Annual Report } 2014 30 years of caring for our community
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From Our President The Birth of AultCare Roundtable
Product Lines Integration Care Coordination - Utilization, Disease & Case Management - Wellness - Patient Centered Medical Home - Pharmacy Year-End Review
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Quality Service - New System - Providers - Employers - Brokers - Community
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Physician Leadership Aultman Hospital Community Relations - Wish-A-Thon - Chris Spielman Football ProCamp Timeline
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Rick L. Haines AultCare President and CEO From Our President
of his extraordinary vision “ It was becausethat we have AultCare today. ”
An Annual Report provides a moment for us to pause and reflect on the previous year’s challenges and successes, as well as outline some ongoing projects for the coming year. In this special Annual Report, we have added another dimension - a glimpse at our beginning in 1985, and reflections about events since that time. We are excited to celebrate our 30th anniversary in 2015 and we wanted to share and reflect back to our origins to show how it all began. During this year, we have aimed to bring to the forefront the idea of Integration. It is a subject of great importance because health care is increasingly moving toward a population health model. AultCare integrates four quadrants: Administration, Care Coordination, Consumerism and Network to best meet this change in how health care is delivered. The goal is to improve the health of our entire community. In striving toward that goal, AultCare joins its vertically integrated partners, our network of doctors and Aultman Hospital, to help manage patient care. By integrating services, we place an emphasis on managing that care, allowing us to maintain our goal of having healthier patients, while also being more cost-effective for the enrollee and employers. In 2015, you will be hearing about how our new Claims Management System is being implemented, which hich will enhance the integration process process. This system is extremely important to our integration process, allowing us to be more efficient. This his new new system will allow us to quickly analyze and react eact to data within each quadrant and to also share that data among the quadrants. AultCare’s ell as quickly ability to better customize plans for our members, as well ue to make us a leader in the make adjustments to plans, will continue field of health care.
Throughout this Annual Last year, the topic on everyone’s mind was the Affordable Care Act. It came into effect at the beginning of 2014, with the Marketplace’s well-documented problems. Fortunately, our team’s planning for the event gave us the opportunity to overcome the national problems, and to offer our community competitive, quality health plan products. Nearly 4,000 people in our community chose those products from the Marketplace. As always, our team of nearly 500 employees is the common denominator that makes our company successful. Throughout these pages you will see their reports, all of which reflect the high quality, local customer service they give to our members. We are tremendously proud of their work. As mentioned, this is a special Annual Report. I am especially pleased to share with you an interview we conducted last year with Richard Pryce, retired Aultman Hospital President and CEO. Mr. Pryce developed the idea of AultCare, and he asked me to lead its development elopment and expansion. It was because of his extraordinary vision that we have AultCare today. y y.
Report, you will find excerpts and photographs from our AultCaring in the Community Campaign. We recognize the immense value of giving back to our great community. Our devoted employees are continually willing to donate their time to worthy projects and organizations.
Additionally, I was privileged to join a roundtable discussion with representative members of our corporate family who helped develop AultCare and who helped nurture it to the company it is today. A section of our Annual Report is dedicated to that discussion. We hope that you will gain a sense of what it was like in the beginning as we came together to develop a community-based health insurance company. We are pleased to offer this Annual Report to you; a report containing pieces from the past, the present and the future, all joined by our unwavering goal: to provide high quality, affordable health plans to our community.
Rick L. Haines President and CEO
Rick L. Haines, President & CEO, and John B. Humphrey, M.D., Chairman of the Board
Mr. Richard Pryce Retired Aultman Hospital President and CEO The Birth of AultCare
“
The overall goals of Aultman and A many services in Stark County as p the local community,
In the early 1980s, Aultman Hospital President Richard Pryce faced a dilemma. He was reporting to the Aultman Board about the hospital’s cost controls and continuing efforts to keep costs down. Yet Stark County business owners, many of whom were Aultman Hospital Board Members, were telling him that their companies were receiving stiff insurance rate increases and the insurance companies were telling them that the reason for the increases were rising hospital costs. Meanwhile, insurance carriers were dictating to Mr. Pryce and other Northeast Ohio hospital administrators the amount of money their hospitals would receive for hospital stays and medical procedures. Those rates “were very low,” according to Mr. Pryce. He reviewed the situation and came to the conclusion that the insurance companies were cost-shifting from more expensive areas of Northeast Ohio, “and using Stark County as a profit center.” pr From F om this analysis, the idea that became AultCare was born _ to offer competitive rates that would lower costs to Fr the community. unity unity. “W w “We wanted anted to offer a plan that all the emplo employers could see was much less expensive than other health plans,” said Mr. Pryce. “So, we would pr prove our point to the community: it was the other health plans that were taking advantage of them, not the hospital. That was our original goal and we expected we would have a small market share. But our rates were so competiti competitive that we got all the big companies in very quickly.” In 1985, Aultman Hospital became AultCare’s first client, then the Timken Company, and then the Hoover Compan Company. Within one year, AultCare was larger than the hospital-related insurance companies that Mr Mr. Pryce and his team had studied before deciding to start AultCare.
