starbucks ® </li></ul><ul><ul><li>Spends more for health care than on coffee beans </li></ul></ul>
  6. 6. <ul><li>Soaring Health Care Costs year-after-year </li></ul><ul><li>Health Care: 2 nd most costly benefit next to salaries </li></ul><ul><li>Unchecked medical inflation affecting employer premiums </li></ul>Health Care Costs Affect Corporate Profits (cont…) THIS IS THE COST OF DOING NOTHING
  7. 7. <ul><li>Employers now must take the next step – </li></ul><ul><ul><li>Bringing employees, providers and administration experts together to promote: </li></ul></ul><ul><ul><ul><li>Consumer Driven Plans </li></ul></ul></ul><ul><ul><ul><li>Risk Identification </li></ul></ul></ul><ul><ul><ul><li>Disease Management </li></ul></ul></ul><ul><ul><ul><li>Wellness </li></ul></ul></ul><ul><ul><ul><li>Information Gathering and Interpretation </li></ul></ul></ul><ul><ul><ul><li>Cost Control Programs that produce REAL results </li></ul></ul></ul>Health Care Costs Affect Corporate Profits (cont…)
  8. 8. We Bring the Industry’s Most Comprehensive Answers for Employers Through THE CYPRESS SOLUTION
  9. 9. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  10. 10. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  11. 11. Claim Administration <ul><li>Quick Turnaround Time </li></ul><ul><li>Accurate Claim Payments </li></ul><ul><li>A Team of Experienced Professionals Dedicated to YOUR Plan </li></ul><ul><li>Consumer Driven Health Plan Experience </li></ul>Key Components: Claim Administration is the most basic of administrative functions. You should EXPECT it to be outstanding. If it’s not, you need to find someone who provides it.
  12. 12. <ul><li>Completely Customized Benefit Plans/Unlimited Plan Options </li></ul><ul><li>Medical </li></ul><ul><li>Dental </li></ul><ul><li>Disability </li></ul><ul><li>Rx </li></ul><ul><li>Vision </li></ul><ul><li>Flexible Spending </li></ul><ul><li>COBRA </li></ul><ul><li>HIPAA </li></ul><ul><li>UM/Case Management </li></ul><ul><li>New York/Massachusetts State Filings </li></ul><ul><li>Consumer-Driven Plans </li></ul><ul><li>Multiple Stop Loss Insurance Options </li></ul>Cypress Offers Employers a Comprehensive Suite of Self Funded Products and Options
  13. 13. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  14. 14. <ul><li>Comprehensive, timely plan implementations </li></ul><ul><li>Regularly scheduled contact with clients </li></ul><ul><li>Satisfaction Surveys </li></ul><ul><li>People talking with people – picking up the phone, answering questions, solving issues </li></ul>Service Cypress Provides
  15. 15. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  16. 16. Cost Control <ul><li>Over the past decade, employers have offered PPO programs as the main cost control program for their self-funded plan. </li></ul>Offering only a PPO, with its “discount from charges” approach is NOT a cost control solution.
  17. 17. Cost Control (cont…) <ul><li>In recent years, employers have embraced Consumer Driven Health Plans as a means of controlling costs. </li></ul><ul><li>Most have simply raised deductibles and out of pocket limits and called that a Consumer Driven Health Plan. </li></ul>Shifting costs by increasing deductibles and OOPs without giving employees tools to become consumers is NOT a CDHP.
  18. 18. Cost Control (cont…) <ul><li>These days, employers must have access to state-of-the-art Cost Control and Risk Management tools in order to save money. </li></ul>Cypress has the widest array of cost control programs available in the industry.
