Health Benefit Services
Employee benefit programs play an important role in attracting
great people and keeping them happy. However, as the cost of providing
health benefit plans escalates, employers struggle to keep the
programs competitive and to control expenses.
HealthFirst TPA can help . . .
We offer Wellness, Lifestyle Management, and Disease Management
programs. Our on-site clinics can be implemented in a variety
of cost-effective ways. We provide access to a PBM with an alternative,
transparent model and guaranteed pricing that passes 100% of the
prescription drug rebates and the pharmacy network discounts for
brand and generic drugs at both retail and mail distribution channels
to the employer. It even offers a unique alternative to the mail
order program, available locally at over 30,000 pharmacies. In
addition, we provide flexible health payment options through FSAs,
HRAs, HSAs.
HealthFirst TPA’s Health Benefit Services division provides
a fully integrated portfolio of services. We categorize our programs
and services into four main topics:
- Wellness & Disease Management (to prevent claims
or reduce their severity),
- Utilization Review and Case Management (to
coordinate quality medical care and contain cost),
- Claims Management (to pay appropriate claims),
and
- Reporting and Analysis (to assess results
and forecast cost trends)
Wellness & Disease Management
services include wellness programs, lifestyle management tools
and disease management programs. We are able to provide these
services for clients that have local, regional and national operations.
Onsite clinics put medical professionals in employer locations
to provide quick and easy access by employees for a wide range
of services.
Our company has delivered Utilization
Review and Case Management services for more than
20 years and is certified as a UR Agent from the State of Texas.
Our on staff nurses provide case management services to optimize
patient care and coordinate activities and referrals to and from
the disease management program.
Claims Management
encompasses not only the work of our experienced claims examiners
utilizing our claims processing system but also it can be integrated
with loss control, fraud detection, and decision support software.
The software includes an integrated data warehouse of medical
and drug claims data and eligibility information.
Our Reporting and Analysis
capabilities have blossomed. We can track healthcare costs, evaluate
benefit plans, forecast the real-life impact of potential changes
to your plans, and evaluate the impact of health promotion and
disease management programs. Utilizing an integrated data warehouse
of medical and drug claims data as well as eligibility information,
HealthFirst TPA can manage plan assets in a most effective manner.
The system also delivers comparative information including local,
regional, and national benchmarks from an extensive, nationally
known normative research database.