d s
AultCare were always to keep as possible, and to keep costs down to and that goal remains today.
”
From the mid-1980s, an era of cost-plus reimbursements, through ough the later 1980’s period of increasing cost controls and competition and into the 1990s, ‘’we went ent along very nicely,’’ said Mr. Pryce. When President Clinton came into office ice and the possibility of some form m of national health care loomed, insurance companies needed to expand in size to remain in the marketplace. AultCare decided to enter the small-business client arena. While what was then called “Hillary Care” (named after the First Lady, the plan’s chief proponent) never happened, AultCare continued to expand into the small-business market and other areas, adding PrimeTime Health Plan in the late 1990s. One of the many good things about AultCare, Mr. Pryce added, “is that if you have a problem with your insurance, you can call AultCare and you will have a local person who understands you and the culture of the community when answering the call. It is one of the reasons it is a lot easier to get through the health care system in Stark County than probably most other cities that don’t have an AultCare type plan.” All in all, the whole key was to keep high quality care in Stark County while supplying the need for local control and accountability to our community. “The benefit of AultCare now is to give the Board and the community some control over what happens, rather than just leaving it to far-off insurance companies and far-off hospitals,” said Mr. Pryce. “The overall goals of Aultman and AultCare were always to keep as many services in Stark County as possible, and to keep costs down to the local community, and that goal remains today.”
A rare discussion was held when six influential members of AultCare gathered around to reminisce about the history of AultCare and how decisions made 30 years ago still impact the way business is conducted to this day. Rick Haines, Dr. John Humphrey, Dr. Allen Rovner, Patricia Grischow, William Belden Jr., and Joseph Feltes gathered together to share stories of AultCare’s history. As stories were shared, the past came alive, the present was appreciated, and the future left everyone with a sense of excitement. An underlying theme throughout the entire discussion was the concept of community and the objective of providing an excellent health insurance company to the people of our community. Mr. Pryce’s famous words of “leveling the playing field” rang true as the inspiration of this new venture. There was an opportunity to be creative and to compete with larger insurance companies, while keeping one goal intact. “A major selling point was to keep money in the community,” said Mr. Belden. AultCare’s second client was the Timken Company and keeping money in the community was certainly a benefit for them. “There is no question that the cost of AultCare gave us [The Timken Company] a competitive edge in this location,” said Mrs. Grischow. Mr. Haines admired Mr. Pryce’s determination to develop a reasonable health plan in the community. If there wasn’t a local health plan that worked well in the community, our community members would be paying much higher Akron and Cleveland rates. “We actually calculated the value and it is worth hundreds of millions of dollars to our community by keeping health care costs at a reasonable level,” said Mr. Haines. Mr. Pryce was constantly looking for ways that all entities could work together and benefit the community. “I remember Mr. Pryce saying: ‘The community is the customer. The employers are the customers,’ ” said Mr. Haines. “It was organic growth from the very beginning,” said Mr. Feltes. Mr. Feltes noted that all stakeholders had input in the creation of AultCare and this gave rise to the alternative delivery system where everyone met to make decisions, and that was the birth of AultCare. “The uniqueness of what was done cannot be overemphasized,” said Dr. Rovner. When traveling to a national meeting in Washington to hear what other companies were doing in regards to managed care, many were confused as to how to make a health plan succeed. Dr. Rovner shared with his colleagues the concept of AultCare and everyone wondered how they made it work.