  19. 19. Cypress Cost Control Tools Wellness Global Health Negotiated Discounts Upfront Claim Financing Organ Xplant Carve-Out Fraud & Abuse Detection Innovative Pharmacy Options Medical Advocacy Disease Management On Site Medical Active and Passive PPO Consumer Driven Health Plans The Cypress Solution
  20. 20. On-Site Medical Services
  21. 21. <ul><li>Provides Primary Care Services at Place Of Employment (NPs, RNs, Physicians) </li></ul><ul><li>Offers 40%-50% Discount off Usual Charges </li></ul><ul><li>On-Site Disease Management, Physicals, Drug Testing, Health Risk Appraisals, Education, CPR/First Aid Training </li></ul><ul><li>On-Site Office and Industrial Ergonomics </li></ul><ul><li>On-Site Physical and Occupational Therapy Services </li></ul>On-Site Medical Services Save Money and Reduce Lost Time Expenses
  22. 22. Disease Management
  23. 23. <ul><ul><li>High-risk Disease Management Level Designed to make an impact on the sickest members of a population </li></ul></ul><ul><ul><li>Population Disease Management Level Designed to make an impact on all chronically ill individuals in a population </li></ul></ul><ul><ul><li>Total Health Management Level Designed to make an impact on all individuals in a population </li></ul></ul><ul><ul><li>Wellness Level designed to provide wellness education to entire population </li></ul></ul>Disease Management A Unique, Multi-Layered Approach
  24. 24. Medical Advocacy
  25. 25. Steering Patients Through the System February 27, 2006, PALLAVI GOGOI Reported: BusinessWeek “… half of patients left their physicians’ offices not knowing what to do … 61% of the time patients chose the wrong type of specialist. This misstep generated an average of $3,500 in extra costs .” “… most patients wanted more guidance in choosing health care.”
  26. 26. Medical Advocacy <ul><li>Picking doctors at random is dangerous & costly </li></ul><ul><li>Not knowing the best medical alternatives can lead to paying too much </li></ul><ul><li>Not knowing the cost of medical procedures leads to paying too much </li></ul><ul><li>Unorganized care leads to frustration, mistake & unnecessary costs </li></ul>Why Employees Need to Change their Medical Purchasing Habits
  27. 27. <ul><li>Talks with the patients before care is rendered </li></ul><ul><ul><li>Focusing on the quality of care </li></ul></ul><ul><ul><li>Communicating medical alternatives and encourage second opinions </li></ul></ul><ul><ul><li>Communicating differences in costs </li></ul></ul><ul><ul><li>Profiling the best care givers for the patient’s specific procedure in each market. </li></ul></ul><ul><li>MAP becomes an independent advocate employees trust to help them </li></ul><ul><li>Transparently interface with the benefit plan administrators </li></ul>Medical Advocate Program The Medical Advocate Program (MAP)
  28. 28. MAP IDENTIFIES THE HIGHEST QUALITY/LOWEST COSTS HOSPITALS SPECIFIC TO A PATIENT’S NEEDS <ul><li>Medicine is one of the few services where </li></ul><ul><li>BEST CARE COSTS the LEAST! </li></ul><ul><li>30% + of health care cost is due to poor quality / ineffective care. </li></ul>Example: Hospital Cost / Quality Juran Institute / Midwest Business Group on Health
  29. 29. MAP Identifies Doctors Who Do the Most of a Specific Procedure
  30. 30. MAP Leads Patients to the Most Qualified Physicians Procedures per Year Total Knee Replacement DRG 81.54 Milwaukee, WI Surgeons MAP guides you to surgeons that do one-two-three procedures per week. Specialists on top of their game ! Low volume, Low current experience! Low volume, Low current experience! Physicians
  31. 31. MAP Narrows Down Physician Choices on a Name-Specific Basis Procedures per Year Physicians Total Knee Replacement DRG 81.54 Milwaukee, WI Surgeons with 50 + Procedures / Yr.
  32. 32. MAP Gives the Patient Doctors Who have Proven the Highest Quality Complication Rate will not recommend physicians with poor quality factors! MAP MAP IDs specialists with top quality factors: “ Complication Rates” HALF the State average! Physicians
  33. 33. MAP Recommends Several Doctors Who Fit the Patient Profile Surgeon A Surgeon E Surgeon D Surgeon C 0.8 1.0 0.6 1.2 1.4 1.6 1.8 2.0 2.2 Surgeon B Surgeon F Total Knee Replacement DRG 81.54 Surgeons by LOS / Charge Surgeon E Charge (1.0 = Average) Length of Stay (1.0 = Average Charge (1.0 = Average) Length of Stay (1.0 = Average)
