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Home My WebLink AboutRes.3585.10-16-2023 BILL NO. 23-158 RESOLUTION NO. 358,57" A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT WITH CRESCENT HEALTH SOLUTIONS FOR EMPLOYEE HEALTH INSURANCE SERVICES AND AUTHORIZING CERTAIN ACTIONS BY CITY OFFICIALS, IN THE CITY OF CAPE GIRARDEAU, MISSOURI BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU, MISSOURI, AS FOLLOWS: ARTICLE 1 . The City Manager, for and on behalf of the City of Cape Girardeau, Missouri, is hereby authorized to execute an Agreement with Crescent Health Solutions for employee health insurance services, in the City of Cape Girardeau. A copy of the proposal information is attached hereto and incorporated herein by reference. The Agreement shall be in substantially the form attached hereto, which document is hereby approved by the City Council, and incorporated herein by reference. The officers of the City are hereby authorized to further execute all documents and take such actions as they may deem necessary and advisable to carry out and perform the purposes of providing health insurance to City employees and to make alterations, changes, additions or amendments to the document herein approved, and the execution of such action shall be conclusive evidence of such necessity or advisability. PASSED AND ADOPTED THIS 1(w DAY OF (Q& Vj /lr , 2023 . Stacy Kin r, ay-or ATTEST: Orucgee. e Ta 0,- , Deputy City Clerk 1 ", '44/' I : t•°;? CRESCENT ir HEALTH SOLUTIONS Set6 9r „,./ HEALTH PLAN M PROPOSAL Prepared for: CITY OF CAPE GIRARDEAU ' t { Presented 'by: Clay Kelley VP of Sales and Channel Distribution clayokelley@crescenths.com Date: Sep 21 , 2023 704.2775655 r _ m .... ...... ,„, ‘, \ EXECUTIVE SUMMARY CRESCENT H.A1:141 SOLUTIO".", AA/tem-9e, Ptoim, ao,catt 0)-(eziek Soeuttom, GEO Dear Jeremy, Thank you for considering Crescent Health Solutions as a potential partner for City of Cape Girardeau and for the opportunity to provide a `�- 4 proposal for our Third-Party Administrative services. Our goal is to earntt \ your trust and deliver with operational excellence from the very Va At beginning. `? Crescent Health Solutions' strengths are our personal,flexible, and responsive service. At our core is a supportive staff whose goal is taking care of our customers,employer groups, plan members,and brokers/consultants. - Crescent Health Solutions is more than your average TPA;we are driven to help employers optimize their benefit plan to drive better outcomes and savings. Our number one goal is to ensure we are bringing solutions to the market and our clients,which demonstrates our deep passion in being careful stewards of our clients' healthcare spend. By partnering with Crescent Health Solutions,you can expect a data driven approach with clinical care and cost management to improve the overall health of the plan and the members. Within our self- funded solution,we offer enhanced core services,these include chronic condition management,stop- loss brokerage,consulting,and benefit account administration. I hope you can see our commitment to our employer groups, broker partners,and the health plan members. On behalf of the Crescent Health Solutions team,we would like to thank you for the opportunity to earn your business and trust. It would be a privilege to partner with your organization to serve its members. s,fi, Y..e________ Jeff Erickson,CEO Crescent Health Solutions, Inc. Crescent Health Solutions 1 1200 Ridgefield Blvd,Suite 215 Asheville NC 288061828.670.9145 www.crescenths.com TABLE OF C CRESCENT HEALTH SOLUTIONS We are excited to partner with you! Here is a roadmap of what we can provide: WHY CRESCENT? 4 COMPREHENSIVE PLAN ADMINISTRATION 5 INNOVATIVE HEALTH MANAGEMENT 6 STRATEGIC COST CONTROL 7 FEES 8 PARTNERSHIP LETTER OF INTENT 10 Crescent Health Solutions 11200 Ridgefield Blvd,Suite 215 Asheville NC 28806 1828.670.9145 I www.crescenths.com CRESCENT WHY CRESCENT? N:AL,1 SGtUi�.P<> We, Cipiaeat / SO 11 AZ, We believe better healthcare is within reach! The healthcare system should be easy to navigate. Members should have more control over their own health journeys. Health and benefits should come at a fair and reasonable cost. We've built a better self- funded solution that does all that and more. Crescent Health Solutions is a community based Third Party Administrator(TPA) based in Western North Carolina. Our ability to quickly and easily meet face-to-face with any of our local clients or their members is only one aspect of the most customer-focused services available in this region. Crescent has been a leader in our community working hand-in-hand with our clients to