“I simply told them that one of the keys was to get the hospitals and physicians together,” said Dr. Rovner. “The confluence of that culture along with the leadership from the business side was one of the unique things that made it work,” said Dr. Humphrey. To have an ambitious edge against competitors, superior customer service was embedded in the AultCare philosophy. From the beginning, Mr. Pryce simply wanted employees to be polite and to answer the phone. Those simple requests launched a campaign that has continued to be implemented to this day. Many AultCare employees take pride in the human aspect of our culture as opposed to the big, prototypical insurance company. “We’ve always had a special culture here. It gets tougher to do because of the business and regulatory environment now, but that is something that we as providers, but more importantly, our patients, have benefitted from,” said Dr. Humphrey. “AultCare was definitely a monumental, quantum leap forward in terms of customer service,” agreed Mr. Belden. It’s a story of organic growth stemming from three fundamental goals: keep it local, keep our companies healthy, and keep the dollars in the community. For 30 years, AultCare has been at the forefront of delivering not only excellent health care, but also first-class customer service, which has positioned AultCare as a leader in the health care field. As we learn from the past and meet the challenges of the future, AultCare is dedicated to fulfill its commitment to unprecedented health care service to our community.
Pictured from left to right: Patricia Grischow, Joseph Feltes, Dr. Allen Rovner, Rick Haines, Dr. John Humphrey, and William Belden Jr.
Established in 1985, AultCare was designed to provide the community with excellent health care services at affordable costs. Since its inception, AultCare has practiced a balanced approach of processing information efficiently, while maintaining personalized attention to its members. AultCare’s ability to create customized plans for employers and individuals exemplifies our commitment to meet the needs of our members, allowing them to receive the most from their health care. AultCare’s founding principles of low costs, quality, and excellent service remain a standard part of the company’s philosophy as AultCare leads the way in the health care field. AultCare has a number of branded entities that provide a diverse number of health insurance products to our community, making AultCare a prominent health insurance company. These entities, as part of the Aultman Health Foundation (AHF), make one of the most effective integrated health systems in the country. Once the AultCare Corporation was established in 1985, there was still a need for a product to be created that had insurance power. In 1989, the AHF created a second company, The McKinley Life Insurance Company (McKinley), which had the power to take an indemnity product (an insured product) to market. For the first 24 years since its implementation, this entity’s legal name was the McKinley Life Insurance Company (McKinley), but recently for branding purposes and for the delivery of a more individualized product, an opportunity was taken to change the name to the AultCare Insurance Company (AIC). This company includes small employer groups, the AultOne Individual product, reinsurance, and now the Affordable Care Act (ACA) Marketplace products. In 1997, McKinley (now known as AIC) started providing a Medicare Advantage product, known as PrimeTime Health Plan (PTHP), to Medicare eligible beneficiaries in the community. In 2010, PrimeTime Choices was established as part of AultCare’s Medicare products portfolio. It offers Medicare Supplement policies to subscribers who reside anywhere in the state of Ohio. PrimeTime Choices features the following policies: A, F, High Deductible F, M, N & G. Medicare Supplement policies pay secondary to traditional Medicare, picking up and paying for costs and coinsurance that traditional Medicare does not cover. Medicare Supplement policies also allow the subscriber freedom to choose any Medicare participating provider nationwide for their health care needs.
As health insurance regulations changed due to requirements established by the ACA, a move was made in 2013 to create the AultCare Health Insuring Corporation (AHIC) to specifically enhance the PTHP Medicare Product’s ability to compete in the market. After encompassing all entities, AultCare is divided into three separate bodies: AIC which includes commercial and Marketplace products; AultCare Corporation, which includes self-funded employers; and AHIC, which in 2015 became responsible for our PTHP Medicare Advantage product line. For a more detailed division of these entities, please refer to the chart below.
g n i r Cain the nity u m m Co
Most recently, the Aultman Health Foundation established the AultCare Holding Company in 2014. The AultCare Holding Company is the parent of the Aultman taxable entities which includes AIC and AHIC.
AultCare Insurance Company
• Individual • Small Employers • Marketplace • Reinsurance • PrimeTime Choices
Corporation
AultCare Health Insuring Corporation
• Self-Funded Employers
• PrimeTime Health Plan
Our enthusiastic employees traveled to the Akron-Canton Regional Foodbank to help organize goods for member agencies in Northeast Ohio counties. Our employees sorted and inspected donated items and labeled products for repackaging.
