What Regence members receive for their premium dollar
Regence members' premium dollars closely track the national trend of all health dollars spent for medical and administrative spending. The claims expense and net profit fluctuates depending on several factors, including the cost of and demand for medical services. This is how the Regence premium dollar was spent in 2011:
Value received for administrative services
Many of our nearly 6,000 employees are devoted to member services:
- Members and providers often have questions about coverage—our customer and provider services handle more than 390,000 calls a month. More than 7 out of 10 get resolution in the first call, and our average hold time is about 30 seconds.
- Members buy a lot of health care, more than 3.2 million claims a month, with more than 98 percent processed automatically.
- Pharmacists examine all available research to establish comparative effectiveness of the most prescribed medications, available online to the public. Through outreach education to providers and members about value and effectiveness, RegenceRx has slowed prescription spending by $1 billion in the past decade for our members
- As stewards of our members' resources, we employ investigative professionals using advanced technology to scan for fraudulent schemes. Their efforts recovered/saved members nearly $10 million in 2011
Keeping "health" in health plan: And our members don't have to be sick to receive help from Regence. We also dedicate resources to help our members stay well, regain their health and become smart users of the health care system—365 days of the year.
- Health Coach—Specially trained staff help members reduce five specific risk factors, such as smoking and stress, to improve quality of life, like overcoming insomnia.
- CareEnhance—Nurses answer every-day health questions: Is this serious? Can it wait until I can see the doctor? Should I go to the urgent care center or the emergency room?
- Special Beginnings—Pediatrics professionals stay in touch with and educate expectant mothers to increase full-term, healthy birth-weight babies and reduce life-long health risk factors.
- Care Coordination—Doctors and nurses support and educate members with chronic conditions to improve daily self-management, in partnership with their physicians, for such conditions as diabetes, asthma and heart disease, to improve outcomes and quality of life.
- Case Management—Experienced clinicians smooth the barriers and reduce the worry for members with complicated medical situations requiring multiple providers, procedures, medications, etc. to help them get the right care at the right time.
- myRegence.com—One-stop 24/7 support, so members can review claims, get email or live-chat answers and leave provider feedback, to research treatment options and costs, take a health risk assessment and starting a wellness program, reading original articles or sharing solutions on a protected community site.