UK Health Benefits Task Force
October 24, 2001
Agenda

CHA Health Profile

Current Relationship

Future Relationship

Questions & Answers
CHA Health Profile
Profile

Roots began back in 1991 when a group of rural
healthcare providers in Eastern Kentucky
approached UK Hospital about working together to
develop an integrated healthcare delivery system

Network was known as CHA Provider Network

1995, CHA Health was created and licensed as an
HMO by the Commonwealth of KY to offer fully
insured health benefits to employers

CHA Health also maintains a Third Party
Administrator (TPA) License for self funded
administrative services
Profile

CHA Ownership
–
–
–
–
–
–
–
University of Kentucky Hospital
Appalachian Regional Hospitals
St. Luke Hospitals
Our Lady of Bellefonte Hospital
Pattie A. Clay Hospital
Gateway Regional Health
Rockcastle Hospital
84.7%
9.6%
3.4%
0.9%
0.7%
0.4%
0.3%
Profile

Executive team and structure
Chief Executive
Officer
Mark D. Birdwhistell
Director
Internal Audit
Ken Taylor
Director of
Human Resources
Kim Nesbitt
Director Govt. Relations
and Legal Affairs
Shawn Crouch
Legal Affairs
Chief Financial
Officer
Dale Fisher
Executive Assistant
Sharon Scales
Chief Operating
Officer
Brent Barber
Accounting
Network Development
Premium Billing
Chief Health
Services Officer
Tim Costich MD
Chief Marketing
Officer
Mark Lamberth
Medical Management
Sales
Claims
Quality Improvement
Provider Relations
Financial Analysis
Member Services
Pharmacy
Marketing &
Communications
Underwriting
Compliance/Appeals
Credentialing
Account Services
Information Services
Director of Corp. &
Plan Development
Matt Sanger
Profile

Mission Statement
– Improve health and healthcare by providing value
and exceptional services

Vision Statement
– CHA Health is the trusted leader serving the
community by making healthy living easier
Profile

CHA Network
Profile

Network Strength
8,000
7,111
7,000
6,025
6,000
5,000
CHA
4,000
Target
2,690
3,000
2,410
2,000
1,404
1,191
1,000
1,214
686
347
178
205 123
Region 1
Region 2
472 550
592
581
145
343
0
Region 3
Region 4
Region 5
Kentucky
Regions
Region 6
Region 7
Region 8
Total - All
Regions
Profile
Total Membership
– 147,600
150,000
140,000
Members

130,000
120,000
Sep00
Oct- Nov- Dec00
00
00
Jan01
Feb- Mar- Apr- May01
01
01
01
Jun- Jul-01 Aug01
01
Sep01
Profile
Member Satisfaction
Customer
Service
90%
80%
70%
Overall Rating

60%
50%
40%
30%
20%
10%
0%
2001 CHA Health
Quality Compass Average (NCQA)
Claims
Processing
Health Plan
Overall
Profile
Personal
Doctor Overall
Specialist
Care Overall
100%
90%
80%
Overall Rating
70%
60%
50%
40%
30%
20%
10%
0%
2001 CHA Health
Quality Compass Average (NCQA)
Overall Health
Care Provided
Getting Care
Quickly
Courteous and
Helpful Office Staff
Profile

HEDIS Results
Cardiac Quality of Care Improvements
CHA
2000
Threshhold
2000
CHA
2001
Threshhold
2001
Beta Blocker Treatment After Heart Attack
80.65%
25-50%
98.67%
> 90%
Cholesterol Mgmt. After Cardiovascular Event (LDL-C
Screening)
64.16%
25-50%
80.42%
75-90%
Cholesterol Mgmt. After Cardiovascular Event (LDL-C
Control)
33.53%
10-25%
61.54%
75-90%
Controlling High Blood Pressure
35.52%
10-25%
64.48%
> 90%
Measure
Interventions:
 Cardiac Disease Management (DM) Program
 DM Program Education to all PCPs
 One-on-one communication with PCP (RE: specific DM program member outcomes)
Targeted Preventive Quality of Care Improvements
Measure
Breast Cancer Screening
Cervical Cancer Screening (CM)
Eye Exam
CHA
2000
Threshhold
2000
CHA
2001
Threshhold
2001
72.67%
66.91%
36.25%
25-50%
10-25%
25-50%
75.66%
78.27%
41.85%
50-75%
75-90%
25-50%
Profile
$30
Statutory
Net Worth
$25
Networth in Millions

$20
$15
$10
$5
$0
1998
1999
Regulatory Requirements
2000
Net Worth
Aug-01
Profile

Received B++ Financial Rating from A.M. Best
– B++ is considered “very good”
– Plans with B+ or higher are considered “secure”