AultCare is continuing its innovative initiative as we incorporate an integrated health care strategy into our company. AultCare is integrating four health plan quadrants – Administrative Services, a Network of providers and hospitals, Consumerism, and Care Coordination – to provide our commercial clients with the best patient-centered, customized plans to meet their needs. AultCare understands the rapidly changing health care environment in the country and our community, which is a shift toward population health and away from reactive treatment. With the structure of our integrated model, we build a company’s health plan based on the knowledge we gain about the culture of the company and employees. inciples within themselv impor y AultCare’s health care quadrants have integration principles themselves, and most importantly, the quadrants integrate among each other. This data flow w within each group rroup oup and acr across oss g groups rroups oups pr provides pro ovides ovides synergistic value to our commercial clients’ products, to the health of their emplo employ employees, yees, yees and to the health of the community. Since AultCare is a local health plan, we are able to react efficiently y to our clients’ changing needs. Our database is held locally and is available ailable quickly for the benefit of our commercial clients.
Other companies are sending out data extracts where the response time is not as efficient and people are interpreting the data differently. Because AultCare’s data is in-house and available across our entire system, there are common procedures set in place to interpret data in the same manner to ensure accurate readings.
Our talented employees put their knitting and crocheting skills toward a great cause as they made hats, scarves, and blankets for those in need throughout our community.
The consumer quadrant of AultCare’s integrated system benefits enrollees as well as the companies for whom they work. For example, we design our plans to encourage enrollees to engage with a primary care physician. Those employees benefit from better health and lower health care costs; employers benefit by having a healthier work force, in addition to lower health care costs. Beyond encouraging the enrollees use of a primary care physician, AultCare’s health plans contain a Care Coordination component that offers management of individual complex cases, tracks and manages utilization of medical systems, and coordinates disease management and pharmacy management. AultCare’s members benefit from our uniquely integrated system as the whole model supports the idea that we want to put our emphasis on managing the care of enrollees. Improved enrollees’ care results in a healthier population that is more dynamic and cost effective. This integration process is how AultCare meets its goals of having healthier members and being cost-efficient for the member and the company. We implement this system that provides a cradle of efficient health care, and we continually improve it through the use of its ever-increasing trove of data. This benefits our members and our community’s health.
gement
As they gave back to those in need, our employees volunteered at the Canton Calvary Mission by packaging food products and serving hot lunches.
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consulting and coaching levels give members the opportunity to choose from many different options. Through our one-of-a-kind, personalized experience we have a team of clinical and non-clinical staff including professional consultants, a registered dietitian, a personal trainer, a tobacco cessation specialist, and registered nurses. AultCare Wellness offers a comprehensive and integrated program that will lead to better health outcomes at a lower cost. Patient Centered Medical Home AultCare’s Patient Centered Medical Home (PCMH) program is a model of care that facilitates partnerships with patients and their primary care physicians. In 2014, the program expanded into19 physician practices with over 60 primary care physicians engaged. Our PCMH practices serve 37 percent of our PrimeTime Health Plan population and 21 percent of all AultCare covered clients. AultCare’s PCMH model is based on the importance of physician leadership and engagement. All of the practices have a registered nurse available to assist with the coordination of care. The PCMH team meets on a monthly basis with each physician practice to review data analytics and to identify opportunities to provide coordinated, patient-centered care. Patients in a PCMH practice will experience increased access to care as well as care that is coordinated and comprehensive, which results in better health outcomes. Pharmacy AultCare houses its own Pharmacy Benefit Management Team, which is directly integrated with the Care Coordination Team. They have developed unique and effective tools to best manage our members’ medications. These tools included: • • • • •
Development of an additional generic drug tier (Approximately 85 percent of all medications dispensed are generic medications) Expansion of the specialty tier classification for appropriate medications Guidance to more cost-effective therapeutic medication choices for enrollees Expansion of clinical prior authorization to ensure appropriate and safe use of such designated medications Expansion of step therapy to promote low costs and high value therapy
AultCare’s PrimeTime Health Plan Part D plans increased the safe usage of medications through formulary management strategies. Part D also continued to offer select generic medications to treat chronic conditions such as diabetes, high cholesterol, and high blood pressure at lower copays, ranging from zero to four dollars.
The Stark County Humane Society was the perfect location for our animal lovers to play with dogs and cats in our community. Our volunteers spent the afternoon grooming animals and walking dogs.
Year-End Review
2014
For nearly 30 years, AultCare has been at the forefront of delivering efficient health care to its community. Our founding principles of excellent service, quality and low costs remain a standard part of our philosophy as we move forward in the ever changing field of health care. This keeps AultCare positioned to pioneer the way health care is delivered to those we serve in Northeast Ohio.
