At SummaCare in Akron, Ohio, the customers’ voice can be heard loud and clear. In fact, listening to the needs and wants of the communities it serves is a fundamental principle that has guided this local health plan since it started more than 25 years ago. But the company’s secret sauce to success has been its ability to turn that customer input into action while also meeting ever-evolving regulatory requirements. Today, SummaCare covers more than 62,000 lives and offers a wide range of services, including Medicare Advantage, self-funded, fully insured, and the government Marketplace.
According to Melissa Rusk, VP of operations at SummaCare, “Listening to our customers, whether it is our members, brokers, or even our employees in our own self-funded plan, is the first and most important step to success. But what really sets us apart is our ability to use modern technology to help us put our ideas into action fast. Products like HealthEdge Source really give us that edge.”
The System Behind the Success
For more than 20 years, SummaCare has trusted Source, the industry’s leading payment integrity platform that is now a key component of the HealthEdge suite of solutions, for its claims editing and pricing. Originally implemented to support its employer group customers who had members traveling to and living in multiple states, Source helped SummaCare navigate the complexities of pricing in many different states. However, as the business grew, so did the need for other pricing tools that addressed the complexities of commercial payers.
“For years, we were dependent on multiple editing solutions for our different lines of business. But when we upgraded to the latest version of Source, we were able to move everything to the new platform. Now, we are running all of our claims, including Medicare and commercial, through Source. It’s now a one-stop shop. This not only reduces the IT burden of having to maintain and update multiple systems, but it also makes it easier for our team members to investigate claims issues. They only have one place to go.”
In addition to finding new efficiencies in the editing process, the team was able to move all pricing data out of its legacy claims system, freeing them to evaluate more modern core systems that can help them adapt even faster to customer input and competitive threats. They also brought the edits into their provider portal so members and providers can see the edits themselves and submit questions or appeals directly through the application. This has reduced the phone calls and emails coming into the provider engagement teams.
Rusk added, “No one holds a candle to the information you have at your fingertips with Source. For example, you can look at fee schedules that existed 10 years go if you need to. You can model future things, like new contracts and the reimbursement implications, so you can make better decisions. We’ve seen Source evolve over the years, and we’re pleased with how they actively engage their own customers’ voices, just like we do with our customers. It’s been a great partnership.”
The Future Looks Bright
As SummaCare looks to the future, the team plans to move to more modern systems that allow them to collaborate with their customers and respond to changing regulatory and competitive market dynamics on a whole new level. Functions such as contract modeling and exploring new payment models are definitely on the horizon, according to Rusk. “We look forward to being more innovative and forward-thinking when it comes to what our contracts should look like. And as new payment models, such as bundled payments, emerge, modern technology like what HealthEdge provides will give us even greater flexibility.
Learn more about Source here.