An Advocate for Employers

We serve as the voice of self-funded employers who want more control over their healthcare costs. We work with you and your broker to develop custom provider networks (our Smarter NetworksSM) using sophisticated data mining and analysis to find savings that others can’t – or won’t.

The Alliance helps you self-fund smart.

How We Help Employers

The Alliance helps employers design custom benefit plans that increase access to high-value healthcare while saving their employees and their business money.

Custom Provider Networks

We know that every employer is different.

That’s why we’ve partnered with 38,000 doctors and healthcare providers across the Midwest to help our 340+ employers create custom Smarter NetworksSM and health benefit plans that satisfy their unique needs.

Our Networks

Steerage

We offer employers data-driven insights – powered by our Smarter HealthSM analysis – that help them steer employees and their families to high-quality care at an affordable price.

Our enhanced Find a Doctor tool allows plan participants to easily find in-network providers near them.

Smarter Health Analysis

Improving Primary Care

The Alliance helps employers increase access to primary care for their employees by incorporating Advanced Primary Care and Direct Primary Care in their benefit plans.

Improving Primary Care

Benefit Plan Design

Benefit Plan Design is the core driver that brings all the components of High-Value Healthcare together. It makes choosing the right care more convenient, accessible, and transparent for your employees by providing them with financial incentives to choose providers that deliver better results at lower costs.

Benefit Plan Design

Employer-Member Benefits

We help self-funded employers get the best care at the best price by developing custom Smarter NetworksSM using deep data mining and analysis to find savings where others can’t – or won’t. Explore more membership benefits below.

Cost Management & Savings

The Alliance aims to establish payment reform in healthcare by aligning financial incentives that reward providers for high-quality care using a Total Cost of Care model, where 100% of the care provided to a patient is considered when analyzing reimbursements. This helps us identify patterns of overuse and inefficiencies in the healthcare system that remain hidden in a fee-for-service model.

We turn those inefficiencies into data included in our Smarter HealthSM analysis, which can be used to help guide individuals toward higher-quality care that saves them and their employers money. This model also moves the risk traditionally born by employers for inefficient care or medical errors onto health systems; its promise is to identify cost-saving opportunities by system so we can reward provider partners that deliver the most cost-effective care to employees and their families.

Achieving payment reform in healthcare by creating the right incentives for care delivery is the platform upon which The Alliance was built. We’ve used our strength in numbers to pursue unique contract provisions that protect our members and their employees from unexpected charges. And we are building on that foundation to include a focus on cost and quality transparency to continue the payment evolution.

 

Real Payment Reform in Healthcare

Reference-Based Contracting by The Alliance®

We’ve implemented Reference-Based Contracting by The Alliance® (or Medicare-based pricing) in over 80% of our contracts. This is important because Medicare is the single largest purchaser of healthcare in the US. Medicare has established base rates for various services, and they adjust them by provider to factor in geography, patient mix, and quality metrics.

Reference-Based Contracting by The Alliance® provides the benchmark we need to pay a fair price for services rather than simply focusing on savings of total charges. Paying providers a percentage of Medicare not only gives us an appropriate benchmark by which we can measure relative value, it also enables employers to use plan design to incentivize employees to utilize low-cost, high-quality providers.

Changing incentives will cause disruption in our healthcare system, ultimately improving the quality of care, expanding access to care, and reducing the cost of care for both employers and patients.

Custom Networks

Together, we’ll help you create a custom Smarter NetworkSM using our vast pool of providers, which is still growing and includes 42,000 doctors and healthcare providers across the Midwest.

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Data Analytics

We find savings where others can’t — or won’t — using deep data mining and analysis to unlock serious savings opportunities.

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Stop-Loss

Stop-Loss insurance (or Reinsurance) is a critical component of a self-insured medical plan’s administrative costs. Network savings performance is a key element that carriers use to calculate your premium. We proactively reach out to carriers to ensure they have the most up-to-date network data so our employers receive the best possible rates.

 

The following stop-loss carriers are trusted by The Alliance®:

American Fidelity
Lori Sartori
405.523.5015

IISI
Mike Tushman
262.719.1695

Matrix Group Benefits, LLC
Timothy Paradis
207.523.8408 x201

Medical Risk Managers
Linda Pruitte
800.732.3248

RMTS LLC
Carmine Franca
212.274.2712

Skyward Specialty Insurance
Peter Burdo
484.328.8004

Summit Reinsurance Services, Inc.
Chris Alexander
704.544.9428

Tokio Marine HCC
Peter Burdo
484.328.8004

WPS Insurance Corporation
Jeremy Ott
608.223.2961

Voya Financial
John Lahti
612.342.3392

Patronage

As a not-for-profit cooperative, The Alliance® gives a share of its net proceeds back to employers in the form of patronage checks – what we call our Cooperative Shareholder Benefit.

The more money our clients save on healthcare costs, the greater our net profit — and patronage checks. The percentage of this cooperative shareholder benefit a client earns is based on how much they use The Alliance network to purchase healthcare.