Our Service Centers
received over
365,000 calls
Over
200 Employees
volunteered in our community
COMMERCIAL HMO
COMMERCIAL PPO
EXCHANGE PPO
MEDICARE HMO
420,000
Over
Covered Lives
*Medicare evaluates plans based on a 5-Star Rating System. Star Ratings are calculated each year and
me PrimeTireceived
4St.a5rs
Health
Plan
* g n i t a R 015 for the 2
Nearly
5,500 Providers in our network
Local ocal 200 Scholarships awarded since 2002 ,
,
More than
99%
ONLY PLAN IN OHIO
Claims Processing Accuracy
Customer Retention Rate
95%
Patient Centered Medical Homes
More than
Offices
2,100 Employers
$725 Million
in claims paid
expands to
19
may change from one year to the next. These NCQA seals represent NCQA Health Plan report card year 2014-2015.
One of AultCare’s founding principles that has held true throughout the years is our commitment to ensuring a high standard of quality service, which is reflected through the variety of plans we offer. In our PrimeTime Health Plan division, our sustained high-level of performance was evidenced again this year by our award of a 4.5 Star Rating in our HMO-POS product by the Centers for Medicare & Medicaid Services (CMS). It is the second consecutive year we have been awarded the 4.5 Star Rating (HMO-POS). PrimeTime Health Plan is an HMO-POS plan with a Medicare contract. Enrollment in PrimeTime Health Plan depends on contract renewal. CMS created the 5 Star Rating system for Medicare Advantage Plans to allow consumers to more effectively compare health plans and to allow health plans to benchmark themselves against best practices. Medicare evaluates plans based on this 5 Star Rating system. Star Ratings are calculated each year and may change from one year to the next. These ratings are cumulative indicators across a broad spectrum of measures and represent the quality of care, health care access, plan responsiveness and member satisfaction. As the 5 Star Rating system has evolved, CMS continues to raise the bar for further improvement, and PrimeTime Health Plan has responded by building a dedicated team and establishing a comprehensive management program to focus on each specific Star measure. Our positive outcomes and our most recent 4.5 Star Rating continue to confirm our high-value for our current members and provide a benchmark for prospective customers who are seeking an alternative to their Medicare coverage. Additionally, PrimeTime Health Plan has been recognized by U.S. News & World Report as one of the best Medicare Advantage Plans in the nation. An even greater honor was that our plan was named the best Medicare Advantage Plan in Ohio. (This award is not endorsed or affiliated with CMS.)
The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
In part with Community Services of Stark County, our employees provided hot meals to those in need and cleaned the dining facility at Samaritan’s Table.
Our Health Insurance Marketplace (Exchange) PPO was awarded NCQA Accreditation. AultCare also was successful in the annual rescoring of our Commercial HMO, Commercial PPO, and Medicare HMO products. Our Commercial PPO product was awarded a NCQA Accreditation status of Commendable for plan year 2014-2015. Our Commercial HMO and Medicare HMO products were awarded a NCQA Accreditation status of Excellent for plan year 2014-2015. In addition to our reaccreditation, we received NCQA’s Private Health Insurance plan rankings for 2014-2015 and NCQA’s Medicare Health Insurance plan rankings for 2014-2015. AultCare HMO is the #2 private plan in Ohio and the #75 private plan in the United States, among 507 private health insurance plans ranked. AultCare PPO is the #9 private plan in Ohio and the #219 private plan in the United States, among 507 private health insurance plans ranked. AultCare’s PrimeTime Health Plan HMO is the #2 Medicare plan in Ohio and the #34 Medicare plan in the United States, among 408 Medicare Advantage plans. The Commercial HMO and Medicare HMO plans also received the highest possible rating of 5 out of 5 for consumer satisfaction.
Smiles and laughter filled the air as our employees played and read with children at The Stuckey Family Interfaith Child Development Center.
