ICM + H2B:
Catalysts for Healthcare Innovation
Health2Business (H2B) is shaking up the health benefits sector. Their unique approach to health coverage addresses many of the frustrations felt by providers, employers and plan members, but to make it work, they need to contract with service providers that share their vision. ICM’s flexible, evidence-based and member-focused utilization management services have proven to be the perfect fit for H2B’s innovative health program.
About H2B
Doug Hetherington is the founder and CEO of H2B, an organization that facilitates direct contracts between employers and healthcare providers. It’s a form of self-funding, in which the employer partners directly with the healthcare providers in their community to provide quality and cost-effective care.
It’s a simple idea, but health coverage is complex. Employers that use the direct partnership plan model need more than just healthcare providers. They also need third-party administrators, pharmacy benefits managers, and other service providers. Utilization management didn’t want to work with a utilization management company that focused on profits at the expense of people. He needed an organization that was committed to providing care that’s both high-quality and cost-effective. That’s where Innovative Care Management (ICM) comes in.
When Goals Align
Doug had met Bill Kane, the Executive Vice President of Business Development at ICM, years ago, way before Doug started H2B or Bill joined ICM. Eventually, their paths crossed again and it quickly became clear that ICM and H2B shared certain goals. H2B wanted to make the healthcare system better for both plan members and healthcare providers, and so did ICM. A collaboration would make sense, but they needed the right opportunity to test out a working relationship.
Then one of H2B’s clients used a TPA that was one of ICM’s clients. The Opportunity they’d been waiting for had arrived.
“It wasn’t long before I started to recognize their organization was different, in the way they undertake a challenge that is predominantly viewed as something negative from providers. They understood that we were improving the experience for providers as well. So we had a really good alignment,” Doug explains.
Collaborating in Oregon
H2B had a prior history of working with Legacy Health, a large healthcare organization based in Portland, Oregon. When H2B set up its Oregon direct partnership program with Legacy, a phone call between H2B, ICM, and Legacy proved that collaboration wasn’t just possible. It was highly desirable.
“I was so impressed,” Doug says, explaining that he was inspired to listen to the way that ICM and Legacy worked together. After the call ended, the Legacy representative reached out to Doug to thank him. It was clear that they were embarking on something truly innovative in healthcare.
That was the beginning of a mutually beneficial collaboration. “I’ve spoken to several of our TPA partners and have made direct introductions to ICM,” Doug says. “Every single one of them has come back and said you’re right, they are very different and we are really looking forward to working with them in the future.”
“I’ve spoken to several of our TPA partners and have made direct introductions to ICM. Every single one of them has come back and said you’re right, they are very different and we are really looking forward to working with them in the future.”
Doug Hetherington
CEO Health2Business
Keeping Everyone in the Loop
As ICM and H2B continued to collaborate, they figured out new ways to solve old problems. One of these solutions is prenotification — a slightly different approach than preauthorization.
When a plan member is going to need expensive care, the payer needs to know. In many cases, preauthorization is used to ensure the care is medically necessary and covered. When applied appropriately, it’s a logical way to control costs and avoid surprise expenses.
H2B uses a preauthorization process, but only for providers who aren’t contracted with them. Providers who are contracted get to use a prenotification process instead. The provider orders the care, and H2B is notified, but no actual approval is required.
Prenotification works because H2B has already vetted the providers and has an established business relationship with them. They don’t feel the need to get involved in the individual healthcare decisions, and doing so could slow care down. However, they still need to be kept in the loop, so they know what kind of costs are on the horizon.
This unique twist on utilization management might not have worked with all service providers. However, because ICM’s utilization management services are thoughtful, balanced and flexible, it was possible to create a process that fit the needs of H2B plans.
Enhancing the Care Experience
Insurers and employers aren’t the only ones to worry about rising healthcare costs. Plan members also want to keep their out-of-pocket costs down. Unfortunately, they don’t always have the knowledge needed to navigate the healthcare system effectively.
Doug sees how ICM’s utilization services can help. If a member needs a procedure but doesn’t know where to go or how to avoid unnecessary costs, that member can reach out to ICM for assistance.
For more serious medical issues, ICM’s case management services can provide assistance as members deal with complex and long-term treatments. “Innovative Care steps in and guides the member through that,” Doug says. “From appointment to appointment, treatment to treatment, they’ll actually have direct engagement.”
Doug thinks providers will benefit as well. Providers sometimes struggle to communicate with patients, and follow up doesn’t always occur the way it should. ICM facilitates better communication and helps members understand their treatment plans and complete any needed follow up.
“All in all, their involvement enhances the care experience for all,” Doug says. “Better care experiences should create better outcomes, so the quality starts to go up, and as you manage quality and risk, your costs ultimately go down.”
“ICM is fantastic to collaborate with, very willing to think outside of the box and innovate. They, like me, believe that there are a lot of areas for improvement in healthcare, and they’re always willing to be one of the catalysts for that change.”
Doug Hetherington
CEO of Health2Business
A People-First Approach
There’s no way around it – cost control is important in healthcare. However, people are more than just numbers.
Doug believes there are a lot of well-meaning people in care management, but in most companies, the person at the top is focused on business and the bottom line.
Right out of the gate, that was one of the things I noticed was different with ICM,” Doug says. “Their whole organizational culture is built around delivering a better experience, not just for the patient, but also for the clinician. I really think that separates them from most of their competition in the industry.”