develop unique self-funded health plans that meet their needs with a sincere focus on our members. Our strategy is three fold; comprehensive plan administration, innovative health management and strategic cost control. Our Commitment L °s Crescent Health Solutions combines the best systems and technology with " { e Personalized service from highly experienced professionals that live and work in our local community to achieve our vision of improving the ��_ �� ° -4,r;' ' _ health and care of all the citizens locally and regionally. All of this is possible through our exclusive combination of � ? data-driven solutions and service you can trust. Crescent continues to focus on local, personalized customer service and our dedication to excellence. Our commitment to collaborative • relationships, open and honest communication, integrity in all business activities, and the highest corporate values will continue to " guide us as we strive to improve the health and care of our clients. • Crescent Health Solutions 1 1200 Ridgefield Blvd,Suite 215 Asheville NC 28806 1 828.670.9145 1 www.crescenths.com , _AL , CRESCENT PLAN ADMINISTRATION 4;AITH SOLUTIONS 1211 file Ate,)4)din, d Arg Aeei Crescent Health Solutions is committed to continuous improvement of all technical aspects of claims processing, population health management, and data storage and analytics. Employers and members have improved access to web-based tools for self-service, claims history and status, benefits and coverage, and overall plan administration. We're here to support you on your self-funded journey. We are laser focused on making it easier for you to take control of your healthcare spend. Crescent Health Solutions Plan Administration includes but is not necessarily limited to: • Claims Administration • . Plan Design/Modeling • Provider and Member Support • Reinsurance • Network Access • Regulatory Compliance • Health Plan Billing and Finance • COBRA Administration • Eligibility and Enrollment • Data Support to Health Management • Account Management • Vendor Integration/Support Whether you're transitioning from a fully insured plan or a self-funded plan, Crescent Health Solutions is committed to making the process as seamless as possible. `,0 T -' ,..,:-.. '- . .,-; : ". 0 ..,,e, ' ilk; , n. _ iiii) . Crescent Health Solutions I 1200 Ridgefield Blvd,Suite 215 Asheville NC 28806 I 828.670.9145 I www.crescenths.com df,„. 9tiwvaLtve C_It_RESC„ \ ENT HEALTH MANAGEMENT .. ,LAL1U SO:OK:N Mk JIMA you, mwte,you, . Crescent Health Solutions'takes a personalized approach to health management.The members of our in-house health management team are skilled at interpreting claims and health data to develop personalized care plans, support,and recommendations for members.This allows us to make strategic and smart decisions that result in better outcomes at a lower cost. Here is what we offer: Wilvtott,(review Pkoyha 'i • Provide employer with comprehensive recommended pre-certification list • Verify medical necessity of pre-certification requests • Identify potential candidates for our case management and disease management programs . • Offer a 48-hour turnaround time from receipt for approvals • Follow established Milliman Medical Criteria • Help manage episodes of care related to acute or chronic illnesses • Provide a in-house Chief Medical Officer for denial reviews • Provide Rx prior authorization reviews upon request • Provide electronic notification of approval for providers Cithz hL& CohcQi&KAA avLeht • Identify members with existing diagnosis of chronic diseases and emerging at-risk conditions by analyzing medical claims, prescription drug utilization and clinical baseline* • Nurses set individualized goals with member and provide one-on-one coaching and monitoring for progress and compliance to program requirements • Clinical staff follows-up and works with the primary care physician and the pharmacy benefit managers for concerns and compliance • Coordinate eligibility of employer incentives and provides quarterly educational sessions *Optional program offering with several levels of service available,including health risk assessments(HRH's,, depending on the population needs and the employer's goals Cr s,eA44,1.yul eh • Proactive focus on prevention and support • Inpatient and outpatient CM for at-risk and emerging-risk individuals • Data analytics to track adherence to therapeutic guidelines and provider compliance with evidence based medical protocols • Experienced,registered nurses on staff,directed by our Chief Medical Officer • Claims analysis to identify,screen and prioritize potential candidates based on cost, risk,utilization and/or clinical triggers • Integration with Medical and Rx Claims • Personal contact,education,decision support,and cost-effective guidance Crescent Health Solutions 1 1200 Ridgefield Blvd,Suite 215 Asheville NC 28806 1 828.670.9145 1 www.crescenths.com I _..,Rs._\' CRESCENT COST CONTROL 1-.AUT!i SOLUTYJWS Cut wc� .