  34. 34. MAP Shows the Hospitals that the Chosen Physician Admits to & What the Hospitals Charge for their Procedure Methodist, MN United Hospital Saint John’s Charge (1.0 = Average) 0.7 0.8 0.6 0.9 1.0 1.1 1.2 1.3 1.4 Saint Joseph’s 40% differential in billed charges! Total Knee Replacement DRG 81.54 Same Surgeon by Location * LOS / Charge Length of Stay (1.0 = Average)
  35. 35. <ul><li>Help employees get more value out of their healthcare benefits </li></ul><ul><li>Advocate support ; “Advocate Nurses” help employees with medical information, treatment options (in network or out), provider profiling, invoice-balance billing </li></ul><ul><li>Understanding, the language of healthcare </li></ul><ul><li>Explaining terminology, alternatives and treatments. </li></ul><ul><li>Help employees become educated purchasers of healthcare </li></ul><ul><li>Help employees get the best care </li></ul><ul><li>Employees are able to make “informed decisions” in their own health care </li></ul>Reasons for MAP
  36. 36. <ul><li>Employees get better outcomes. </li></ul><ul><li>Employees become better purchasers of healthcare. </li></ul><ul><li>Employees get educated on differences in the costs of facilities in their area. </li></ul><ul><li>Employer’s Plan saves money – </li></ul><ul><li>the best care costs less! </li></ul>Employer Advantages
  37. 37. Fraud & Abuse Detection/Inappropriate Billing Prevention
  38. 38. $250B of Waste in Health Care <ul><li>Aetna discloses 11% payment error rate </li></ul><ul><li>BCBS Association estimates that 5 – 10% of healthcare claims are paid incorrectly. Business Insurance March 2003 </li></ul><ul><li>Federal Government negotiated more than $1.8B in judgments and settlements in health care fraud matters. Health Care Fraud and Abuse Control Program Annual Report by the DOJ and HHS. </li></ul><ul><li>CMS announced 9.1% error rate </li></ul><ul><li>4 Billion transactions annually – 6.3% error rate. HHS-OIG </li></ul><ul><li>$150B in fraud is paid by commercial payers annually National HealthCare Anti-Fraud Assoc. </li></ul><ul><li>54% of Physicians reported using deception of third-party payers to obtain benefits </li></ul>Fraud & Abuse, creative billing schemes, claim system deficiencies, lack of good & aggregated data and transparency are all prime drivers Claims Systems have been designed for an environment that creates efficiencies in cutting checks with strong capabilities in managing Eligibility and Benefit Plans. Applied Risk Management requires a new dynamic!
  39. 39. Who is Helping Employers Avoid Waste? <ul><li>Over half of the country’s payers do not employ fraud detection technology </li></ul><ul><li>BCBS Association Fraud Results: 0.18% of paid claims. </li></ul><ul><li>Class Action Lawsuit for arbitrary and unfair reimbursements: </li></ul><ul><ul><li>CIGNA - $540 million </li></ul></ul><ul><ul><li>Aetna - $470 million </li></ul></ul><ul><li>Business Intelligence is rarely applied to health care costs </li></ul><ul><li>Cost Containment programs, when applied, are typically done retrospectively: </li></ul><ul><ul><li>Retrospective recovery yields an average savings of $0.10 on every dollar identified </li></ul></ul><ul><ul><li>Prepayment avoidance yields an average savings of $0.54 on every dollar identified </li></ul></ul>
  40. 40. Cypress Employs the Industry’s Leading Edge Loss Control Solution <ul><li>Provider Integrity Program </li></ul><ul><li>Data Driven Fraud & Abuse Prevention </li></ul><ul><li>Intelligent Claim Surveillance </li></ul><ul><li>Pre-Payment Investigations </li></ul><ul><li>Automated Code Edits </li></ul><ul><li>Provider R&C Negotiations </li></ul>Employers Can Expect a reduction in OVERALL claim costs of 5% - 10% through these efforts: Nobody Matches the Power and Control of the Cypress Medical Risk Management Program!
  41. 41. Provider Integrity & Fraud Prevention <ul><li>Data driven, provider centric fraud prevention with over 12,000 provider TINs on our “ watch list ” </li></ul><ul><li>Mine and manage over 1,100 data sources. </li></ul><ul><li>35,000+ HHS sanctions </li></ul><ul><li>40,000+ high risk addresses </li></ul><ul><li>Automated FSA Deathmaster Matching </li></ul><ul><li>Patriot Act Compliance </li></ul><ul><li>Identifies providers with a track record of aberrant billing practices and/or positive investigations experience – before claims are paid </li></ul><ul><li>Relevant Statistics </li></ul><ul><li>3.4% of all provider records in the U.S. are “phantom providers” </li></ul><ul><li>$0.10 of every dollar spent in health care is fraud or abuse (NHAA) </li></ul><ul><li>Average savings of 54% for every dollar reviewed </li></ul>REDUCES OVERALL PAID CLAIMS AN AVERAGE OF 0.5% - 1%.
