Mission & Vision
Our Mission:
To offer our Clients and their Employees an elite package of integrated, consumer-driven health plan tools that empower them to become responsible, health conscious, market-driven consumers of healthcare.
Our Vision:
- To provide infrastructure that fosters lasting market-driven changes in the US Healthcare System
- To eliminate fraud, paperwork and the confusion associated with traditional transactions
- To save costs and to redistribute healthcare savings to Members, Employers & Providers
- To empower our Members with the tools necessary to live healthier and wealthier lifestyles
- To become the national standard for a consumer-driven healthcare system
Our Business Model
Simplicity Health Plans aligns the interests of the Employer, Employee and the Provider to provide a turn-key,
fully integrated Consumer Directed Health Plan. It also delivers a low cost, scaleable solution to control claim
costs. The Plan fuses unparalleled technology, point of service adjudication,
real-time data, and first of its kind anti-fraud controls.
Services include an ERISA compliant health plan, HSA administration and banking,
medical claims administration, TPA functions, pharmacy, dental & vision, COBRA,
stop loss reinsurance, real-time Utilization Review and Case Management, Health
Coaching, Comparison Shopper, Health & Wellness programs, and a host of
on-line tools for Providers, Employers and Members.
Plan Benefits
For the Employee
- Convenience of selecting Providers who accept Simplicity’s price with paperless, rapid payment
- Inspires a sense of personal responsibility for one’s health & define a greater awareness of costs
- Employees have less anxiety over health decisions with qualified Nursing guidance
- Curbs spending and empowers Employee to assure accuracy of every bill
- Saves time and frustration by eliminating forms, checks and debit cards
- Inspires Employees with financial incentives to get fit and to stay fit
- Greater wealth building with interest bearing HSAs and NO FEES
- Inspirational access to StayFit Plan and Health and Wellness Coaches
- Generates a more positive view of Employer and instills a sense of partnership
- Greater confidence in managing health care expenses with on-line consumerism tools
- Less anxiety about a high deductible and one’s ability to pay bills with an employer LOC
For the Provider
- No collection costs or paperwork, substantially lowering the cost of doing business
- No debit card transaction fees deducted from payments
- 72 hour payment after adjudication and Employee approval
- Easy-to-use paperless claim submission with integrated accounting system to track every claim
- Eliminates credit risk with 100% payment guarantee from Employee’s HSA and/or Employer’s integrated line of credit
For the Employer
- Employee relations improve and fears are reduced with the Employer integrated line of credit
- Anti-fraud devices eliminate “piggy-back” fraud & defines valid employees and dependents
- Employees get healthier, stay better fit, and are more productive with the StayFit Plan
- Lower claims costs in the self-insured retention; savings are driven to the bottom line
- Avoids the Mismanagement Disasters of Debit Cards and Credit Cards
- Fewer Human Resource issues and contacts over healthcare
- HSA claims administration is "Follow-Up Free"
- Administrative costs are driven down
- Billing errors decrease significantly
- Lowers reinsurance costs
- Flattened annual cost increases due to utilization control
- Greater Employee satisfaction as HSA’s grow with interest tax-free
- Real-time claims data (medical procedure codes and pharmacy data) enables
IMMEDIATE intervention and Case Management supervision of emerging chronic and
catastrophic claims
- Providers prefer SHP Members with paperless, 72 hour payment; Members get preferred treatment
- Fixed PEPM Fee makes Simplicity a savings advocate with no profit incentive on expenditures
- Integrated financial HSA accounting system for audit control with individual and group claims
Plan Features
UNPARALLELED MANAGEMENT OF DATA AND TRANSACTIONS
- On-line, real-time & transparent transaction information sharing between Members, Employers, Healthcare Partners & Providers
- Real-time integration of all Member Services with Providers and Healthcare Partners
- Easy-to-use on-line, real-time Employer and Member financial reporting
- Paperless transactions; no insurance forms or snail mail
- On-Line, real-time HSA Account Administration
EMERGENT CONSULT WITH ASSISTIVE HEALTH AND WELLNESS MANAGMENT PROGRAMS
- Provider quality evaluations and discount data tracked for Members
- On-line Member website tools for comparing Provider pricing
- Medical Auditing of each transaction
- Real-time personal health data storage
- Comprehensive on-line medical research library
- Member Nurse reviews for personal health management