AultCare distinguishes itself in the marketplace through the service we offer to our enrollees. Our direct and personal service is something we can offer our customers since we are located in their community. Additionally, our service is demonstrated through our timeliness and accuracy in processing claims. Each year, we hold ourselves accountable to high service standards, in part by the goals we set. In 2014, some of our key service metrics were: • Claims Processing Time – the time between the date a claim is received and the date it is processed – was 6.5 days, compared to 7.39 days in 2013, and a goal of 8.0 days • Average time before a customer was connected to a Service Representative was 30 seconds, equal to our goal • Percentage of people abandoning calls to Customer Service was 3.0 percent, equal to our goal • Same day call resolution met the goal of 90 percent; this is the minimum goal for AultCare to resolve customers’ issues, questions, or concerns in the same day they were received
AultCare Converts to New Claims System In 2014, we continued our preparation for a conversion to a new Claims Management System throughout AultCare. Two of the largest areas that will be positively affected by this conversion will be the Claims Department and Customer Service. In 2015, when the implementation of the system is completed, our Claims Management Department will be able to process claims in a more efficient manner through increased automation and improved cost control initiatives. All of this will happen while maintaining the personal, local touch that our clients deserve and appreciate. From a customer service perspective, we always believe the best service comes from the ability of our enrollees and providers to speak directly to an AultCare Service Representative. The system conversion will not change that, however it will help reduce the need for phone calls and help our Service Representatives answer the calls they do receive more efficiently. Providers AultCare continued to establish and maintain valued relationships with our network providers in 2014. The Provider Relations Staff was dedicated to providing personal communication with physicians and their office staffs through individual visits, telephone and email correspondence and by conducting provider meetings. In addition to individualized communication, providers received mailings and provider newsletters throughout the year. As health care continued to evolve, we recognized the many challenges our physicians faced and we strived to be a resource to them and their staffs. The Provider Relations Staff was available for our network physicians and their staffs to meet one-on-one to assist with their inquiries and provide educational materials regarding AultCare and insurance industry trends. Provider Office meetings were coordinated by our staff throughout our local area. These meetings provided an opportunity for our network physicians and their staffs to receive beneficial information regarding insurance industry updates, quality initiatives, and AultCare operational updates. The meetings also gave providers an opportunity to meet and network with other local provider practices.
At the center of nature, culture, and life-long learning, our employees had the chance to work outside at Sippo Lake Park. Employees did a bit of spring cleaning as they tended to the landscape and playground area.
Employers AultCare’s Retention Department serves as our continuous communication channel for over 2,000 employer group clients on a daily basis. They communicate to our employer groups the initiatives occurring in AultCare and take in feedback from the market. The Retention Staff also assists our clients in the development of health plan strategies that fit their unique needs. Our staff organizes regular visits with each client assuring that we tailor their specifications to their health care needs. During these visits, our staff serves as a resource for our customers and brokers, educating them on new regulations, providing guidance to interpret new policies, or helping to determine the best health care options for their employees. During 2014, Retention focused on achieving specific initiatives. The first initiative was maintaining education on health care reform, how the modifications of the law impacted each client and what their options were in response. This was a major endeavor throughout the year and it impacted all of our clients. Our second initiative focused on communication to our clients on emerging health care trends and strategies. These strategies included topics on Population Health, Care Coordination, Wellness, and Patient Centered Medical Homes. One of the main areas of focus which takes into account all of these topics was AultCare’s Integrated Health System Strategy. This integrated approach continues to emphasize proactive and preventative treatment while increasing member engagement and coordination between the member, physician and AultCare, which improves outcomes and cost control. Due to AultCare’s personalized customer service, pro-active communication, and close relationship with its commercial corporate clients, AultCare achieved a 95 percent customer retention rate in 2014. Brokers During 2014, Broker Education meetings were held to provide updated information to Brokers about the latest AultCare developments and health care information. The benefit was to make sure AultCare was communicating and cultivating relationships with brokers. Two large Broker Education events, with approximately 125 brokers in attendance at each, were held to discuss various topics including Sales, the Marketplace Exchange, Retention, Pharmacy, Wellness, and Reform updates. Additionally, smaller scale events were held to capture the highlights of specialized products such as our Exchange AultCare Choices, AultComp, and AultCare’s PrimeTime Health Plan. Also, broker roundtables and mid-year reviews were held to further establish our broker relationships.
