REGIONAL CARE, INC.
SCOTTSBLUFF, NE

Regional Care, Inc. (RCI) is one of the nation’s premier independent third-party administrators. We have continued to grow our business by offering unique products and delivering exemplary services to our clients and broker partners while managing health care costs effectively. As a 'one-stop-shop', RCI offers a complete portfolio of products and services for self-insured companies, either directly or through partnerships. This results in a high level of flexibility to clients and their brokers in the selection and design of innovative benefit plans. Customization is key; employers are encouraged to tailor plans specifically to the needs of their workforce. RCI serves over 200 clients with members in all 48 states- from right here in western Nebraska. We have teamed up with best-in-class business partners, from leading PPO networks in each geographic area, to care management companies, telemedicine providers, and transparency tools - all the components needed to manage costs and provide a great member experience. As businesses grow, often so do insurance costs. RCI manages health care costs effectively by utilizing a variety of tools, including medical management. In addition, on-site clinical staff is supported by the resources of some of the nation's leading medical management companies, allowing us to: provide tools to covered participants to manage their health status; ensure that proposed services are medically appropriate and delivered in the correct setting; actively manage the most acute conditions; intervene with patients who are chronically ill or non-compliant with treatment for a condition to ensure that their condition is not exacerbated. We are committed to partners that are ethical and transparent in their business dealings, as well as 100 percent focused on delivering the lowest net cost for the most effective drugs. RCI has made a substantial investment to fully integrate with a multitude of independent PBMs so that pharmacy data flows through claims and predictive modeling systems. With typical Midwestern friendliness, client services and support is one area in which RCI prides itself. Members can go online, day or night, to view the status of claims for themselves, as well as for their dependents. We know that fast claims service is important to our customers - RCI's experienced claims representatives typically turn around claims in five to seven business days. We believe that it's not only critical to process client claims accurately and timely, but is essential that members are able to reach customer representatives directly. In addition, RCI ensures that providers of care can access the information they need in order to concentrate on the delivery of care. In 1992, a home-grown western Nebraska business success story quietly began in the basement of Regional West Medical Center. With just two employees and a mission to contain rising health care costs, Regional Care, Inc. (RCI) was born. Twenty-five years later, RCI is recognized nationally as a premier independent third-party health plan administrator and resides under the umbrella of Regional West Health Services, western Nebraska's largest provider of health care services. With two employees and a mission to help control rising health care costs, RCI was incorporated. The new business was located in the basement of Regional West Medical Center. Began working with Midlands Choice to help expand their network in western Nebraska. RCI contracted with PHIA, the industry standard in legal advice, to provide compliance support. RCI rebrands its small group product. RCI now serves 200 clients in 48 states and is poised for the future. As a third-party administrator (TPA), we work with you and your broker every step of the way to develop the right plan for your business needs. Our role as your TPA includes: Working with you to develop a plan that's the right fit for your business. Developing an annual, highly detailed, graphically oriented report that helps our clients understand exactly how they are spending their money and how employees are using the plan. We then provide analyses and recommendations to enhance your plan even more. RCI works with a number of partners to provide our clients with the best possible combination of services for their specific needs. Some of those partners are listed below. Regional Care is very focused on ensuring that our clients contract with the most effective PPO available for their covered participants. This isn’t as simple as it appears. Our experience has shown us that there are vast differences in the quality of Preferred Provider Organizations (PPOs) available for contracting in any market. For that reason we have dedicated a team of PPO Analysts to continual research of PPO quality and cost effectiveness and maintain a database of PPOs covering over 125 geographic areas in the United States. Provider Management Gains an understanding of the support provided to the Claims Payer in handling problematic providers, related to inappropriate billing, including unbundling, upcoding, undocumented charges and unreasonable “mark-ups”. Reviews the volume and location of different providers used most frequently by covered participants and those which if not contracted could result in extensive out-of-network cost for the Plan Sponsor. Provider Disruption Reviews the PPO contracting strategy related to lesser discounts for a broader network versus deeper discounts for a more limited network. If the limited network strategy is used we review our negotiation success on the excluded providers to determine if the overall cost structure for the geographic area is beneficial. Reviews the contract structure of the most utilized and highest potential cost providers to determine if the arrangement places the provider at risk to deliver services cost effectively. Examples are DRGs, case rates and per diem arrangements on hospitals and fee schedules with controlled “carve-out” charges like injected drugs. Contracts without provider risk require much greater scrutiny of claims being negotiated and re-priced.