Products and Services

Self-Funding Advantage: A Smarter Benefits Strategy 

Employers choose a self-funded plan because it allows customization and flexibility to tailor comprehensive benefit solutions with the potential to realize savings. Partnering with BSA is the key to success. 

Our Network Advantage

Blue Solutions allows businesses situated in South Carolina to realize the value of the BlueCard National Provider Network. The BlueCard National Network is a seamless network that affords members the ability to use any network doctor or network hospital in any location. Choose our preferred Pharmacy Benefit Manager to experience deeper savings and overall superior performance.

BlueCard National Provider Network

With access to the largest national preferred provider network, BlueCard provides:
• Strongest nationwide PPO network averaging 96% claims paid in-network
• $24 PMPM savings over competitors1, averaging 5-9% total lower cost in care over competitors2
• Delivering 10% total cost of care savings over other industry PPOs3

1 PMPM savings vs competitor average based on national consulting firm CY2018 benchmark data weighted by national census. PMPM savings averages vary by customer. TCOC advantage vs. national competitors as determined by a leading national consulting firm based on calendar year 2018 TCOC data
2 Savings based on new BCBS customer vs. competitor average, weighted by national census—National Consulting Firm CY17 benchmark data.
3 Total cost of care savings based on Consortium Health Plans analysis, 2019. Savings are on average and assume 100% enrollment. Results will vary based on employer locations and implementation.

BSA Preferred Pharmacy Benefit Manager

Pharmacy spending represents a significant and growing portion of health care costs. That is why our preferred partner is Blue Solutions Pharmacy Benefits powered by OptumRx*. Our pharmacy solution is one of the largest pharmacy benefit management offerings available, with access to more than 68,000 pharmacies nationwide and serving more than 13.5 million members. By creating better health care connections, BSA helps your  members realize improved care, lower costs, and a better overall experience.

Tools and Programs

Never sacrificing care for cost, our tools and programs are chosen and managed by a team of medical directors, pharmacists and clinical professionals to ensure the member pharmacy experience we offer extends the best clinical and therapeutic benefit, at the most reasonable costs. Ask how our Tools and Programs bring added value and enhance your member experience:

  • Drug Card
  • Mail Order Pharmacy
  • Drug Lists
  • Drug Management Programs
  • Optum Specialty Pharmacy
  • CVS90 Saver Plus

 

Population Health

Blue Solutions Administrator offers a range of population health and wellness management program choices to meet your specific needs and goals. We partner with industry leaders, as well as offer outstanding in-house products, to provide guidance to your members and encourage healthy behaviors. Our packages and á la carte solutions make it simple for you to customize offerings specifically for your members.

Clinical Care Package Options (CareCor included)
Carecor (included)

Stabilizing progression of chronic conditions and managing complex needs.

  • Chronic conditions* support including medium-to-high risk medical and behavioral conditions
  • Complex Case Management supporting acute, high-risk maternity, NICU, transplants and ESRD
  • Maternity Care including digital and telephonic care manager support
  • Gaps in Care, including preferred reminders based on claim history for screenings and appointments (managed members only)
  • My Health Planner integrating individualized, interactive care management app with personalized features

*Asthma (adult and pediatric), Attention Deficit Hyperactivity Disorder for Adults, Bipolar Disorder, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Coronary Artery Disease, Depression, Diabetes (adult and pediatric), Hyperlipidemia, Hypertension, Migraine, and Recovery Support for Substance Use Disorder.

Carecor+ (Option)

Proactive prevention, wellness promotion and risk management.

  • Includes all the programs in the CareCor Package, plus
  • Lifestyle Programs for back care, stress management, tobacco cessation and weight management (adult and pediatric)
  • Precision Care Solutions* preventing hospitalizations through predictive analytics, to impact member before conditions worsen
  • Gaps in Care including preferred reminders, based on claim history, for screenings and appointments (whole population)
  • Clinical Performance Guarantees backing program goals with measurable engagement and clinical results
  • Quarterly high cost claimant calls and reports

*Must have carve in PBM or carve out PBM with appropriate data files and consistent frequency.

Care Connected (Option)

Concierge-style support for complex conditions and high-need populations.

  • Includes all the programs in the CareCor, plus
  • Episodic Management including ER diversion, readmission avoidance through dedicated nurse check-ins
  • Specialty focused including high-touch case management for high-need conditions
  • Specialty Care Management for Oncology, Palliative Care and ESRD
  • Precision Care Solutions* preventing hospitalizations through predictive analytics, to impact member before conditions worsen
  • Gaps in Care including preferred reminders, based on claim history, for screenings and appointments (whole population)
  • Clinical Performance Guarantees backing program goals with measurable engagement and clinical results
  • Coordinated Cancer Care
  • Monthly high cost claimant calls and reports

*Must have carve in PBM or carve out PBM with appropriate data files and consistent frequency.