Community Along with providing education to our providers, employers, and brokers, numerous educational sessions were presented by AultCare to our community members. After four years of preparation by our dedicated Reform Team, AultCare entered the Affordable Care Act Marketplace Exchange on January 1, 2014. AultCare’s ACA strategy was a multi-year plan that included successfully implementing two main components. First, position AultCare as the best area resource for our community on the ACA. Second, understand the components of the ACA to create the best opportunity for AultCare to successfully interact with the law through our plan offerings. Realizing from the start the complexity of the ACA venture, AultCare built an infrastructure designed to support customers as they walked through the process of securing coverage through the Marketplace. The difficulties encountered by our customers on the HealthCare.gov website created opportunities for us to demonstrate our knowledge and to provide the needed education to those who sought coverage. Our Reform Team educated the community about specific Reform regulations. We helped our community develop a basic understanding of the application process and the decisions they faced to secure coverage for individuals and their families. Nearly 900 community members attended these educational sessions which focused on individual mandates and how to obtain coverage through the Marketplace. Physician office group manager sessions were also held and they focused on the demographics of individuals purchasing Marketplace plans. Additionally, our Reform Team met with several of our clients to discuss the ACA impact on their specific business model. Through our education sessions, AultCare strived to be an internal resource for our providers, employers, brokers, and community members. Additionally, as an organization, we realized the need to educate our community about the Medicare options available to them given the recent changes in our government system. Informational meetings were organized to explain the basics of the Medicare system and the different options that were available. A team of AultCare representatives organized free Medicare Education sessions and assisted our community members with understanding the details of Medicare as they prepared to make decisions about their health care needs. Nearly 400 people benefited from these educational sessions.
Refuge of Hope is a rescue mission which serves hot meals to those needing an extra bit of help and they also have an emergency men’s homeless shelter. Employees prepared the facility by painting walls and cleaning the dining room.
AultCare’s Physician Leadership provides medical guidance, oversight and direction on our Care Coordination programs, including Utilization Management, Pharmacy, Disease Management, Case Management and Quality Programs.
John B. Humphrey, M.D., Chairman of the Board Dr. Wymyslo
Dr. Mitri
Dr. Alford
Dr. Samaan
Dr. Wakulchik
Dr. Ferguson
Dr. Marvin
Dr. Rich
Dr. Haban, Chief Medical Director
The state of today’s health care industry can be summarized in a single word: change. The U.S. health care industry is being transformed into a value-based, consumer-driven model where service, outcomes and cost performance define future reimbursement. The transformation mation is impacting e ev every very hospital and health ver system across the country. Here is a glimpse of how Aultman is preparing for the future of health care by building strategies around integration, collaboration and innovation. Population Health Aultman and other leading health systems across the country are moving toward a new model of care delivery and care management called Population Health. At the core of Population Health is the recognition that there are three distinct patient populations: low-risk, rising-risk, and high-risk patients. Each group requires a different care delivery and care management strategies. The primary goals of Population Health are to maintain the health of people who are well and improve the health of people who are sick. To do this, Aultman will consider the physical, mental and cultural aspects of health; will improve care coordination among health care providers and community resources; will use evidence-based decision-making, and will engage individuals in their own health and wellness. Independent Hospital Network (IHN) Sourcing Group The IHN Sourcing Group is a cooperative service organization for nonprofit and governmental hospitals that engage in joint purchasing and other collaborative activities. Members include nine Ohio hospitals, 12 Indiana facilities and one Michigan hospital. The IHN Sourcing Group collaborates on services ranging from purchasing and warehousing, to printing and communications, and to training and education. Cooperatives such as the IHN Sourcing Group generate lower costs through group purchasing and contract negotiation, improved operational efficiencies and peer-to-peer connections that result in sharing best practices. In the era of Reform and Population Health, Aultman is proactively preparing for the new health care environment, and is well prepared to continue to fulfill its mission to “Lead Our Community to Improved Health.�
On one of the largest, single-day health and human care volunteer events in our community, AultCare and Aultman volunteers came together with other workplaces around Stark County to paint, landscape, clean, and complete various projects for nonprofits across the county.