How our Cooperative Shareholder Benefit Works

When The Alliance’s fiscal year ends on May 31, we tally our books and determine our operating surplus – or the amount of net profit that remains after expenses and obligations are paid – and that total is used to distribute our Cooperative Shareholder Benefit.

The Alliance Board of Directors splits the Cooperative Shareholder Benefit into two categories: allocated equity and patronage checks.

  • Allocated equity can be used as cash reserves and operating capital but is held in the names of specific employers. The Board may periodically decide to pay out this allocated equity to employer-members.
  • The second category is a patronage check payment made directly to each employer-member.

An employer’s earned percentage of Cooperative Shareholder Benefit is based upon how much they used The Alliance network to purchase healthcare in that year. In other words, an employer’s contribution to the total revenue received by The Alliance determines their share of patronage payout.

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Not-for-Profit Cooperative

Because we’re member-owned and led, our priorities are your priorities. We use our financial resources to help you achieve better value for your healthcare dollars, focusing on your bottom line — not ours.

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Vendor Partnership

We’re proud to work alongside partners that share our commitment to High-Value Healthcare. Our partnerships provide employers, employees, and their families with preferred pricing and performance guarantees on prescription drug benefit management, dental insurance, and vision insurance.

National CooperativeRx

National CooperativeRx gives employers greater value for their pharmaceutical spending with discounts, leading-edge clinical programs, a national network, enhanced data reporting, and more!

Employer Benefits

• Volume purchasing power and aggressive pricing
• Transparency and disclosure
• Flexibility through benefit design choice
• Routine claim auditing
• Cutting edge clinical programs and pooled purchasing dollars to facilitate implementation of programs
• 50% reduction in enrollment fees

Delta Dental®

Delta Dental offers employers administrative discounts, flexible options, and performance and savings guarantees — all while protecting the smiles and oral health of employees and their families.

Employer Benefits

  • A 7% discount on administrative fees
  • Flexible employer contribution options
  • Performance guarantees for customer service and plan administration
  • Fully insured or self-funded options
  • Additional discounts on DeltaVision® when employers offer both a DeltaVision and Delta Dental plan
  • Employee and Family Benefits
  • Easy-to-use online directories and a toll-free phone line
  • Access to a vast network of dentists nationwide
  • Considerable cost savings when visiting a dentist in the Delta Dental PPOTM network
  • Access to benefit summaries, claims statuses, and Explanation of Benefits (EOB)
  • Online access to dental and vision directories, oral health resources, and more on our convenient online member portal

DeltaVision®

Encouraging routine vision exams is critical to preventing more serious vision and health problems. Whether you offer DeltaVision on a completely voluntary basis or as a contributory plan, your membership with The Alliance generates additional discounts that provide exclusive value to your employees and their families.

Employee Benefits

  • A discount on administrative fees
  • Flexible employer contribution options
  • Options for comprehensive plans and materials-only plans
  • Employee and Family Benefits
  • One eye exam per year (comprehensive plan)
  • Low (or no) co-pays
  • Extra discounts on items not covered by the plan or once the funded benefit has been used
  • Online savings on replacement contacts
  • Access to a vast network of providers nationwide, including private practitioners and popular vision outlets

High-Value Healthcare

High-Value Healthcare is our North Star. It serves as the platform on which our four core drivers come together. This drive us to build value-based provider contracts, influence lawmakers to promote price transparency, and create innovative employer programs and resources that encourage employees to choose high-quality, low-cost providers.

Transparency

You can’t manage what you can’t measure. The Alliance is working to provide accurate, easy-to-access information comparing cost and quality from different providers so high-value healthcare can be chosen that delivers good results at lower prices.

The Alliance also actively participates as a leader in public health policy by influencing legislation through education and encouraging hospital price transparency initiatives.

Payment Reform

The way healthcare is paid for influences the behavior of doctors and hospitals, which is why we continue to expand our Reference-Based Contracting initiative. The fee-for-service isn’t working for employers or patients, which is why we need to redefine the payment methodology to reward cost-effective, high-quality care rather than the volume of services provided.

The Alliance will also continue to provide programs to further our payment reform efforts.

Benefit Plan Design

Employers can add incentives to their benefits plan, encouraging employees to use certain doctors and hospitals – not to limit employee choice but to choose those that deliver the best care at the lowest cost. And when enough employers get involved and provide these kinds of incentives, physicians will be motivated to improve the value of their care.

Networking & Learning Opportunities

We hold educational events and webinars to keep our employers current on regional and national healthcare issues. We also provide networking opportunities for employers to exchange strategies and share best practices with one another.

The Alliance Events

We’ve got you Covered

Employer Resources

Whether you’re looking for information about your membership benefits, The Alliance employer-member handbook, or participating providers in our Smarter NetworksSM, we’ve got you covered.

Find a Doctor Transparency Tool

We help your employees and their families make smarter “shopping” decisions when choosing care using our Find a Doctor tool. This tool allows users to search for in-network providers by doctor name, specialty, facility, and location.

Interested in learning more about The Alliance?

Contact Us