  42. 42. Intelligent Claim Surveillance <ul><li>Pattern Recognition: </li></ul><ul><li>Identifies sophisticated schemes by integrating statistical models with historical claim patterns to score the probability of fraud or abuse. Technology originally used for credit card industry. </li></ul><ul><li>Uses historical data to develop profiles and constantly updates the data to “learn” and detect both known and emerging fraud schemes. </li></ul><ul><li>Claim line analytics ranks claims according to fraud risk with reason codes to quickly pinpoint claims that warrant review on a prepayment basis. </li></ul>REDUCES OVERALL PAID CLAIMS AN AVERAGE OF 0.5% - 1.5%.
  43. 43. <ul><li>Claim Line Analytics Include: </li></ul><ul><li>Procedure Repetition </li></ul><ul><li>Unusual Modifiers </li></ul><ul><li>Geographic Improbabilities </li></ul><ul><li>High Dollars/Day </li></ul><ul><li>Unusual Procedure Rate </li></ul><ul><li>Improbability Illustrations </li></ul><ul><li>Improbable Timed Billings (avg. hrs billed per day or per week or on holidays </li></ul><ul><li>Collusive Networks/Drop Box Scams (Patient selling/Provider identity theft) </li></ul><ul><li>Geographic Improbabilities (procedures hundreds/thousand of miles away) </li></ul>Intelligent Claim Surveillance (cont…) <ul><li>Surge Analysis (hit & run) </li></ul><ul><li>High paid procedures </li></ul><ul><li>Timed Procedures </li></ul><ul><li>Missing Modifiers </li></ul>
  44. 44. More Cypress Solutions <ul><li>Upfront claim financing </li></ul><ul><li>Individual Provider Discount Negotiation </li></ul><ul><li>Innovative Stop Loss Products </li></ul><ul><li>Advanced Pharmacy Options </li></ul><ul><ul><li>Drug Mix Management </li></ul></ul><ul><ul><li>Specialty Pharmacy </li></ul></ul><ul><li>Global Health/Medical Tourism </li></ul><ul><li>Collateralized Health Care Obligation </li></ul>
  45. 45. The Bottom Line Cypress Benefit Administrators – the industry leader in health cost management
  46. 46. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  47. 47. <ul><li>The need to identify the highest risk people is obvious. </li></ul><ul><li>Getting the –at risk population healthy and keeping the healthy population in their current state is equally obvious. </li></ul><ul><li>Many employers are turning to “Wellness” plans as the answer. </li></ul><ul><li>Most employers implementing a “Wellness Plan” do so by offering a health risk assessment . </li></ul><ul><li>Doing an HRA alone is NOT a wellness plan. </li></ul>Wellness
  48. 48. Wellness Medical Advocacy Disease Management Consumer Information Incentives Coaching On Site Medical Health Risk Assessment The Cypress Solution
  49. 49. Introducing:
  50. 50. <ul><li>On-site HRA with published results </li></ul><ul><li>Professional Coaching & Follow Up </li></ul><ul><li>Positive incentives to get and stay healthy </li></ul><ul><li>Access to information for the consumer </li></ul><ul><li>On-Site Medical </li></ul><ul><li>Disease Management </li></ul><ul><li>Medical Advocate Program </li></ul><ul><li>Employee incentives for participation & health improvement </li></ul>Major Components of Thrive
  51. 51. <ul><li>“ Across all 56 studies the average R.O.I. was 3:1; using studies published in the last 10 years the R.O.I. improves to 6.3:1” </li></ul><ul><li>Source: Larry Chapman, MPH </li></ul><ul><li>“ Obviously, putting in place a wellness plan is the single most important investment we can make in our company.” </li></ul><ul><li>Don R. Powell, Ph.D President, American Institute for Preventive Medicine </li></ul>Return on Investment
  52. 52. <ul><li>25 have cardiovascular disease </li></ul><ul><li>12 are Asthmatic </li></ul><ul><li>6 are diabetic </li></ul><ul><li>26 have high blood pressure </li></ul><ul><li>30 have high cholesterol </li></ul><ul><li>38 are overweight </li></ul><ul><li>21 smoke </li></ul><ul><li>31 use alcohol excessively </li></ul><ul><li>20 don’t wear seatbelts </li></ul><ul><li>24 don’t exercise </li></ul><ul><li>44 suffer from stress </li></ul>Risk Factors for Every 100 Employees <ul><ul><li>SOURCE: US Dept. of Health & Human Services </li></ul></ul>
