Our Partner Promise
Built on our core values
With a high employer group retention rate, we are proud to know that Community Health Options is delivering high satisfaction among employers and Members. Plus, we have solid relationships with the brokers you have come to trust.
Specifically designed for Large Groups with 100+ Members, we recognize the unique challenges your organization may face. We want to be your partner over the long term and are committed to you through our Partner Promise, a 13-point, time-bound promise built on three core principles:
You will have a simple transition
We will provide personalized assistance for employees with complex health needs when they enroll. We will reach out to all new groups via phone or email within 90 days to introduce you and your employees to your new plan. Group administrators will have access to a dedicated phone queue for efficient support.
Your group and employees will save money
We will help your employees save on out-of-pocket expenses and reduce your claim expenses. We will offer targeted assistance to high-cost claimants, review expenses and collaborate with our Pharmacy team to help lower medication costs through unique programs. We will also assist with making convenient and cost-effective provider referrals.
Your employees will feel valued
Our Care Management team will provide personalized support and referrals for employees and their dependents with chronic conditions and complex care needs. The Member Services team will always advocate for your employees. In fact, we have a 98% overall Member-reported satisfaction rate. We will remove barriers to care with our popular Chronic Illness Support Program for asthma, diabetes, coronary artery disease, chronic obstructive pulmonary disease and hypertension. Our digital wellness platform and personal health coaching will help your employees and their dependents 18+ feel supported in their journey to wellness and building healthy habits—with no cost share
Our Partner Promise
We want to be your partner over the long term and are committed to your success.
| Timing | Desired Goal | |
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High-Cost Claimant Assistance Outreach to high-cost risk Members with greatest predicted impact of intervention or cost reduction (medical/pharmacy combined) based on claims history |
Within 60 days of highcost claims identification. | Reduce Member expenses, ensure Members’ care needs are being met, help manage claim expenses. |
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Complex Care Support Outreach to Members with complex care needs based on claims history |
Within 30 days of identified need.* | Support Members’ care needs and cost-effective use of resources (provider network, Rx formulary, durable medical equipment, etc.) |
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Post Behavioral Health Inpatient Hospitalization Care Outreach to behavioral health inpatient discharges within 7 days of discharge date. |
Available on Day One and on an ongoing basis. | • Ensure Member has access to follow-up care, support with referrals as needed • Prevent readmission |
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Site of Care Program (SOC)
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Group will be enrolled on Day One and ongoing outreach will be made upon receipt of the initial request for a drug included in the SOC program. | • Make it easy for Members to adhere to treatment regimen with convenient and cost-saving locations • Reduce claims expense, which could impact the group’s renewal rate • Reward Members with financial incentives |
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ScriptSaver Program Outreach to Members to assist with saving money on Rxs. |
Ongoing basis as claims are received. | • Save Members money and assist them with medication adherence • Reduce claims expense, which could impact the group’s renewal rate |
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Price Assure Program Members benefit from a partnership between our pharmacy benefit manager (Express Scripts®) and GoodRx, which unlocks additional potential savings on generic medications at retail innetwork pharmacies. Members pay the lower of their copay, pharmacy usual & customary cost or GoodRx price. |
Group will automatically be enrolled in program on Day One | Offer Members a way to secure the lowest price for generic Rxs, helping them save money. |
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SafeGuardRx® Programs Members will have access to a suite of products offered through our pharmacy benefit manager (Express Scripts) to tackle difficult-to-manage conditions—combining specialized clinical support, patient engagement tools and effective cost containment strategies. More information can be found at www.safeguardrx.com. |
Group will automatically be enrolled in program on Day One | These programs offer lower downstream medical and prescription costs, which will ultimately reduce claims expense and offer the potential to favorably impact the renewal rate. |
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Chronic Illness Support Program (CISP) Members have access to CISP for asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and hypertension.
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Available on Day One and on an ongoing basis. | • Reduce the cost of care for Members and support increased adherence while also reducing complications from a given condition • Offer potential to favorably impact the cost of claims and renewal rate |
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Personal Health and Well-Being Coaching 1:1 coaching for Members via trained coaches on health and well-being matters including stress reduction and financial coaching. |
Available on Day One and on an ongoing basis. | Demonstrate a commitment to improving the health and well-being of employees and their dependents with a personal resource supporting employee retention. |
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WellRight® Wellness Platform
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Available on Day One and on an ongoing basis. | • Demonstrate a commitment to improving the health and wellbeing of employees/dependents, supporting employee retention • Offer an understanding of health conditions to address and improve claim expenses |
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New Member Welcome Outreach
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Within 90 days after the contract start date. | • Help Members gain optimal use of the tools available to them • Help Members save money and engage in wellness |
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Dedicated Phone Queue for Group Administrator Offers rapid and efficient support. |
With new contract and ongoing. | Save Group Administrators time |
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Member Services Advocates
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With new contract and ongoing. | Save Members time, support optimal use of benefits and resources |