Plans have a strong or good ability to meet their long-term
obligations to members
Maintain a level of financial strength that can withstand
unfavorable changes in the business, economic or regulatory
environment
– Heavy emphasis is placed on financial rating by
Consultants and Brokers
– “…rating formally ratifies the significant improvements
that have taken place…”
Current Relationship
Current Relationship
University of Kentucky
(Self Funded Employer)
*Maintains Risk
UK Health Care Plans
PPO Plan
UKHMO
Humana
CHA Health
Subcontracted
Services
Subcontractors
Current Relationship

UKHMO has had a contract with CHA Health to
provide certain Administrative Services for UKHMO
Lexington Service Area (LSA) and Regional Service
Area (RSA) members since July 1997

Obligations are different between LSA and RSA
Current Relationship


LSA
RSA
Current Relationship

LSA
UK HMO
Services Performed
CHA Health
1. Payment settlement of all claims,
excluding OOA emergency and DME
2. Member Services
3. Utilization Management
4. Financial Accounting
5. Benefit Administration
6. Formulary Management and
PBM Interface
7. Service Area determination
8. Member Appeals
1. ID card production and COC
distribution
2. Access to PBM
3. Network Access and Provider
Directory development/distribution
4. Utilization Management for OOA
emergencies and DME claims
5. Membership eligibility and
reconciliation
Current Relationship

RSA
UK HMO
Services Performed
CHA Health
1. Financial Accounting
2. Benefit Administration/Determination
3. Formulary Management and
PBM Interface
4. Service Area Selection
1. Payment settlement of all claims
2. Preparation of financial statements
3. All Utilization Management
4. Coordination of appeals process
5. Member Services
6. ID card production and COC distribution
7. Access to PBM
8. Network Access and Provider
Directory development/distribution
9. Reporting
sm
10. eHealthConnect access
11. Membership eligibility/
reconciliation
Profile

UKHMO’s relationship allows for access to technology and
reporting capabilities that require economies of scale
sm
1. eHealthConnect
– CHA Health’s online service for members and providers that
allows them to access key information
 Members
 Providers
–
–
–
–
–
–
Order replacement ID card
View claims status
Verify member eligibility
Change PCP
View member benefit
information
– View claim status and
authorizations
– Verify member eligibility
– PCP access to patient list
– View patient benefit information
Available 24 hours a day, seven days a week
2. CHA Health’s Reporting Module
– Allows for real-time ad hoc reporting
Profile

UK HMO has access to all these services at
competitive marketplace pricing
Future Relationship
Future Relationship

Today, UK Health Care Plans has 13,729
employees participating with its Plan
– 98% reside in the Commonwealth of Kentucky

CHA Health is well positioned as a locally
owned Managed Care Organization to meet
the needs of UK Health Care Plans
– In addition to the UKHMO RSA, CHA Health
Provider Network could accommodate a PPO
product that would cover 96% of the UK
employees
Future Relationship

Distribution of UK employees by county
– 96% reside in CHA Health service area
Boone
Kenton
Campbell
12
24 12
Gallatin
Robertson
Carroll
Grant
4
Trimble
4
18
3
Oldham
Henry
292
Henderson
78
4
66
Daviess
Union
Webster
McLean
11
Livingston
4
86
16
Muhlenburg
7
Lyon
107
2
4
Graves
20
4
6
Warren
9
Calloway
Trigg
9
Todd
51
3
6
Barren
14
Metcalfe
3
3
6
5
Simpson
Allen
4
Monroe
Jackson
Adair
23
Knox
Harlan
9
Wayne
4
19
157
Russell
20
24
17
129
Leslie
7
12
McCreary
Whitley
16
22
Bell
96
Pike
86
Knott
Perry
Clay
Laurel
6
2
73
7
8
Floyd
Breathitt
17
Pulaski
Cumberland
8
Lee
Owsley
11
36
13
9
5
4
5
Johnson
4
Wolfe
Estill
20
Rockcastle
Casey
4
6
26
66
19
2
Hart
Lawrence
4
Morgan
62
253
Lincoln
Taylor
Edmonson 5
5
Logan
Marshall
Hickman
Fulton
Butler
Christian
22
Carlisle
Larue
Elliott
Powell
Madison
57
Marion
Grayson
10
4
6
Clark
226
Boyle
119
12
Hopkins
12
Ballard
Hardin
21
Rowan
20
Jessamine
641
81
13
Bath
Fayette
8,723
76
Carter
13
166
Mercer
Washington
Nelson
5
Ohio
13
Fleming
Bourbon
210
Woodford
10
15
Crittenden
3
10
8
27
99
79
8
6
McCracken
Breckenridge
Shelby
Spencer Anderson 304
Bullitt
9
Franklin
24
Boyd
Greenup
Lewis
53
45
Scott
17
Mason
Harrison
12
2
Hancock
3
3
2
10
Jefferson
2
Owen
41
Future Relationship
Partnership
Questions & Answers
YOUR KIND OF PEOPLE.
YOUR KIND OF CARE.