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Introducing a Simpler Approach to Health Care
If You Have ELCA-Primary Health Benefits:
What will it be like to work with a Care Coordinator? Watch this 4-minute excerpt from our recent webinar presented by Stacy Kruse, Portico’s Chief Operating and Financial Officer.
It’s time to prepare to use your ELCA health benefits in 2017.
- Watch for Your New Portico Health ID Card
For 2017, your new Portico Health ID card will replace the Blue Cross and Express Scripts cards in your wallet today. Show your Portico Health ID card at the doctor and pharmacy starting Jan. 1. Also, if you’re enrolled in the fitness center discount, show your new card at the gym in December or your first visit in January to continue receiving your monthly discount.
- If Applicable, Watch for a New SelectAccount Debit Card
If you have a SelectAccount debit card that expires Dec. 2016, you’ll be mailed a new one to access your personal wellness account, health FSA, or HSA.
- Call Portico Care Coordinators by Quantum Health, Starting Jan. 1
Care Coordinators will guide you through today’s complex health care system, making it easier to ask your questions and get the best possible care at the right price. Starting Jan. 1, call this team first when you need help using your medical, mental health, and prescription drug benefits.
Planning a medical procedure in January? Call Care Coordinators at 877.851.5656 now to ask questions and verify coverage for your upcoming procedure.
Care Coordinators are the health care experts so you don’t have to be. Starting Jan. 1, they will:
- Work with you and your doctors to help ensure you receive the right care, so you’re better able to serve
- Suggest proactive opportunities, so you can create healthy lifestyle habits and model them for others
- Support your efforts to manage a condition, so you can sustain a lifetime of service
- Guide you toward lower out-of-pocket costs, so you and your family have more to spend, save, and share
- Help you purchase health care wisely, so our self-insured plan can continue providing life-giving care for our brothers and sisters in need
Not changing for 2017:
- Deductibles, out-of-pocket limits, prescription drug copayments
- Access to Blue Cross network of doctors and hospitals, negotiated discounts
- 100% paid preventive check-ups and screenings
- $400 wellness dollars incentive
- Employee Assistance Program (EAP)
- Dental coverage
- Tax-advantaged accounts
- Fitness center discount
- Hearing discount
If You Have ELCA Medicare-Primary Health Benefits:
These changes won’t affect you. We're not changing ELCA Medicare-Primary deductibles, prescription drug copayments, benefit-related phone numbers, or ID cards. However, you will receive a new Express Scripts ID card in December. While the Mayo Clinic health assessment and Healthy Living website won’t be available in 2017, you’ll continue to have the SilverSneakers fitness program and ELCA NurseLineSM to support a healthy lifestyle, and Portico health care advocates to help you navigate the health care system.
Sounding the Alarm on Our Leaders' Health
In Oct. 2015, Portico’s president and CEO, the Rev. Jeff Thiemann, delivered a poignant message to the ELCA Conference of Bishops: “Jesus came that we would have abundant lives, and I believe that it is time for us to stop walking away from that promise in the way that we live.”
ELCA-Primary medical claims are 23% higher than Blue Cross and Blue Shield's average for a national group our size. And what's worse, our health risks, left unchecked, spell for many of us a future of chronic illness and reduced ministry longevity. Though sobering, our risks aren't unique. "Clergy suffer from chronic diseases such as hypertension at such alarming rates that it's become a mark of the profession," reported the Leadership Journal published by Christianity Today. We must change course.
Read "Sacrificing the Body" from the Fall 2015 issue of the Leadership Journal
Jeff shared with the Leadership Journal, "Some people think about [ministry] as a sacrifice. They think, 'I've chosen this as a sacrificial calling, and so I'm willing to live that out.' And we're trying to help people see that bigger picture: we need them to be healthy in order to be able to serve well."
He told the Conference of Bishops, "I believe rostered leaders and the congregations they serve can become significantly healthier, physically and emotionally. And I believe our congregations can better support these leaders. In the process, we will not only contain health care costs, our leaders will become more resilient, the kind of leaders the church can call upon to thrive in the coming decades."
Watch Excerpts From Jeff's Speech
1. The Problem
Escalating health care costs are more than a strain on congregation and household budgets. They’re a threat to our shared ministry.
2. Where We've Been
After eight years of sampling wellness, our community is still not as healthy as it needs to be. We've taken small steps. It's time for longer strides.
3. What the Numbers Tell Us
Since Portico launched the Mayo Clinic health assessment in 2008, our health risks haven’t significantly improved. In fact, some have worsened.
4. Next Steps
What do we need to do differently? How will we get started?
5. A Wellness Reformation
What will a healthier ELCA look like? Now is our opportunity to imagine and shape culture change together.