- Personalized Health Coaching with Disease Management
- On-line line item bill auditing for both Employer & Employee
- Member Nurses "On-Call" for basic condition-related questions
- Live Nurse assistance for healthcare pricing and quality evaluations
- On-going Member education programs via internet and publications
- StayFit Plan Incentive Employer Contribution program reward healthy lifestyles
No Employer, Provider or Member Banking and Transaction Fees
UNPARALLELED REAL-TIME SECURITY
- Line item billing procedures eliminate fraud and theft typically associated with Debit Cards, Credit Cards
- Comprehensive Employee audit & validation requirements with Dependent Eligibility Program
- PIN Codes and on-line, anti-fraud Security Photos for Employees and Dependents
- On-line real-time Member bill approval, denial or hold system
- Financial Auditing of each transaction
UNPARALLELED 24/7/365 CUSTOMER CONVENIENCE
- Member HSA overdraft protection with an integrated Employer line-of-credit
- Simple HSA account management for Employers, Members and Providers
- Direct deposits for Employers, Members and Providers
- Automated real-time withdrawals for Employers and Members
- 24/7/365 Customer Service
Simplicity Management Team
Simplicity’s core Management Team is an experienced group of medical services, software development, insurance and entrepreneurial practitioners. They contribute well over 100 years of relevant experience, backed by a number of successful medical ventures, to Simplicity’s corporate knowledge base.
| Name & Title |
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Relevant Experience |
Dr. Gregory J. Hummer, M.D.
Chairman and CEO
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16 years experience as a trauma surgeon
Managed a practice of over 100 physicians
Co-founded a successful start-up, IVY Medical Group, which developed 12 ambulatory medical centers
Co-founded PBM Corporation, a 15 year old successful software development company that created the underlying technology for Simplicity (technology now processing close to $5 billion in annual medical claims)
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R. Stephen Barrett
Vice Chairman |
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26 years experience in high level corporate financial positions, most recently as Group CFO for Procter & Gamble Global Fabric & Home Care Division and CFO of Whirlpool Corporation
Key strategy positions in launch and building of new brands, to include “Aleve” pain medication
Extensive experience in business organization & value creation
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John Guiher, CPA
CFO |
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25 years experience in software development for medical & financial applications
CIO for IVY Medical Group
Co-founded PBM Corporation
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James J. Hummer
President, Luxemburg Capital |
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25+ years in human resources consulting and medical clinic administration
Co-founded IVY Medical Group
Founded Whole Health Management and for 19 years has been successfully delivering medical services to many large, national corporations, now providing on-site services to over 300,000 employees
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Karen Agnich, R.N.
President, Advocare |
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25+ years experience as a Registered Nurse
Medical Program Developer for Parker Hanifin, a 50,000+ employee global corporation
President of Advocare, a 10+ year old, URAC accredited Utilization Review and Case Management company staffed with over 40 Registered Nurses and 30 call center operators, now serving the medical case management needs of an employee base in excess of 200,000 lives
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Scott Hettesheimer
Business Development Consultant |
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25 years as accomplished Sales and Marketing Executive with success in driving profitability objectives through new business development
Fortune 500 consulting experience
Health and Welfare Benefit Consulting
Consumer Directed Healthcare Expertise
General Agent
Self Funding Expert
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Kathy Scira
Consultant to Simplicity Health Plans
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Past Experience CEO Simplicity Benefit Services LTd.
Managing Director, Health Reinsurance, HRMP, Danvers, MA
EVP & COO, c/CSI, Washington, DC
Regional Manager, AIG, Boston, Chicago, Dallas
Risk Manager, Sun Life of Canada, Wellesley Hills, MA
Managed several MGUs and startups
VP of Marketing & Underwriting, AtlantiCare Risk Mngt, Vienna, VA
Licensed Broker
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