Health Plan Administration For Hospitals-Part II

Health and Wellness Integration

Integrating health and wellness into your benefit plan is much more than just integrating the data. Yes, you need to integrate the data, but you also need to integrate the hospital’s culture, community resources and your knowledge of health care. You do this by first aligning your extensive health care resources that you already have with experienced, proven outside vendors that can make an impact, and then integrating all of those resources into one plan.

This level integration will give you a clear advantage in:

  • Simplifying administration
  • Earlier identification of health problems
  • Minimizing the financial impact of health risks and conditions
  • Member-centric management of health conditions and improvement of health

It is important that we build your plan and processes around identifying and engaging members. Members who are healthy so we can provide them with tools and support stay healthy, as well as those members with known health risks who need help managing their illness.

Administratively, the benefit management needs to help the hospital achieve its financial and benefit objectives. To accomplish this, the following three areas are a “must do”:

  • Claims: Allowing the hospital to automatically reimburse itself as a provider for services that members have received at your own facilities can be accomplished through a process known as “zero-draft” claim. Implementing the right EFT payment system provides paperless claim reimbursements for “owned” providers.
  • Benefit design: We need to develop benefit designs which include a three-tier plan. This steerage will help encourage participants to use certain facilities and providers that you own.
  • Reporting: In addition to standard reporting, your facility will be benchmarked against the entire health care segment. 

For additional information, contact Kirby Horton at