6
How the Trust Has Responded
Automation and
Technology with
Personalization.
The Trust implemented a new
phone system allowing for more
efficiency, making it easier for
the staff to address the needs
of our members. The Trust
has made continued efforts to
utilize technology to benefit the
participants. In 2015, the Director
created a video presentation to
explain the benefits provided to
the participants. This video
along with other resources for
our members can be found
on the Trust’s website at
.
Addressing Medicare
Changes.
In 2015, the Trust staff continued
to work diligently on bringing the
Trust into compliance with new
claims rules from the Centers
for Medicare and Medicaid
Services (CMS). The rules were
implemented in 2015. The Trust
was on target and in compliance
with these new rules, which
dealt with certain diagnostic and
inpatient procedures, as well as
the management of electronic
health care transactions.
CAQH CORE
Operating Rules
In 2015, the Trust once again
received requests for new
electronic transactions that
were included in the CAQH
Core operating rules. The
Trust partnered with Change
Healthcare to comply with
requests to provide real time
electronic eligibility response
files, known in the industry as
270/271 transactions.
Contractual Savings
For the Trust’s non-Medicare
participants, a big advantage
of selecting coverage under the
Trust’s PPO Option is the impact
of network discounts available
through Blue Cross Blue Shield
under this program. In 2015,
these discounts produced savings
on average of 55% off non-
discounted providers’ fees.
For non-Medicare participants
who do not participate in the
PPO Option, the Trust has a
contract with First Health to
provide network discounts for
participants should they utilize a
participating provider. The First
Health network has helped the
Trust and its participants realize
savings on average of 24% off
non-discounted providers’ fees.
Disease Management
Program
The Nurtur disease management
program is another example of
an important investment for
the Trust and its participants.
The program is designed to
help participants manage their
disease, avoid hospitalizations
and improve their quality of life.
The Trust pays Nurtur for each
participant who uses the program.
To date, participants with
diabetes continues to be the
largest group in the program.
The program is assisting these
participants by having them work
with a registered dietitian and
a certified diabetes educator to
create meal plans and set goals
for increasing their physical
activity. Seventy-seven percent
(77%) of the participants were at
goal or improved in their exercise
outcomes.
Medicare Part D
Subsidy
The Trust received $2.72 million
from Medicare for its sponsorship
of a prescription drug program
that is at least as valuable as the
Medicare Part D program.
