QualityPath®: A Higher Standard of Health Care

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QualityPath Is A New Way To Buy Health Care

The cost of surgeries and tests varies wildly – by hundreds, even thousands of dollars. With QualityPath, you and your employees benefit from:

  • For surgeries, a bundled price that covers most care. For tests, a standard price provides savings.
  • A warranty that protects you from the high cost of complications for surgeries. For tests, the warranty covers the need for repeating the same scan due to quality issues.
  • Requiring doctors, hospitals, and clinics to take steps that lead to better results for patients.

    Use QualityPath for these tests and surgeries.

    Tests

    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) also known as computerized axial tomography (CAT) scans
    • Colonoscopies

    Surgeries

    • Total hip replacement
    • Knee replacement

    The Alliance plans to expand QualityPath with more tests and surgeries as we search out more opportunities to identify high-quality care. Selected tests and surgeries must also offer the potential to negotiate savings based on guiding a higher volume of patients to QualityPath doctors, hospitals, and clinics.

     

    This is Health Care Made Simple

    Warranty

    Doctors, hospitals, and clinics pay for surgery complications or repeated tests due to quality issues, not the employer or employee.

    A New Way to Buy Care

    A single price covers most elements of surgeries and tests.

    High Quality

    Doctors, hospitals, and clinics meet quality measures and use practices that reduce unnecessary care.

    A Better Patient Experience

    You have less paperwork. For surgeries, the patient experience manager offers personal assistance.

     

    QualityPath is:

    • Saving an average of $12,000 per surgery; savings for tests are projected at 20 percent below current costs (actual results will vary by usage).
    • Reducing out-of-pocket costs for employees and family members.
    • Guiding employees and family members to high-quality care for surgeries and tests.
    • Inspiring and sustaining changes in the way you buy health care.
     

    An Employer's Experience: Miniature Precision Components shares their experience with QualityPath

    Your employees need clear choices for taking control of their care.

     

    Here's How it Works

    • The Alliance annually designates high-value doctors, hospitals, and clinics based on their ability to meet national quality measures, adopt processes that improve care and agree to a lower price.
    • Your business or organization signs up to participate. QualityPath is part of your Alliance membership, so there’s no additional fee.
    • You promote the program to employees so they understand what they can gain from QualityPath and how to use it.
    • Employees get a warranty, lower out-of-pocket costs (sometimes nothing!) and less paperwork.
    • For surgeries, employees also get support from a patient experience manager who can make appointments, transfer medical records, and serve as a liaison.
    • For tests, employees can notify The Alliance after they have a test appointment.
     

    Plan Design For QualityPath

    The Alliance provides detailed SPD model plan language for employers to use when implementing QualityPath.

    Highlights of plan design language are provided below.

    Mandatory Elements

    For Tests (CTs, MRIs, and Colonoscopies)

    • 100 percent coverage for services in the bundle. The deductible is waived for QualityPathhowever, the employee still pays the deductible when using other health services. This is modified for plans with health savings accounts (HSAs) to comply with Internal Revenue Service (IRS) rules.
    • Patients are required to tell The Alliance when they are having a QualityPath colonoscopy by going to qualitypath.com/TellUs. Patients may also call The Alliance Customer Service Department at 800.223.4139. Patients who do not tell The Alliance in advance will not get QualityPath’s enhanced benefits. If the patient does not inform The Alliance, employers do not receive QualityPath pricing.
    • Patients are encouraged to tell The Alliance when they are having a QualityPathCT or MRI by going to qualitypath.com/TellUs. Patients who forget or do not use the Internet still get QualityPath’s lower price. However, they may be unaware of the warranty and end up paying more if a repeat scan is required.

    For Surgeries

    • 100 percent coverage for pre-operative care; inpatient care; post-operative care and physical therapy/cardiac rehabilitation; and any services covered under the QualityPath warranty. The deductible is waived for QualityPath; however, the employee still pays the deductible when using other health services. This requirement is modified for plans with HSAs.
    • Patients are required to call the Patient Experience Manager at 800.223.4139 to be eligible for QualityPath’s enhanced benefits. If the patient does not inform The Alliance, employers do not receive QualityPath pricing.
     

    Optional Enhancements that are Recommended but Not Required

    For Surgeries and Tests

    Optional enhancements can provide an incentive when a patient has already hit the out-of-pocket maximum and so does not benefit from 100 percent coverage. These enhancements may include:

    • Cash incentives or bonuses.
    • Reimbursement for travel expenses (mileage, parking, tolls).
    • Hotels.
    • Per-diem travel allowances.

    Eligibility & Eligible Services

    For Surgeries and Tests

    • Exclusive Provider Organization (EPO) plans are ineligible.
    • Only people who have primary insurance that uses The Alliance network qualify for QualityPath; patients with secondary insurance do not have access to QualityPath benefits and services.

    For Surgeries

    • QualityPath covers only medications given during the inpatient stay; coverage for other prescriptions is based on the employer’s health plan.
    • Sub-acute care provided at a facility such as a nursing home is covered only for a patient who has a bilateral knee replacement; for all other patients, this care is not covered.
    • Pre-operative visits and related tests are covered at 100 percent if the patient chooses not to have surgery due to shared decision-making with a designated QualityPath.
    • QualityPath can be extended to employees outside The Alliance service area if your third party administrator (TPA) can support it. Talk to your Account Executive to learn more.

    Adapting Plan Design for Health Savings Accounts (HSAs)

    For Tests

    100 percent coverage after the deductible is paid and a cash reimbursement worth at least $100, which may be either funded in the HSA account or paid directly to the patient

    For Surgeries

    100 percent coverage after the deductible is paid and a cash reimbursement worth at least $1,000, which may be either funded in the HSA account or paid directly to the patient.

    All other plan design requirements apply to plans with HSAs.

    QualityPath Toolkit

    Materials to help your employees understand the benefits of QualityPath. Learn more by clicking on the title of each piece.

    The Alliance Network Map with QualityPath Hospitals & Clinics

    This map shows The Alliance network area and the locations of designated hospitals for QualityPath procedures.

    Employee Brochure

    Download this full-color, trifold brochure to share vital information about QualityPath with your employees. This brochure can also be combined with a letter for mailing directly to employees and family members at their homes. A limited supply of printed brochures are available free from The Alliance. The Alliance also has a limited budget available to help with direct mailing costs. Contact Marketing Communications at 608.276.6630 for more information.

    Infographic

    These four-color graphics help employees understand how their care will move along the QualityPath for surgeries, colonoscopies and CT/MRIs.

    Poster

    Download our poster to print and display in your workplace.

    Poster can be made available in other languages on request. Contact The Alliance Marketing Communications team at 608.210.6642.

    Logos

    The  QualityPath logos may be used to provide visual aid for the written content.

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