3.
Benefits Committee Meeting
- Meeting Date:
- 11/10/2022
- Title:
- Submitted By:
- Shelley Loughrey, Human Resources
- Department:
- Human Resources
Information
Agenda Item
Discuss, consider and take appropriate action regarding Holmes Murphy & United Health Care Strategy:
- Financials
- Trend Update - Monthly Paid Claims
- Current Large Claims
- United Healthcare 1/1/2023 Stop Loss Renewal Summary
- United Healthcare Aces MSK Bundle
- United Healthcare Financial Renewal and Terms Amendment No. 6
Background
Review and consider adding MSK bundle.
Introducing the Optum® MSK Bundle. This first-of-its-kind program offers bundled end-to-end care across MSK conditions. This solution combines best-in-class musculoskeletal support programs (Virtual Physical Therapy- powered by Kaia, Optum® Orthopedic Health Support and Second Opinion by 2nd MD), to address virtual physical therapy, orthopedic nurse support and second opinions that ensure members receive the right level of care for their condition. It delivers an average of $14,000 average savings per operation3 and 20+% lower negotiated rates compared to median costs in the same metropolitan area.3
The Optum MSK Bundle provides:
Virtual physical therapy
$1,500 per enrolled member would apply – no PEPM charge. This would be an additional program under the bundle – no PEPM fee.
Tanya Haught
UnitedHealthcare of Central Texas – Key Accounts
901 South Mopac Expressway, Building 2, Suite 275
Austin, TX 78746
Introducing the Optum® MSK Bundle. This first-of-its-kind program offers bundled end-to-end care across MSK conditions. This solution combines best-in-class musculoskeletal support programs (Virtual Physical Therapy- powered by Kaia, Optum® Orthopedic Health Support and Second Opinion by 2nd MD), to address virtual physical therapy, orthopedic nurse support and second opinions that ensure members receive the right level of care for their condition. It delivers an average of $14,000 average savings per operation3 and 20+% lower negotiated rates compared to median costs in the same metropolitan area.3
The Optum MSK Bundle provides:
Virtual physical therapy
- Case review and referrals through Advocacy/Clinical programs, including appointment scheduling for local peer-to-peer consults as needed
- Fast consultations and second opinions with an expert MD via phone or video
- Access to Centers of Excellence (COE) and high quality providers (lower bundled case rates if COE is utilized)
-
- The Benefits Committee approved adding 2nd MD and KAIA on 1.1.2023
- 2nd MD was added for an additional PEPM charge of $2.76 PEPM. (~$51,000) Under the MSK bundle the $2.76 PEPM charge for 2nd MD would be removed and a case rate would apply instead - $2,136 per consultation instead of the $2.76 PEPM
- KAIA is only billed through case rates based on utilization. $200 per active user for 1-3 months; $20 per user ongoing. This was approved by the benefit committee.
- Orthopedic Health Support was not added, which I believe was due to the perception of mandated enrollment and mandated use of COE.
$1,500 per enrolled member would apply – no PEPM charge. This would be an additional program under the bundle – no PEPM fee.
Tanya Haught
UnitedHealthcare of Central Texas – Key Accounts
901 South Mopac Expressway, Building 2, Suite 275
Austin, TX 78746
Attachments
- Holmes Murphy 11-10-22 Presentation
- 2023 UHC Stop Loss Rider
- Williamson County ASA Amendment No.6
- 2023 ACES MSK Bundle
Form Review
- Form Started By:
- Shelley Loughrey
- Started On:
- 11/03/2022 10:54 AM
- Final Approval Date:
- 11/03/2022