Smart Consumer Tips to Help Control ELCA Health Costs
Choosing the right place to get health care can make a big difference in quality and cost. As part of the wellness reformation, Portico offers this growing series of tips to help members shop for health care wisely. If you’re a plan member, see how many you can try! You’ll spend less out-of-pocket — and make a dent in the amount that sponsoring organizations need to contribute next year.
NEW: Skip the Pharmacy, Save Time and Money With Home Delivery
Some things make sense to buy locally — like fresh produce, or prescriptions for an infection. But for many medications taken on an ongoing basis, it’s tough to beat the cost and convenience of Express Scripts home delivery service. Consider simvastatin, a generic high cholesterol drug used by about 1,350 ELCA-Primary plan members. In 2016, a member with Gold+ or Platinum+* could either:
- Make 12 trips to the local pharmacy and spend $120 out-of-pocket, or
- Receive 4 shipments via home delivery and spend $80 out-of-pocket
*Costs for the ELCA-Primary Bronze+ or Silver+ option may vary.
Today, ELCA-Primary members and their families use home delivery for 50% of all prescriptions — a decrease from 61% in 2012. We know some bumps in the road caused some folks to drop the service. But the good news is, home delivery is worth a fresh look. Thanks to recent improvements, Express Scripts has made ordering prescriptions easier, with more frequent status updates and faster delivery. And Express Scripts says it’s making a difference, citing an increase in overall customer satisfaction this year.
Smart Consumer Tip: If you take medication on an ongoing basis, make the switch to home delivery. You’ll get a 90-day supply instead of 31 days from the pharmacy — and save money for yourself and the ELCA Health Plan. It’s easy to get started. Visit the Prescription Drugs page on myPortico and go to Express Scripts, then go to Manage Prescriptions >Transfer to Home Delivery. Or, call Express Scripts at 800.575.8090.
Potential Savings: Even small savings add up quickly, considering ELCA-Primary households purchased about 301,600 prescriptions last year. If we could fill 61% instead of 50% of those through home delivery, members could save nearly $160,000 in out-of-pocket costs, and reduce costs for the plan by nearly $180,000 this year.
More Tips to Try
Save More Than Your Health With Your Flu Shot
A flu shot costs ELCA Health Plan members nothing out of pocket. But there is a cost — and our plan pays for it. You can probably guess, the most expensive place to get a flu shot is a hospital. But you might not know that the second most expensive place is the doctor’s office, even if you’re already there for something else. And that’s where almost 70% of plan members got a flu shot in 2014.
Smart Consumer Tip: If you have ELCA-Primary health benefits, you can save the ELCA Health Plan about a third of the cost by getting a flu shot at a pharmacy like Costco (show your Express Scripts card) or a walk-in retail health provider like Target or Minute Clinic (show your Blue Cross card).
Potential Savings: With more than 9,000 flu shots covered for sponsored plan members and family members in 2014, saving $15 per shot could save us, collectively, upwards of $100,000.
Take Care of Your Cold (and Other Maladies) for Less
Of course, you trust your primary care doctor to help you manage ongoing health conditions and stay healthy. But for many situations, an online doctor can provide the care you need at a much lower cost to your pocketbook and the ELCA Health Plan.
Smart Consumer Tip: If you have ELCA-Primary health benefits and the flu bug (or something else) bites, give Doctor On Demand online care a try. A visit via Doctor on Demand costs $40, whereas an average office visit costs $140. Not only is it a lot less expensive, it’s convenient. Online care is typically available seven days a week, no appointment necessary. Videoconference with a board-certified doctor who can diagnose, treat, and even prescribe medication for a host of conditions — all without leaving your home.
Learn more about Doctor on Demand online care
Potential Savings: ELCA-Primary members and their families visited a doctor’s office about 25,000 times between January and June 2015. If even 10% had chosen online care instead, plan members and the ELCA, together, would have saved about $330,000!
Keep the Cost of Chronic Conditions in Check
Managing a chronic condition isn’t easy. For example, if you have diabetes, it’s possible to slow down the progression of the disease by controlling your weight and the foods you eat, increasing physical activity, monitoring your blood sugar, and getting annual A1C tests and exams recommended by your doctor. All of this takes time, energy, physical and emotional resilience, and attention. But it can make a big difference in your quality of life — and in the cost to the ELCA Health Plan.
Smart Consumer Tip: If you’re living with a chronic condition, ask your doctor to help you manage it wisely. And then take care to heed their recommendations.
Potential Savings: Thousands of ELCA-Primary plan members and spouses received care for a chronic condition in 2015 — such as cardiovascular disease (approximately 4,100 people), diabetes (1,300), cancer (1,050), and asthma (900). Following your doctor’s treatment plan can help you enjoy life more, make you a healthier leader, and add up to significant savings for yourself and the ELCA Health Plan.