�®t c.,,ae, We're putting the power of controlling costs back in your hands with a unique set of solutions and strategies. We'll strategize with you to decide what works best for your group and your bottom line. Here's a look at how we can help you keep prices fair and costs low: • Comprehensive in-house health management • Crescent Health Solutions proprietary regional ° network containing 4,000+ providers. • Other Innovative network options such as direct �°�� contracting, narrow networks and traditional networks • Robust data analytics reporting through Conifer data a ; " ��, ,":„. warehouse ,,, ,,,,.„,4--1,1,-,. ° . ,i • Stop loss marketing tohigh- quality carriers and . e MGU's to obtain the most competitive proposal �� • Navigation support and member advocacy with our • vendor partners - ° • Out-of-network repricing management ,,;:i• Alternative reimbursementstrate ieslike re- a ang P P y ,single case agreements $ _ r ;;;11-,,' • Specialty and high-dollar prescription savings program through our preferred PBM • Innovative cost-saving solutions like bundled surgeries, imaging networks and virtual care options When it comes to high value solutions,you can count on our seamless and efficient approach of cutting costs without sacrificing quality care. Crescent Health Solutions 1 1200 Ridgefield Blvd,Suite 215 Asheville NC 28806 1 828.670.9145 1 www.crescenths.com t, CRESCENT FEES 1.1£:,\LT SOLU1IONS - Client Name: City of Cape Girardeau Effective Date: 1/1/2024 Client Address: 44 N. Lorimier Cape Girardeau, MO 63701 Total Enrolled: 662 All services below are part of the core package,please select any optional services on the second page and sign following letter of intent. • Core:Adminiel rative S.erviceg •° �� ,Fee' Type Medical Administration (includes billing, reporting and analytics) $18.00 PEPM HealthLink OA III PPO Network Access $8.00 PEPM Implementation Fee* Included Included Stop Loss Integration Included Included Utilization Management $3.00 PEPM Case Management $100 Per Hour Government Transparency Compliance(Required) $2.00 PEPM Preferred PBM Integration $2.50 Per Script Out of Network Repricing(Phia Unwrapped) 25% %of Savings Stop Loss Marketing Fee TBD TBD PCORI/5500 Reporting Information $0 Included Medicare Part D Notices $0 Included NY Public Goods Pool Administration $0 Included Total Crescent Health Solutions PEPM Fees T $31.00 Projected PEPM RX Rebates** $20.00 Net PEPM Projection ` $11.00 Net PEPM Monthly $7,282.00 Net PEPM 12 Months $87,384.00 *Any integration request with a non preferred vendor that is not currently implemented with Crescent Health Solutions will be pass through cost to the client. **The Projected Monthly Rx Rebates shown in this proposal are estimates used for illustrative purposes only and do not imply a guarantee.Actual Rx rebates will vary and are determined upon a variety of factors including but not limited to the PBM used and contract terms related to Rx rebates contained therein,actual Rx utilization patterns,and group enrollment. Crescent Health Solutions 11200 Ridgefield Blvd,Suite 215 Asheville NC 28806 828.670.9145 1 www.crescenths.com CRESCENT NT FEES ___ ._ .AtTtkSGLU 5 _. .,.._ .., , , -- ___, ,,,_ .. . . _... ... .. , ,, .._ ..._ „ ;Optiona1AdministattveServices„ e :$ _ ._ Fee --e Type ❑✓ Chronic Disease Management $4.00 PEPM ❑ Dental Administration $2.00 PEPM ❑ Vision Administration $1.50 PEPM ❑✓ COBRA Administration($500 Implementation,CHS retains the 2%) $1.00 PEPM ❑ COBRA Open Enrollment Packages $15.00 Each ❑✓ Consolidated Billing(Conditions Apply) $1.50 PEPM ❑ Run In Administration(3 months) 5 months Admin fees Gross ❑ Run Out Administration(12 months) 4 months Admin fees Gross ❑ On-Site Enrollment Meetings $300.00 Per Day&Travel ❑ SPD Preparation $2,000.00 Each ❑ SBC Preparation $250.00 Each ❑ Subrogation Administration(5%to Crescent) 30% %of Recovered ❑ Replacement ID Cards(Initial batch included) $1.50 Each+Shipping • a i a dditior a ICendlr Offer ngs % gee � t Type ❑✓ Telemedicine(Ally Health) $5.25 PEPM ❑ Employee Navigation and Advocacy CUSTOM CUSTOM ❑ Fiduciary Support(Phia PACE) $2.00 PEPM ❑ Dialysis Network(Renalogic) 25% %of Savings ❑ Transplant Policy(QBE) CUSTOM CUSTOM ❑✓ Community Health $2.00 PEPM Crescent Health Solutions 11200 Ridgefield Blvd,Suite 215 Asheville NC 28806 1828.670.9145 I www.crescenths.com