Specialty Utilization Management
  • Radiology Benefits Management - Management of advanced diagnostic imaging performed in an outpatient setting.
  • Oncology Benefits Management - Management of patient treatment plans for radiation therapies delivered in an outpatient setting.
  • Musculoskeletal (MSK) Benefits Management - Spine care and interventional pain management (IPM).
  • Hip, knee and shoulder utilization management.
  • 24-Hour Nurse Line - This call line provides support for members. A registered nurse is available 24/7 to help them make good health care decisions. Program provides case management for both the member and caregiver. A board-certified Oncologist Medical Director provides oversight.

Note:  Utilization management services are available individually or bundled.

Specialty Oncology Case Management
  • Coordinated Cancer Care - Provides a member-centric approach to assist adult members in active treatment for cancer.
  • Oncology Case Management - This program provides comprehensive cancer support. It uses structured approaches to assist in the management of all aspects of cancer care for persons in active treatment, applies science-based proprietary clinical guidelines to improve participant’s compliance and enhances the quality of the life for remaining care.
Telehealth Options
  • Teladoc Comprehensive Medical (Core) (includes Behavioral Health, Dermatology, Pediatrics) - Provides members with 24/7/365 access to quality care from their home or office as opposed to more expensive settings like the doctor’s office or emergency room.
  • Teladoc Tobacco Cessation - Telephonic support from a trained health coach and online tool to help members quit all forms of tobacco.
Telehealth Enhanced Options (Purchase of Core is Required)
  • Teladoc Core:  General Medical (including pediatrics), Behavioral Health and Dermatology.  24/7/365 care from licensed doctors via app.  Physician consult within 30 minutes after completion of the medical health disclosure.  Teladoc provides a care team, care plans and referrals to brick and mortar doctor's office as needed.
  • Teladoc Enhanced Package:  Additional virtual support via 5 programs - Back Care, Caregiver Support, Global Care, Sexual Health and Nutrition.  Requires purchase of Core.
  • Teladoc Primary360:  Virtual primary care solution via continuous support from Teladoc Care Team.  Requires purchase of Core.
  • Teladoc Expert Medical Services:  Virtual support for Expert Second Opinions, Critical Case Support, Treatment Decision Support, Oncology Insight, Specialty Pharmacy.
  • Teladoc Tobacco Cessation:  Telephonic support from a dedicated health coach and online tools to help members quit all forms of tobacco.  Requires purchase of Core.
Onsite Biometric Screening Options
  • Quest Diagnostics - Onsite Biometric Screening and other wellness services.

Other Solutions

Other Programs
  • Quit for Life Tobacco Cessation - An aggressive tobacco cessation program, offered in coordination with Optum, for all types of tobacco users. It combines telephonic counseling, nicotine replacement therapy (NRT) and access to a Web Coach.
  • End Stage Renal Disease (ESRD) management
  • Dental - Offers access to a National Network to maximize benefits and minimize out-of-pocket expenses. Members have the freedom to choose their dentist at the time of treatment.
  • Vision - EyeMed Vision Care provides vision benefits including eye exams, lenses, contacts and frames.
AccrueHealth Health Care Spending Accounts
  • Health Savings Accounts (HSA) - A tax-sheltered savings account used with a high-deductible health plan. (HSA account fees can be paid for by the member [out of their HSA] or employer.)
  • Health Reimbursement Arrangement (HRA) - Tax-advantaged account funded with employer dollars to pay expenses not covered by their health plan. The employer outlines what expenses qualify, within the limitations of the IRS.
  • Flexible Spending Accounts (FSA) (Medical and/or Dependent Care) - Allows employees to set aside pretax dollars for eligible expenses like health care and/or work relate dependent care, depending on plan type.
Enrollment, Membership Claims, COBRA, Stop Loss
  • BluesEnroll online enrollment tool - Allows employees to enroll in benefits online.
  • Claims Fiduciary Services
  • Subrogation Services (Threshold $1000)
  • COB – Enhanced Recoveries via Rawlings
  • Rawlings Mass Tort service (Group Litigation Fee)
  • Retroactive Termination Recoveries
  • Standard COBRA and Retiree Services
  • Filing of Stop Loss packets to non-Blue vendors - Initial notification to Stop Loss vendor begin once a member hits 50% threshold. At 100% threshold, a packet is sent within 30 days with all information including: claims summary and details, COB information, and Managed Care documentation.

Reporting

  • PAI Analytics®
  • Population Health Utilization reports
  • Dedicated data-analyst to support reporting

Questions?

We're happy to talk about any of our offerings. Contact us and we'll be in touch shortly. 

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