  53. 53. <ul><li>Total to non-Federally employed, office based physicians: 911 million </li></ul><ul><ul><ul><ul><ul><li>Source: National Ambulatory Medical Care Survey </li></ul></ul></ul></ul></ul><ul><li>Unnecessary Visits: 25%, or 228 million </li></ul><ul><ul><ul><ul><ul><li>Source: Dunnell, K. and Cartwright, C. Medicine Takers, Prescribers and Hoarders </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>AVERAGE COST: </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>$101/visit x 228 million </li></ul></ul></ul></ul></ul>Physician Office Visits Annually
  54. 54. <ul><li>Breast Cancer $3,463,725 </li></ul><ul><li>Cervical Cancer $ 543,785 </li></ul><ul><li>Colon Cancer $ 296,363 </li></ul><ul><li>Prostate Cancer $ 127,693 </li></ul><ul><li>Metastatic Cancer $ 885,543 </li></ul><ul><li>Total - $5,317,109 </li></ul>Five Year Study: Claims Paid 4,000 Employees THIS IS THE COST OF DOING NOTHING
  55. 55. Incentives Drive Employee Participation 3-4% <4% <1% <1% SMOKING CESSATION 5% <4% <2% <2% WEIGHT LOSS >7% 5-7% 3% <3% 24/7 NURSE LINE 70% 21-30% 10% <5% HEALTH SCREENING 75-80% 30-50% 25% <20% HRA Significant Incentives ($100-$500) Moderate Incentives ($25-$75) Token Incentives No Incentives Activity
  56. 56. <ul><li>1600 employees at $10.00 pepm </li></ul><ul><li>$192,000 in wellness cost vs. $8,534,583 in total health care expenditures </li></ul><ul><li>Wellness = 2.2% </li></ul>What Should Wellness Cost? $192,000
  57. 57. <ul><li>What can $192,000 buy? </li></ul><ul><li>One and one-half Bypass Surgeries </li></ul><ul><li>2 Cardiac Pacemakers </li></ul><ul><li>Major Breast Reconstruction, Unilateral </li></ul><ul><li>Dialysis for 24 weeks </li></ul><ul><li>A Wellness Plan for 1,600 Employees and their Dependents </li></ul>The COST of Wellness vs. The Cost of Doing Nothing
  58. 58. Compare Thrive vs. Others X On Site Medical X Disease Management X Online Consumer Information X Medical Advocate Plan X Incentive Plans X X Client Aggregate Report X Telephonic Health Courses X Trend Analysis X On Site Coaching X Compare to National Guidelines X X Detailed Lab Results X X Personal Report Mailed X Online Results X X Health Questionnaire X X On Site Blood Draw Other Plans Thrive
  59. 59. The Cypress Solution: A Comprehensive Set of Administration, Service, Cost Control, Wellness & Data Management Tools for Employers Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION
  60. 60. Information Provider Quality Measures Medical Advocacy Predictive Modeling Plan Modeling Cypress Online Client Specific Reports Monthly Reports The Cypress Solution
  61. 61. <ul><li>Employers are starving for information: </li></ul><ul><ul><li>“ How is my plan doing?” </li></ul></ul><ul><ul><li>“ How much am I spending?” </li></ul></ul><ul><ul><li>“ What are my largest costs?” </li></ul></ul><ul><ul><li>“ Is there information my employees can use?” </li></ul></ul><ul><li>Most administrators send nothing more than a monthly report showing how much money was spent last month. </li></ul><ul><li>Sending a monthly aggregate report is NOT providing information. </li></ul>Information
  62. 62. <ul><li>Cypress provides multiple information sources and analytical tools to employers and employees </li></ul><ul><li>Armed with information ( not just data ), important decisions can be made about the direction of an employer’s benefit plan </li></ul><ul><li>Given access to critical information about their plan, consumer options and providers, employees can make important decisions about where and how they will receive health care services. </li></ul>Everyone Can Use Information
  63. 63. <ul><li>Standard monthly reports </li></ul><ul><li>Client-specific reports </li></ul><ul><li>Cypress Online </li></ul><ul><li>Plan Modeling/predictive modeling </li></ul><ul><li>Medical Advocacy </li></ul><ul><li>Provider quality measures </li></ul>Cypress Information Tools
  64. 64. No single administrator has brought together Claim Administration, Service, Cost Control Programs, Wellness Options and Access to Information like Cypress Benefit Administrators through THE CYPRESS SOLUTION Information Wellness Cost Control Service Claim Administration THE CYPRESS SOLUTION