CATENAHealth is a technology and product management company responsible for the entire product development lifecycle including all technology development requirements, as well as all benefit design, packaging, distribution, and vendor partnerships that will be supported by an affiliated captive, PEACEPlan Insurance Company. CATENAHealth will offer new self-funded alternatives to traditional fully insured plans that can significantly reduce total annual healthcare expenses and provide employees 24/7 member advocacy, no cost preventative wellness and primary medical care visits.
We believe that employers health benefit solutions begin with us. Our vision is to curate benefit products using the latest technology to create an optimized experience for members/patients who access services with one of our best of breed healthcare partners.
Our corporate model allows CATENAHealth to concentrate on innovative product development and technology design without distracting from the important fiduciary responsibility the insurance captive (PEACEPlan Insurance Company) will have for employers. CATENAHealth will have the capabilities to aggregate data from the sponsored plans in order to better understand, manage and mitigate the future risk taken by the captive. CATENAHealth products will accommodate employers of all sizes and types including public entities.
WHAT WE DO
Technology & Data
Our vision is to create technology that enables and optimizes health benefits while providing seamless care navigation support. Furthermore, data will be collected and shared in a meaningful way to ensure the sustainability of benefits and associated funding solutions.
Health Benefit Design & Product Development
With an affiliate captive platform, we are able to create self-funded health benefit products that are affordable and sustainable in today’s market.
Marketing & Distribution Management
Our experience with developing and managing sales channels is based on partnership principles that keep the customer needs at the forefront of the solution and a commitment that a win-win exists for all.
There are five major differentiators that allow CatenaHealth to create More value than Insurers, TPAs and other competitors.
CATENAHealth and its best-of-breed service firms are connected electronically so that the use, cost and payment of health benefits occurs quickly and seamlessly. These linkages allow CATENAHealth to track and assess how Members are using their benefits and what adjustments to the CATENAHealth model could improve performance for employers. This type of assessment doesn’t happen with the insured benefit plans offered by competitors to small employers.
The Healthcare Bluebook technology managed by American Health Group, AHG, drives cost effective utilization of the CATENAHealth vendor provider network. CATENAHealth also has its own smart phone and tablet application that gives Members immediate access to plan benefits and CATENAHealth service firms. These technology investments are not in place with most competitors.
CATENAHealth benefit plans cover all 66 preventive services for men, women and children that are required by the Affordable Care Act. There is no cost to Members for these services. Nearly all preventive services can be provided by primary care physicians in the CATENAHealth provider network. But with competitors that don’t incent and encourage primary care, the preventive services can end up being delivered by specialists who may “capture” the Members and provide unnecessary or costly additional services that aren’t discussed with the primary care physicians.
3. Primary Care
Primary care physician visits with CATENAHealth benefit plans are covered at no cost to Members. Health benefit plans from competitors almost always charge copays or deductibles for PCP care. In addition, most competitors don’t make efforts to encourage Members to select a primary care doctor. CATENAHealth advocacy partner, American Health Group, Inc. (“AHG”), reaches out telephonically to Members to help them choose a PCP and build a relationship with their primary care physician for prevention, wellness and referrals to other providers.
In CATENAHealth benefit plans like the PEACEPlan, Members have 24/7 access to AHG Advocacy Coaches. These Advocacy Coaches support Members in understanding prevention, treatment options, provider choices and how to navigate the health care system. Most competitors do not invest in advocacy services. In addition, the AHG Advocacy Coaches use Healthcare Bluebook online price/quality tools to help Members compare price and quality rankings between local providers for any health care procedures, tests or services they may need. Prices can vary by more than six hundred percent (600%) for the same in-network procedure or service of similar quality, depending upon which provider is selected. When Members understand how to choose high value providers, significant cost savings occur for both Members and their employers.
Healthcare Bluebook is also integrated into AHG’s precertification platform for approval of certain inpatient and outpatient services that are required by CATENAHealth benefit plans. With almost all competitors, precertification requests come from network providers after such providers have been contacted by employees and dependents. In CATENAHealth model, precertification requests must be made by the Members directly to the AHG precertification team. AHG then utilizes Healthcare Bluebook tools with Members to identify high quality and lower cost providers before approving the precertification requests. Similar to Advocacy Coaches, less costly provider alternatives yield material cost savings.
5. Cost Management
The CATENAHealth self-insured benefit plans are less expensive when compared to insured benefits provided by competitors. When the comparison is between CATENAHealth self-insured offerings versus self-insured plans of the competition, CATENAHealth has its own captive insurance firm (PEACEPlan Insurance Company) that generates superior cost savings for employers; the financial risk assumed by the captive lowers’ reinsurance fees and the reduced costs are passed on to employers. As noted above, CATENAHealth differentiation in prevention, primary care, advocacy and technology cuts the use and cost of health benefits for Members and employers. These savings are also passed on to employers through lower benefit plan pricing. CATENAHealth believes its pricing advantage will be between 15-30% in most markets.
We value the broker community and understand the frustrations of providing affordable, high quality health benefit solutions. We believe the PEACEPlan health benefit product will arm you with an innovative and effective way to address this important human capital recruitment and retention tool.
Brokers can expect the PEACEPlan to:
- Be a plug and play comprehensive health benefit products that includes the full spectrum of medical needs.
- Be a better solution for their customers with a technology enabled customer experience.
- Provide self-funded options for smaller employers that normally would not consider this healthcare financing tool.
- Potentially lower customer costs on both premium and out of pocket expenses.
- Create a vehicle for quality health care and cost optimization for customers.
- Navigate with easier access to health care & benefit questions.
- Be a compensation tool that will highly competitive and above market standards.
CATENAHealth has curated a health benefit package with some of the best partners in the business. With a shared vision for impacting and disrupting the current health benefit market, these partners stand ready to provide best-in-class service through an integrated benefit offering.
Regional Care Inc.
Third Party Administrator
Regional Care, Inc. (RCI) is one of the nation’s premier independent third-party administrators. We have continued to grow our business by offering unique products and delivering exemplary services to our clients and broker partners while managing health care costs effectively.
Transparent Pharmacy Benefit Manager
RxPreferred offers a full line of Pharmacy Benefit Management solutions for employers, hospitals, hospices, brokers and third-party administrators. RxPreferred focuses on guaranteed savings and cost-containment strategies while providing our clients with innovative, efficient, and effective pharmacy benefit management services.
Teladoc provides access to healthcare on your schedule with 24/7 access to U.S.-licensed doctors, connect by phone, web, or app from anywhere, and get medical treatment for non-emergency conditions.
American Health Group
Advocacy and Care Management
American Health Group, Inc. (“AHG”) provides a suite of health engagement services to employers, union trusts, health insurers and third party administrators in the western U.S. AHG offers an integrated engagement solution for PEACEPlan members that includes advocacy coaching, PCP selection, pre-certification of certain services directly with members, hospital stay review, second opinions, case management and use of Healthcare Bluebook to access less costly, quality providers.