From:
Sent:
Hogan, Scott W [Scott.Hogan@umr.com]
10/2/2018 5:38:49 PM
To:
CC:
Subject:
Czech, Bruce P [Bruce.Czech@umr.com]
Ziemer, Scott A [Scott.Ziemer@umr.com]
FW: CEO Call-OON Programs
Attachments: OON Deep Dive w Local Market CEOs (092818)_fv.pdf
Bruce as per our discussion — attached above is what was presented by UHC/UHN on Sept 28 CEO call. The email below
that Scott Z sent was in response to what was discussed on CEO call letting Greg and Kathy know we are working to track
similar to what UHC/UHN are doing. Thanks.
From: Hogan, Scott W
Sent: Friday, September 28, 2018 11:47 AM
To: Benson, Mike; Braun, Helmut M; Czech, Bruce P; Dahlke, Ann M; Dunn, Lori A; Freiberg, Brian H; Hiatt, Kimberly M;
Johnson, Heidi J.; Lattimer, Patrick J; Napier, Donald P; Pavlic, Gregory M
Cc: Ziemer, Scott A
Subject: FW: CEO Call – OON Programs
FY!
From: Ziemer, Scott A
Sent: Friday, September 28, 2018 11:42 AM
To: Pavlic, Gregory M; Wiseman, Katherine E
Cc: Freiberg, Brian H; Hogan, Scott W; Aue, Bobbie ]
Subject: CEO Call – OON Programs
Pav/Kathy,
Plaintiffs’ Exhibit
142
Cause No. CJ-2019-482
It is my understanding that on the UHC CEO call, UHN will be laying out a strategy to become more aggressive with their
OON programs. They have done some investigation and believe that UHC is reimbursing OON providers at much greater
levels than our competition. In order to reduce the gap, they are proposing a move over time towards non-secured (i.e.
not a contracted discount) reductions backed by member advocacy to help keep members from being balanced billed.
As you are aware, today UMR and UHC have comparable shared savings (CRS and SSP) programs – especially now with
our rollout of our new CRS solutions and specifically the solution that impacts RAPLE. However, with this new direction
there may be some questions about UMR and our strategy. The good news is that we already have programs available.
CRS Benchmark program (30% of savings with $50k savings cap per claim) – we rolled this out as a solution to
address reasonableness of OON reimbursement. It achieves reimbursements below an established Medicare
benchmark through a program administered entirely through MultiPlan. Multiplan leverages it’s DataiSight program
(non-secured) for the most of the reimbursements and has a back end member advocacy program to limit member
balance billing. The program gets to lower OON costs (DiS generally is less than 250% of Medicare) while impacting
almost all OON claims.
о
Non Par Cost Containment (NPC^2) program ($3.50 PEPM +30% of savings) – this program rolled out because of
pressure on shared savings fees and level of reimbursement. The program leverages MNRP for all services except for
those paid at the INN level of benefits as well as radiology, anesthesiology, pathology, lab and emergency
claims. Members are not held harmless for the claims that are impacted by MNRP but are for the other
claims. Effective 10/1 we made an enhancement to use the CRS Benchmark process, rather than only network and fee
UHC_PA_00299725
P142.001
Source: Elections - nytimes.com