AultCare and its staff have a special bond to the communities they serve. Our bond is unique because AultCare is the only health insurance business whose corporate headquarters is in the midst of the communities it serves and AultCare’s staff members also are neighbors to their customers. The company and its staff not only provide the highest quality health plans to their neighbors, but they also provide many volunteer hours and contributions to their home community. The following are just a few ways of how our employees gave back in 2014: • • • • • • • • • •
Donated $63,091 to United Way Raised more than $10,000 for the Junior Achievement Bowl-a-Thon Donated 182 pints of blood to the Aultman Blood Center Donated more than $3,500 to the Wishes Can Happen Wish-A-Thon, which the corporate office matched Participated in and raised money for the American Cancer Society Relay for Life, Juvenile Diabetes Research Foundation Walk to Cure Diabetes, American Heart Association Heart Walk and Making Strides Against Breast Cancer Walk Made monthly donations of personal care items for underprivileged people in Canton Operated snack shops throughout the year to raise money to adopt families for Christmas; participated in the Community Christmas Adopt-A-Family program Participated in the United Way Day of Caring Volunteered for the Inaugural Pro Football Hall of Fame Marathon and the Canton City Marathon Participated in the Domestic Violence Project, Inc. Walk A Mile in Her Shoes event
During the fifth annual AultCaring in the Community Campaign, over 200 employees volunteered approximately 500 hours in more than 15 locations around our community, some of which included: • • • • • • • • • •
Samaritan’s Table, a division of Community Services of Stark County The Stuckey Family Interfaith Child Development Center J.R. Coleman Adult Day Care Stark Parks Exploration Gateway Akron-Canton Regional Foodbank Canton Calvary Mission Refuge of Hope Stark County Humane Society Massillon Salvation Army Wishes Can Happen Wish-A-Thon
Pegasus Farm welcomed our volunteers as they cleaned the Judges’ Booth and the barns, making everything clean for horses and visitors.
AultCare
Wish-A-Thon During our seventh annual Wishes Can Happen AultCare Wish-A-Thon, our AultCare family and volunteers made a difference to local children with life threatening medical conditions and their families. Throughout the 36-hour live fundraiser, our employees greeted walk-up guests, answered phone calls, and collected donations. At the end of the 36 hours, a record number of donations totaling $150,225 had been raised, which granted approximately 30 wishes for local children.
AultCare
Chris Spielman Football ProCamp Over 300 local boys and girls had the opportunity to play alongside one of our very own football greats. The AultCare Chris Spielman Football ProCamp was a fun filled day of football and fitness led by Canton native and former Ohio State All-American Linebacker Chris Spielman. Kids practiced football drills with coaches and participated in some friendly competition with the other football enthusiasts.
History of AultCare
2004 2001
1985
AultCare was established as a joint venture between Aultman Hospital and Stark Quality Care Physicians
1987 The Timken Company becomes our second client
1995
Cardinal Administrative Services established
2005
AultCare HMO is established AultCare now covers 100,000 lives
1997 ’S
AultOne was established
2002 AultComp MCO received Case Management Accreditation from URAC AultCare grows to 500,000 lives
1989 McKinley Life Insurance Company established Aultman Hospital is the first client
PrimeTime Health Plan PPO established
PrimeTime Health Plan established AultComp MCO established
2003
Schneider Lumber is the first client
Received J.D. Powers & Assoc. Award Acquired Professional Claims Management (PCM) AultCare celebrates its 20th Anniversary
1998 AultComp TPA is created
W O R K E R S ’ C O M P E N S AT I O N T PA
Received Wilson RX award
2010 2007
Received CORE certification
2008
PrimeTime Choices was established
MEDICARE HMO
2012 McKinley Life Insurance Company changed to AultCare Insurance Company
2014 EXCHANGE PPO
Awarded NCQA Accredited status for Exchange PPO
PrimeTime Health Plan HMO product awarded a 4.5 Star Rating
AultCare Holding Company was established
Named the best Medicare Advantage Plan in Ohio
COMMERCIAL HMO
AultCare HMO recognized as the top ranked plan in Ohio by NCQA’s Private Health Insurance Plan Rankings 2010-2011 AultCare celebrates its 25th Anniversary
INSURANCE
COMPANY
2013
2015
PrimeTime Health Plan HMO product awarded a 4.5 Star Rating Offered health insurance choices on the Marketplace
PPO Product
AultCare PPO received NCQA Full Accreditation. This accreditation shows that AultCare is providing access to care and high quality service
2009 Patient Centered Medical Home (PCMH) was introduced
H E A LT H I N S U R I N G C O R P O R AT I O N
2011
AultCare celebrates its 30th Anniversary
AultCare Health Insuring Corporation was established AultCare Choices was established
Years 1985 - 2015 COMMITTED TO T H E F U T U R E
COMMERCIAL PPO
Awarded NCQA Excellent status for AultCare PPO Established MLIC Dental product
You Matter.
Where
2600 Sixth Street Canton, Ohio 44710 330-363-6360 1-800-344-8858
www.ault .aultccar aree.c .com om
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